Sustainable Weight Loss - Introduction
3 Elements to Sustainable Weight Loss
"Simple Math Program"
Mindful Eating
Long View
One of the most effective ways to reduce your health care costs is to maintain a healthy weight throughout life. People who want to lose weight often try any and every "diet", lose weight, gain it back, and give up in frustration. You can become so intimidated by "diet" you don't even want to try. Instead of a "diet" I offer you sustainable weight loss:
What are the rewards of sustainable weight loss?
A sense of empowerment
More energy
Enhanced self esteem
Significant health care cost savings
Freedom from guilt and negative self-talk.
Better wardrobe to choose from (you can stride right past that XXL rack in Wal*Mart with a biiiig smile)
Simple Math Program: Calories Expended Exceed Calories Ingested
You've tried "South Beach", the "Blood Type Diet", Weight-Watchers, possibly others. If you're in the lucky 10% who "diet" and maintain the weight loss, congratulations! If you belong in the other 90% who diligently followed the diet and didn't lose weight, or who gained it back, read on.
No diet works without simple math. The converse is also true: ANY diet works if calories expended exceed calories ingested for the duration of the "diet". To maintain a desired weight, intake must equal or be less than output.
The simple math program isn't a fad diet. You can use it alone or with any of the above-mentioned, written-by-the-famous-so-and-so diets. You could even apply it to the Haagen Dazs chocolate ice cream diet (My favorite--you eat nothing but chocolate ice cream as long as you limit your total daily calorie intake to 900 calories/day--or about 3 scoops of Haagen Dasz chocolate. Just make sure you also have a salad somewhere in there for "balance").
Here is the *secret success* to weight loss: Expend more calories in a day than you take in and you are *guaranteed* to lose weight.
The Simple Math Program expressed mathematically in 2 ways:
weight change = calories ingested - calories expended;
if the resulting value is a negative number you will lose weight. If it's a positive number you will gain weight.
calories expended > calories ingested = weight loss
Although it may be "simple" the "simple math program" is not EASY. The key to success with any "diet" is Mindful Eating.
Mindful Eating
To be mindful is to be presently conscious of and accountable for your actions and the world you create around you. Mindful eating encompasses a broad range of behaviors from being aware of everything you put in your mouth and how it affects you long-term (for the obsessive-compulsive club); to merely planning ahead and developing a simple eating program that doesn't require a lot of mental acrobatics to incorporate into your lifestyle.
Mindful eating involves making conscious choices to maximize high-nutrition foods and minimize low-nutrition foods.
Three "P's" to mindful eating are:
Planning
Portion control
Possibilities
Please note: Fasting or eating just one meal a day is not a good idea for sustainable weight loss:
Fasting resets your metabolism into "starvation" mode and can actually lead to weight gain if not done in a healthy way. If you enjoy fasting for self-cleansing or religious reasons, limit it to a 12 or 24-hour fast once weekly. Make sure you drink plenty of water when fasting or you will dehydrate yourself.
Regarding Hydration: You May be Thirsty, not Hungry
Sometimes thirst is perceived as hunger. If you're "constantly hungry" or feel hungry between meals (see Post #2 under "planning"), you are probably dehydrated. When you feel the urge to reach for food between meals or snack times, drink a large glass of water instead, and I'll bet you 10-to-1 the sensation of hunger dissipates. Try this and let me know if it works for you.
Alternatives to water for non-water drinkers:
coffee or tea (no caffeine after noon if you have sleep issues)
iced tea or coffee (ibid on the caffeine)
diet, caffeine-free soda
water with lemon or sliced cucumbers and ice
herbal tea--iced or hot
enjoy unsweetened varieties of drinks such as tea and coffee, it can help you appreciate the flavors within
The Three P's of Mindful Eating
Planning
Portion Control
Possibilities and Parties
Essential to sustainable weight loss is a sustainable eating program. This can be attained through the three P’s of Mindful Eating
Planning
Planning can consist of making a detailed meal plan that adheres to whichever diet you feel works for you; or you can create a list of food options for "habitual eating times".
A "habitual eating" program is a bit looser than a planned diet and can account for what you may have on hand in the fridge at any given time. It's the idea of knowing a list of healthy food options so you're not always guessing, postponing eating until you're starving, and then caving in to the nearest Starbucks or fast food restaurant.
In general home-made meals will have healthier ingredients, less fat, smaller portions, and be cheaper than meals bought out.
Think of habitual eating as an internal menu of healthy foods you like
An example of habitual eating would look like this:
Breakfast Options:
2 eggs with toast;
OR bowl cereal (low sugar) with milk (2%);
OR bowl 2% cottage cheese with fruit
OR yogurt/granola
Mid-Morning Snack Options: One of the following:
Toast with spread, raisin-toast w/ spread (e.g. margarine, cream cheese, or peanut butter)
1/2 bagel with spread,
hard-boiled egg,
apple or banana,
cucumbers and/or carrots
celery sticks (with or without peanut butter)
handful of nuts or sunflower seeds
1/2 avocado w/ scoop cottage cheese and sunflower seeds on top (Can be expanded into a lunch--see below
yogurt (can sprinkle fruit, nuts, sunflower seeds)
Lunch Options: One of the following:
Sandwich (home-made): Turkey, tuna, ham or veggie with a side of veggies (e.g. veggie salad e.g. lettuce, tomato, carrots/celery sticks) can also have a side of a small portion (e.g. ice-cream scoop size) of potato or pasta salad--better if made with oil than mayo, but either works fine.
"Chef-type" salad: (sample ingredients: lettuce, tomatoes, red/green peppers, cukes, olives, ham slices, turkey slices, cottage cheese, grated cheddar or other cheese, nuts, sunflower seeds, dressing--vinegar and oil type)
"Hearty" soup (e.g. with meat, veggies, rice or potato) and piece of toast or a roll
Any of the a.m. snack options can be expanded into a lunch by combining 2 or three options or taking the "chef salad" approach to the ingredients.
Afternoon Snack: select from same foods as "morning snacks".
Dinner Options:
Protein (chicken, turkey, fish, lean red meat, ham, pork, tofu, eggs)--grilled, sauteed, baked, or poached.
Veggies (salad or steamed) with oil & vinegar dressing--e.g. "Newman's Own" oil and vinegar
Starch (potatoes, rice, pasta, whole grains such as barley)
Portion Control
Portion control is essential for sustained weight loss and maintaining a steady weight once you succeed in losing the weight. In general a "portion" of any part of a meal or snack should be no larger than your fist, unless it's raw or steamed non-starch vegetables.
Portion control does not mean deprivation: you can still have that ice cream once or twice a week: instead of a whole bowl, though, have one scoop.
Possibilities and Parties
We plan to do something but life inevitably happens.
We're distracted or interrupted in our process and get off track. This will occur from time to time: Expect it. Make a plan to either manage it or prevent it.
Make a list ahead of time--what gets you off track?
Is it eating out?
Going to a party?
Getting sick?
Work stress?
Family (spouse, kids) meal needs are different from yours?
Take a few minutes and think through each of these possibilities. You can use a cognitive approach such as listing contingency options for dealing with specific challenges and set-backs.
You may succumb to a binge once-in-a-while. Accept it and use a technique called "mental aikido" in which you visualize your backslide as an opponent who you first engage (e.g. grasp fists), then step aside, allowing your adversary's momentum to throw her off balance.
If it does happen, don't beat yourself up over it. Use your tools--your contingency plan, your mental aikido to regain your balance and get back to your program as soon possible.
Alcohol and Treats
One of my favorite decadences is a glass of good red wine and a piece of chocolate (Dove or Ghirardelli).
Alcohol and goodies can be incorporated into your program as long as you remain mindful of your portions. However, portion control applied to alcohol and desserts is more like a half-fist:
If you enjoy a glass of wine or beer with dinner, don't deprive yourself of that luxury--limit it to one. Try not to have beer or wine more than three times per week as they are both high-calories for the "nutrition".
Go ahead and have that yummy dessert--but have a slim slice of cake or pie, not a huge chunk, a small scoop of ice cream, etc.
Better yet--make a habit of substituting healthful desserts (e.g. fruit) for high-calorie desserts (e.g. ice cream). Eat yogurt with your fruit instead of ice cream. Make a plain cake without icing, or corn bread, and put a dab of honey on it for a dessert...endless possibilities!
Why You Need Fats and Carbs to Sustain Weight Loss:
I am NOT a fan of "low fat" or "low carbohydrate" diets (see simple math). You'll notice I said to use a spread such as margarine, cream cheese, or peanut butter on bread; and I encourage you to use a vinegar and oil dressing on your salad/steamed veggies.
Fats and carbohydrates are not only essential to your body's needs, they also create a sense of "satiety" so you don't feel hungry after a meal. A healthy balance of fats and carbohydrates within each meal is necessary for proper metabolism of sugars and appropriate insulin secretion. If you eat a "low carb" or "low fat" meal and feel hungry an hour later, you're more likely to over-snack or over-eat at the next meal, or have a sugary "treat" in-between meals. So you've lost any perceived gain of the "low fat/low carb" meal.
What Do You Think?
Are the Three P's of Mindful Eating and the principle of simple math things you think you can incorporate into your eating plan?
Have you lost a significant amount of weight?
What worked, what didn't?
Now you understand the "simple math" program and the three P's of mindful eating, how do we put the "sustained" into weight loss?
Keep Your Eye on the Prizes:
What are the rewards for sustained weight loss?
More energy
Enhanced self esteem
Significant health care cost savings
Better wardrobe to choose from (you can stride right past that XXL rack in Wal*Mart with a biiiig smile)
The Long View
Your health is your most important asset, and it's worth investing in your health to fully enjoy your time on earth. An investment in your health in the form of time and energy now will save you thousands of dollars in the future by avoiding the need for surgeries, medications, and other interventions for poor health caused by excess fat.
Most patients who see me expressing a desire to lose weight wish to lose anywhere from 30 too 100 lbs plus. This type of weight loss doesn't happen overnight. It didn't get there overnight. And it will not stay off without some changes in lifestyle and thought processes related to food. To enjoy sustained weight loss requires a commitment to yourself.
Set Your Goal
A healthy goal is a body mass index of 22-26 (BMI, height in meters squared divided by weight in kg). You can easily determine your present BMI by going to the U.S. Dep't of Agriculture site, My Pyramid Program. It will walk through calculating your body mass index and setting goals with your activity level and eating plans.
If you don't want to bother with your BMI, an easy way to determine a healthy weight, if you're a woman, is to allow 100 lbs for 5 feet in height plus five pounds for every inch you are over 5 feet. For example, if your 5'3" a healthy weight is 115 lbs; if you're 5'7" a healthy weight is 135 lbs.
No woman should weigh 200 pounds unless she's 6'8" tall. Period. If you are over 200 lbs set your initial goal to get under 200 lbs.
Time Frame: One Year
When I'm setting weight loss goals for patients I give them a year to meet their goal. Some may get there a little before or a little after a year--that's fine. If you get there sooner than a year congratulations; after--congratulations as well. There's no blue ribbon for the fastest weight loss. Your prizes are (all together now):
more energy,
enhanced self-esteem,
and future cost-savings
Enlist Supporters
Sometimes the largest barriers to weight loss are found among family, friends, and co-workers. Sidestep the Nay Sayers.
Seek the people with the positive attitude (PPA's) and tell them about your program. Share your goals. Enlist their support. I've seen lots of people tweet their weight loss on Twitter. What a great way to get those daily "Atta Girls!".
Better yet, see if you can make weight loss a group effort. Does your entire family need to lose weight? Entire communities have had success in implementing and realizing weight loss goals on a community-wide basis.
You can find some great on-line support here (3fatchicks blog) and here (Twitter #10morepounds founder) and here (sparkpeople).
If you want someone to be "accountable" to and set deadlines, ask your physician to play that role.
Sustainable Activity
The best "exercise" program is an increase in your activity you can incorporate into your lifestyle. My favorite weight loss exercises are walking (30 minutes 5 times/week) and yoga (love Shiva Rae's DVD's on Flow Yoga). Walking is excellent for weight loss because it keeps your heart rate in the "fat burning" range (60-70% of your max heart rate). Running is great as well, but can be hard on the joints. Yoga dramatically improves balance, flexibility, and core strength.
Incorporate activity into your day.
Walk or bike to work.
Take the stairs instead of the elevator.
Walk during your lunch hour or after dinner.
If you drive to work, park at the edge of the parking lot so you have to walk some to get to your office.
As with diet, pick an array of exercises to choose from to avoid boredom. Make contingency plans for bad weather, illnesses, family emergencies, and plain old busy days. If you have a treadmill or elliptical, use it. Aim to exercise five times per week. Keep a calendar if necessary; hold yourself accountable.
How Can "Health Care" Help?
The best appetite suppressant is regular exercise. An early morning yoga session can curb your appetite for the entire day. An evening walk after dinner can suppress the desire to snack at night and help you sleep better.
There are medications to suppress appetite (such as phentermine and sibutramine). However, I'd only recommend these if you feel you need something to "jump start" you.
Many weight loss "magic potions" and "magic pills" are scams that will do nothing more than lighten your wallet. Exercise caution.
Bariatric surgery is a last resort for those who are morbidly obese and have struggled repeatedly with "diets". It is effective but is costly, has risks, and you can actually be too heavy to undergo bariatric surgery safely.
What has worked for you? Share your experiences...
