“I can’t seem to get enough motivation to exercise.”  Motivation is something that people find to be mysterious and out of reach – especially when it comes to being able to exercise consistently, instead of in the start-and-stop fashion that many people find so frustrating and defeating.

Yet, having the motivation to exercise isn’t as mysterious as it’s believed to be.  It’s within everyone’s reach.  It’s just that people tend to look for it in the wrong places and have expectations that immediately put them at a disadvantage before they’ve even begun to exercise.

In my experience, the three most common reasons why people have difficulty finding motivation to exercise are the following:

1. They think exercise has to be more intense than it has to be.  “When I lose weight I’ll be able to exercise the way it should be done.”  Barring any medical reason why you’ve been advised not to, exercise can be done anytime and at any body size as long as you realize that the only requirement is that you move consistently, frequently, and easily.  You don’t have to perform any particular type of exercise.  You don’t have to exercise at any particular speed or intensity.  You simply start from your current fitness level and “move” more than that level.  Exercise should not be a strain or feel painful.  If it is, it’s too intense.  So ease up a little, but keep moving until you’ve reached a level where it feels comfortable. For example, if you’re walking at a speed that feels too difficult, uncomfortable, or unenjoyable, slow down until it feels like you’re working harder than usual but it also feels relatively easy.

If you think of exercise as having to be something that’s intense, it’s logical that your mind won’t want to do it.  No one wants to do something that seems overwhelming.  It should be no big surprise, then, that you would resist anything that feels out of reach.  Make it reachable and you’ll keep doing it. It doesn’t matter how simple the activity seems compared to what you see other people do.  If you start at your level, you’ll want to keep doing it.  There will be opportunities to increase intensity later and you’ll still feel comfortable.

2. They think they have few options with exercise and none appeal to them.  Instead, exercise can be whatever you want it to be as long as you move consistently.  You do not have to be a runner, a walker, or a gym person.  Perhaps you’re more of a dancer, a rope jumper, a hiker, a stair climber, or like to jump up and down while watching TV.  You pick the exercise – whatever it is.  Make it your own and you’ll be more likely to want to stay with it because you’ll like it.

3. They only want to exercise to lose weight.  Weight loss alone is not a good motivator because of the short-term nature of it.  If your brain isn’t thinking past losing weight, what will be the incentive to keep being active for the rest of your life?  The person needs to find a long-term reason to exercise in addition to weight control.  The best motivating approach is one which includes a life-time goal of health and fitness mixed with short-term goals that are directly related to the long-term goal.  For instance, frequently reminding yourself that the main reason for exercising is to achieve older age without diabetes, cholesterol, or blood pressure problems like too many people have today, can keep the larger and more important picture in focus.  Try to imagine how the exercise you’re doing each day is insuring that your muscles stay strong enough to allow you to get around independently or  look healthy and strong at any age.

Within this global focus you can have short-term goals that give you an extra push – like walking a little further or lifting a heavier weight today.  With any goal, however, attitude is everything so keep challenges fun and achievable.

Remember, being fit and lean are both important for health, but if you’re only focusing on the number on a scale you’re missing the point as well as the motivation that will keep you wanting to exercise.

In short, motivation is the feeling of wanting to approach something because we imagine it to be a good thing.  Nothing destroys motivation faster than anticipating something negative or even torturous.  It’s human nature to avoid such negative things.

However, the human brain is intelligent and it can think about pleasurable things, also.  So use that wonderful brain and create your own enjoyable ways to move more in your life.  You’ll be surprised how quickly motivation will appear.

By Lavinia Rodriguez, Ph.D.

Previously published in the St. Petersburg Times

I wish I could write the weight loss resolution article to end all weight loss resolutions.

Why?  Because, if I could convince people to adopt the right behaviors for managing their health, it would make this annual ritual obsolete.  By following the right behaviors, setbacks would be rare and so minor, they would have little negative impact.

But here we are — another new year and people are still looking for the answer to their weight struggles.

Here’s a question to consider: Are you looking to get those extra pounds off quickly, or are you willing to change your life and lose the weight slowly but permanently? I’m going to bet that you would like to end the cycle of up and down
pounds with its potential for negatively affecting your health in the long run.

If that’s the case, it’s important to recognize that some kinds of resolutions can actually stand in the way of reaching that important goal.

Among them:

•       Focusing on the scale. It’s surprising how often people expect their body to achieve some arbitrary weight. If you’ve always been told to keep your goals specific, it may make sense to to declare, “My goal is 115 pounds.  I’m going to keep going until I get to that weight.”

But there’s a genetic component to weight management. Stubbornly insistingon getting to 115, if that’s not a reasonable goal for your body, will only backfire. Either you’ll make yourself sick, or you’ll rebel against your strict diet, gaining even more weight.

The logical way to approach weight loss is to focus on lifestyle changes in diet and exercise that will help you burn fat while eating healthfully.

Once you’ve done that, allow your body to show you what it’s capable of doing.  If, say, you stabilize at 130 pounds, consider if there are other reasonable changes you could make to discover if your body has a leaner yet still healthy plateau.  If not, then celebrate your achievement, maintain your new habits and move on with life.

•       Taking away rather than adding. People tend to think that the best strategy for losing weight is to cut out carbs, calories or fats. This approach, however, is psychologically ineffective.  The mind cooperates much more happily when we decide to add rather than take away. This is why it probably sounds less daunting to add a salad every day than it would to cut out fast food entirely. Adding healthy foods and habits tends to displace unhealthy ones, but in a more appealing way.

• Missing the pattern. Losing weight and keeping it off is more complicated than simply going on the latest diet and hitting the gym a few times a week.  Sure, you’re putting in a good effort. But if your body isn’t reacting as you would like, it’s time to look for the reasons rather than just continuing to do the same things expecting different results.

Often, there’s a simple pattern that is holding you back. Perhaps you’re in the habit of going out to eat too frequently. Even “healthy’’ establishments usually provide meals with more calories than you’d prepare for yourself. Tweaking just this one habit can make a tremendous impact on your weight.

If you’re serious about making this the year that you get off the weight gain/loss rollercoaster, here are some resolutions that can make a major impact:

•       Educate yourself about healthy eating.  There are plenty of sound websites to peruse such as www.choosemyplate.gov/.

•       Take cooking classes that focus on how to eat nutritiously with little-to-no cooking.

•       Vow to try a variety of ways to exercise and find out which you like best.

•       Learn to stretch on a regular basis.  The older we get the more important it becomes.

•       Learn to meditate.  Decreasing stress makes it easier to control portions.

If the same old weight loss resolutions have never worked for you in the past, why would you think they’ll work now? Instead, look for vows that address your real problems, and that you can stick with all year around.

Previously published in The St. Petersburg Times

“I messed up again! Now I’m back to square one. What’s the use!”

Sound familiar? That’s the self-defeating voice that tells us to quit our healthy eating program whenever we’re less than perfect. It gets louder than ever during the holidays.

It’s a stressful time and stress is known to push us to eat mindlessly. It’s also a time when we’re rushed, making it hard to have regular meals at home. Then there are the scores of party invitations and the high-calorie, high-fat foods crossing our paths continually.

Maybe it’s time to adjust our expectations of ourselves, and consider a new way to manage weight and health during the holidays.

NO TO THE NEGATIVE

The verbal “recordings” that become embedded in our minds through the years and are played over and over again can have a huge impact on our lives.

But these recordings can be edited and even deleted if we’re willing to face them.

I like to think about losing and managing weight as more like a marathon than a sprint.

The marathoner must first train in order to gain fitness and endurance. This includes feeding the body well and knowing when to rest. Running a successful marathon requires pacing. Running too fast means risking injury and possibly having to quit. Winning runners know that they must ignore others that may pass them and keep focus on their own pace.

All of which should sound a lot like weight management. Yet many people treat it more like a sprint, resorting to fad diets and expect large, fast losses.

This sprinter’s mentality applied to a marathon event like weight management sets the dieter up for failure. Familiar self-defeating thoughts then take over. “What’s the use? I failed again.”

The holidays are particularly tough for people with the sprinter’s mentality about weight. Their unreasonable expectations extend to thinking that even during the most elaborate feasts, they’ll pass up all the goodies. They inevitably disappoint themselves and give up.

If they had taken the long-distance runner’s perspective, they would hang in there during the tough times, just like the marathoner gets through the “wall,” and continue past the holidays without losing motivation.

Perhaps they don’t lose weight during the holidays, and maybe they aren’t “perfect,” but they are far more likely to maintain rather than gain. They’re also more likely to enjoy the festivities.

Above all, dieters with more realistic expectations and proper pacing don’t quit. They can continue successfully managing their weight for life, one progressive step at a time.

CREATE NEW MIND-SET

So how about replacing the old, self-defeating thoughts with these:

. “I’m not going to try to do anything extreme during the holidays this year.”

. “I’ll pace myself, stay calm, and focus on the positive.”

. “I won’t let myself get too hungry before eating, I’ll make physical activity a priority, and I’ll feed my body nutritious things.

. “What I do will be more important than the number on the scale and if I’m able to maintain my weight instead of gaining, I’ll consider that a success and continue on.”

So, think of the changes you want to make with weight – and other health goals – like the long-distance runner thinks of the next marathon. Stay calm and pace yourself.

Previously published in the St. Petersburg Times

Now that Halloween is behind us, the holiday season is off and running. With it comes all the goodies that we so desire and that we so fear will make us overindulge.

But with a little planning, the food conflicts that can drain the joy from the holidays can be a thing of the past. We can use a wealth of solid research about why it’s so much better to control portions instead of falling for the same old failing dieting tactics.

There are researchers who devote their careers to studying what makes us eat more and what helps us push away from the buffet. Food psychology laboratories produce information of particular interest to the food industry, which wants us to eat their products in abundance. But there’s no reason we can’t use this information to gain insight into how we tend to respond to different eating situations so we can better manage portions – and weight.

Some of the research findings:

. Out of sight, out of mind: he more visible food is (like the candy dish on the coffee table or your co-worker’s desk), the more likely we are to eat it. No problem if it’s food you don’t like, but if you love chocolate and have to stare at a bowl full of holiday M&M’s, you’ll probably surrender. The trick here is to make tempting goodies less visible. Using covered, opaque dishes for candy, and open dishes to display fresh fruit will encourage the healthier choice. Also, try keeping nutritious foods in front of the fridge or cupboard while putting the ones you want to control in the back.

. Size matters: The bigger the package, container, or plate you’re eating from, the more you’re likely to eat. The brain seems to be looking for signals to mark the end of eating. Something about seeing an empty plate, bowl or bag helps us feel satisfied whether the container is large or small. That’s why using smaller plates is so effective. So, when going to that big holiday buffet, put your entree on the salad plate.

. Serve and step away: During party situations, whenever possible, serve yourself reasonable portions and then step far away from the rest of the food. The less you look at food, the more likely you will be to feel satisfied with what you served yourself. I saw this in action myself at a party last weekend. Engrossed in conversation with a local chocolatier, I didn’t step away from the serving trays filled with exquisite chocolates. Result: I ate more than I would have if I had invited my conversation partner to have a seat in another room.

. Slow down: It’s takes about 20 minutes for your brain to receive all the physiological signals that you’ve eaten enough. So the faster you eat, the more you’ll eat.

What’s the hurry anyway? There are few things we will do as often in our lives as eat, so let’s sit back, take a deep breath and enjoy. The more you let your body get the full enjoyment out of what you’re eating, the sooner it will say, “Okay, that was good, but I’m done.”

These are only a few research-based tips that you can incorporate into your holiday eating. Use your creativity to come up with others and practice them as you enjoy not just the food, but the people and the surroundings.

Consider the alternative – getting overly preoccupied with weight, food and dieting. When has that ever worked? It’s the gentle, positive, consistent approaches that make for the best results.

The greatest myth about calories and losing weight is this: The less you eat, the more you lose.

The human body is not so simple. It’s built for the complicated work of survival. It kills foreign invaders, digests all kinds of things that we throw into it, it tries to make sure that we have the energy we need, and much, much more.

Calories have gotten a bad reputation because of the scores of fad diets that tell us we should eat as few as possible. However, calories are key to survival. Sure, if we eat too many calories we will gain weight and we don’t want that to get out of hand.

But if we don’t provide enough calories for our body to do its many jobs well, we are setting ourselves up for weight-loss disappointment. The right number of calories can help us lose weight and maintain weight loss.

Experts in the field have known for some time that eating enough calories is important for efficient fat loss. Here are just a few of the negative consequences of skimping on calories:

Slowing metabolism. The last thing you want to do when losing weight is to slow down your fat-burning mechanism. Eating too few calories, however, does just that. You’re giving your body no choice but to protect its vital functions by conserving energy when you undereat. This is why, for instance, people who are undernourished tend to feel cold and lethargic.

Psychological deprivation. When you are calorically deprived, hunger becomes tough to ignore and cravings intensify. It’s next to impossible to stay in this state for long. Before we know it, we make up for undereating with compulsive eating or bingeing followed by weight gain.

Fatigue and lack of energy. Not eating enough calories also decreases our energy levels so we feel weak and unable to exercise, further slowing metabolism and weight loss.

Breakdown of muscle. Muscle burns calories, but not eating enough calories can break down muscle mass. The more muscle we have, the more calories we can eat without storing fat. If we’re eating so few calories that the body has to break down muscle to function, we’re setting ourselves up again to gain rather than lose weight.

So the wise person who wants to become leaner will make sure that they get enough calories to keep their metabolism burning efficiently, avoid fatigue and deprivation, and prevent muscle breakdown.

Figuring out the precise number of calories your body needs requires sophisticated equipment not available to most people. But these general USDA guidelines will get you close enough:

. An adult woman who isn’t physically active has an estimated total calorie need of 1,600-2,000.

. An adult man who isn’t physically active has an estimated total calorie need of 2,000-2,400.

TIPS FOR FAT LOSS

Counting every calorie isn’t necessary, but it’s important to avoid fad diets that expect you to go below these levels. Here are steps you can take to make sure you’re fueling your body properly:

. Be active on a daily basis.

. Don’t skip meals and eat 4-6 small, nutritious meals and snacks daily.

. Eat when hungry, but don’t let hunger get intense.

. Reduce portions gradually until you start noticing your clothes becoming looser.

. Strive for gradual, rather than rapid weight loss.

. Stay away from weight loss programs that make you feel deprived.

Getting enough calories makes losing weight an easier task with more permanent results. Your body will thank you for giving it the fuel it needs to burn fat, rather than expecting it to go into survival mode.

Previously published in St. Petersburg Times

The pursuit of thinness long has been a major preoccupation for American women. But why are women trying to be downright slender, as opposed to maintaining a healthy weight?  If it’s for the approval of men, then women seem to be putting themselves through needless worry and discomfort.

I work with a lot of women with body image issues so the question of what men find attractive and what women think men find attractive is of particular interest to me. Many women suffer a great deal believing that they’re not thin enough to be attractive to men.  But are their
expectations shaped by men?  Let’s take a look.

During decades of practice numerous women have told me how they try to avoid being seen naked by their husbands or boyfriends.  Other times I’ve heard women share that they believe they will never find a man to love them because they don’t have the “perfect” body they assume men seek.

Research investigating what body shape most men prefer has revealed some interesting things.  For example, it appears that:
•       Men find a greater range of female body shapes attractive than women do.
•       The body shape that men generally find attractive in women has a waist-to-hip ratio of 0.7. That’s the ratio of a 28-inch waist and 40-inch hips, though the study found that size wasn’t as important as the balance. Men like curves. If you doubt it, consider actor Christina Hendricks, who stars in the television series Mad Men.  Today’s men find her shape incredibly attractive, even though the show is based on 1960’s standards. Interestingly, in a study with blind men, the same ratio was found to be most attractive to the males in the study.
•       The average American man is less bothered by a few extra pounds in a woman than her being what he considers “too thin.”

Apparently, American women consider the most beautiful female figure to be one that is thinner than average while American men prefer a more rounded shape.  Could this be why fashion models are so thin?

So, who are women wanting to please?  Is it men or other women?  Do they even know?  If it’s men, they seem to be missing the mark.  If it’s women, why would that be? What would pleasing other women with respect to body size accomplish? If it’s other women that American women wish to please, why is it worth going through such pain?  These are questions each woman ought to ask herself.

There are men out there who are already attracted to women who themselves are convinced that they aren’t at all attractive. Perhaps these women could profit from looking at what they might be passing up, and reconsidering their distorted expectations.

Of course, there are men who expect their women to look a certain way at all times, and these women have my sympathy and my earnest hope that their husbands and boyfriends can get over themselves. Or that these women can find a better man.

If you’re feeling bold, try asking the men you know what they find attractive in women. I found an informal survey by MSN that indicated most men prefer women who are comfortable in their own skin to those who trowel on heavy makeup and are obsessed with whether their stomachs are flat.

While the best thing for all of us — both men and women — is to accept who we are and pursue having the healthiest and fittest body we are naturally capable of achieving, letting go of any mistaken ideas of what is attractive to the opposite sex is not a bad place to start.

Previously published in the St. Petersburg Times

People being treated for eating disorders and other eating related problems often believe that they’re more dysfunctional than they actually are.  Invariably, I find myself showing patients that many of the behaviors they think are unique and “weird” about themselves are experienced by people they consider “normal eaters.”

Most articles discussing the differences between thin and overweight people focus on the things that thin people do better than overweight people, but what do these thinner people have in common with those that have problems with their eating and weight?

Here are some of the most common misperceptions my patients have about normal eaters:

• They never overeat – The truth is that most people sometimes overeat – it’s normal.  Those people who consider their health and fitness a priority, however, do pay attention to when they have overeaten, try to make subsequent meals more balanced, and try to increase activity.
• They don’t have sweet cravings – Sweet tastes are particularly pleasurable to humans and most people have sweet cravings from time to time.  The normal eater will not panic or get anxious when they get a sweet craving.  In fact, they will readily admit they’re having one since they see no shame in it.  Then they will satisfy it as soon as possible by asking themselves what it is that they want, getting what they want instead of some dissatisfying substitute, and proceed to savor every bite.  Because of how they treat their sweet cravings, however, most of the time they’re able to feel satisfied with a normal portion.
• They have healthy diets – The truth is that just because someone does not appear overweight doesn’t mean that they eat healthily.  In fact, some overweight people eat better than some thinner people.
• They exercise – Unfortunately, most people do not exercise regularly regardless of whether or not they have eating problems.  Sedentary lifestyles are pervasive in our society.
• They eat only when they’re hungry – Although people who don’t have eating and weight problems usually don’t eat when they aren’t hungry, people do sometimes eat when they’re not hungry.  If this were not the case, we wouldn’t have desserts.  Desserts are eaten after a meal – when people are no longer hungry.  Eating when we’re not hungry too frequently can certainly lead to health problems but everyone sometimes eats when they’re not hungry.
• They never gain weight or watch their weight –The truth is that people who are successful managing their weight experience weight fluctuations, too.  It’s normal.  Most people who don’t have eating problems have a weight range that their body goes through as they live out their lives.  However, most of these people don’t focus excessively on it.  They understand that the pattern is normal for them. Typically, the weight shift can be easily attributed to some temporary change in lifestyle (i.e. eating out more or less often, eating or moving more while on vacation, or not having engaged in the usual exercise program). Invariably, the person gets back to their regular lifestyle shifting the weight back to its usual place.  For others, they calmly note the change, its cause, and then consciously set about correcting the behavior that has caused any weight gain by getting back to their healthy lifestyle.
• They never lose control of eating – Although this is generally true, most people have experienced times where they’ve felt out of control with their eating after being ravenously hungry.  Interestingly, a normal eating person might refer to this as simply “pigging out.”  The emotional roller coaster that the binger puts themselves through when they lose control is what makes it a binge.  Feeling a loss of control with eating isn’t seen as a character flaw by the normal eater.  It’s just a function of not having eaten properly to begin with.  In this case, avoiding intense hunger helps prevent the problem in the future.

Understanding that “normal” eaters aren’t perfect eaters can be a relief to those with food and weight problems.  It helps them resolve their eating issues sooner when they know they’re not so different after all.  In fact, the best known professionals in the weight and fitness field don’t do things perfectly themselves.  It may look like they do and they may even suggest that they do, but they don’t.

“Normal” eaters that are mindful of their health pay attention to the behaviors that can take them in the wrong direction with their health and weight.  They do it with a relaxed mind, however.  They use “concern” rather than “self-punishment” and strive for “improvement” rather than “perfection”.  A good average is all that’s necessary.  Expecting that your behaviors be perfect and thinking that you’re different from others because of your imperfections only leads to low self-esteem, frustration, and giving up on achieving health and fitness.  So let’s all strive for good health while accepting our imperfections.  After all, they’re normal.

“I was aware of eating disorders due to media coverage, but eating disorders are usually presented as female problems so I never made the connection with myself. Looking back, I can see that I had behaviors associated with an eating disorder from my late teens into my twenties but I never considered I might have an eating disorder until my happiness and quality of life began to diminish. I obsessed with food. I counted calories constantly and the anxiety from it defined my daily existence. I was paralyzed emotionally and socially. It was hard for me, but I finally realized that I, a man, had an eating disorder.” These are the words of a man who struggled for years with an eating disorder before having the courage to seek help and recovery.

Although women still comprise most cases of eating disorders, men are not immune from such problems.  The symptoms of an eating disorder in a man can be the same as those in women:  preoccupation with weight and size, body image distortion, severe restriction of food, purging, compulsive eating and binging, emaciation or obesity – to name a few.

The following eating disorders that afflict women can also present in men:

• Anorexia – Primary symptoms are excessive food restriction, severe body size distortion, and severe weight loss.
• Bulimia – Primary symptoms are frequent episodes of loss of control through food binges, followed by some form of purging to prevent weight gain, i.e. vomiting, taking laxatives and/or diuretics, or excessive exercise.
• Binge-eating – Primary symptom is frequent binging on food without purging.

There are a few things, however, that are more common precipitators of eating disorders in men as compared with women.  It’s not unusual to find a male with an eating disorder whose problem started after involvement in activities or sports with weight restrictions such as wrestling, boxing, or being a jockey.  Binging and purging are often reported by males in these fields in order “to make weight”.  Some of these men go on to develop eating disorders long after leaving the sport.

Another frequently heard story from men with eating disorders involves a history of obesity and being bullied in school.  In these cases, the man may report that the bullying affected his self-esteem to such a degree that he vowed to lose the weight and never to regain it in order to escape the emotional turmoil.  The weight was lost but, in the process, an eating disorder developed.

It’s difficult to know how many men today struggle with eating disorders because we know that men are less likely to seek help than women.  This may be for a number of reasons:

• Shame may be holding them back from getting help.  Men who recognize they have an eating disorder feel particularly different since their cases are unusual and society doesn’t show as much concern for their problem compared to women with eating disorders.
• Anorexic men who are extremely thin may not attract the same attention as their female counterparts.  Rather than thinking the man may have a problem – as they might when seeing an emaciated woman – the tendency by others is to assume that the man has always been a “really skinny guy.” Therefore, it’s less likely that the anorexic man will be encouraged to get help by others.
• Most bulimics (male or female) aren’t obese or emaciated so their disorder doesn’t show on the outside as it usually does with anorexics.   In addition, the bulimic gets adept at hiding behaviors of purging and binging.  Because of this, the bulimic, usually seeks help on his or her

1. But since men are less likely than females to seek help, less bulimic males are likely to go to therapy.

• Overweight is tolerated more in men than women both by men themselves and by society. In addition, a man who eats large quantities of food in front of others is not as likely to be judged negatively.  Instead, he might just be seen as a “big eater” and “more man-like” rather than someone who has a problem.
• A man with a compulsive overeating problem is likely to feel his problem is just one of self-discipline rather than an eating disorder and expect himself to “just get it under control” rather than seeking help for the never-ending cycle of binging and dieting.

It’s important for society to recognize that eating disorders affect males as well as females and that the suffering is the same for both sexes.

By the same token, males with eating disorders need to allow themselves to seek information and help without feeling shame so they, too, can get the benefits of recovery that exist today.  For more information on eating disorders in men and boys go to http://www.nationaleatingdisorders.org.

By Lavinia Rodriguez, Ph.D.

A version of this article was published in the St. Petersburg Times

What we experience as children and teenagers in school can stay with us for the rest of our lives.  If we’re fortunate, those experiences are fun, exciting, and filled with personal growth but that’s not always the case.  For some, memory lane is filled with pot holes, rusty nails, and dead ends.

As a psychologist and expert with weight and eating, I’m able to get to know people more intimately and help them discover what is at the bottom of their weight and eating problems.  In many cases, a weight problem isn’t as simple as just learning the most successful ways to eat and exercise.  Weight and eating problems are sometimes psychological issues rather than simply a matter of overeating and little exercise.  Oftentimes, negative experiences from our early school years can have a long-lasting impact on the person – getting in the way of their emotional and, sometimes, physical health.

Dale, a patient who developed an eating disorder shared the following story:  “I was an overweight child.  Although I’m not fat anymore, I don’t go to school reunions because I don’t have any good memories of those years.  My school days usually began with a feeling of dread.  It wasn’t a matter of IF I would get picked on about being fat that day but WHEN and WHERE.”  Because Dale was no longer overweight as an adult, people would assume that he didn’t have a problem anymore.  Nothing could be further from the truth.  Long after the weight was lost, Dale struggled with eating issues and still perceived himself as fat.  In addition, the emotional impact of his childhood traumas continued to plague him as an adult.  His eating disorder interfered with his progress in college, his intimate relationships, and his general happiness in life.

Children don’t have the psychological sophistication to understand why they are being picked on and that it has little to do with them as people.  They have a tendency to think in more concrete terms.  So, if school mates are picking on them because they are overweight, they automatically believe that something is fundamentally wrong with them.  This belief can grow into believing that they are not worthwhile individuals and this loss of self-esteem is what is carried on into the rest of their lives.

It’s important for the adults in the lives of overweight children to be sensitive and vigilant for signs that they may be having problems at school because they are being treated unjustly about their weight.

A few things to keep in mind are:

• If your child is being picked on because of their weight, speak to them without judgment.  Show compassion and a willingness to listen instead of immediately providing advice.  Everyone wants to be listened to and to feel that the listener wants to understand.
• Focus on the emotional impact of the problem rather than on the weight itself.  It’s the feelings that are hurting.  The child needs help with dealing with the thoughts and feelings that are causing him or her to feel the way they do.  Problems with low self-esteem because of weight prejudice don’t go away from just losing weight – as Dale’s story above demonstrates.
• Deal with the weight indirectly instead of putting the child on a strict diet or criticizing them for what they eat.  This can only add to the problem.  Instead, learn to provide nutritious alternatives for the whole family and engage everyone in a more active lifestyle.  This way the child doesn’t feel “different” at home as well as at school and the changes will make him or her more successful with weight loss.
• Don’t be afraid to get guidance about how to best help your child. Talking to school officials and a skilled professional who specializes in children and teens can be of great service to a family.  They can make a complicated problem much easier to deal with.  When children are having emotional problems it’s usually more effective for the adults to seek help for themselves in order to learn what they can do rather than just taking the child to a therapist.

School is part of our culture and a place where we can learn to cope and socialize.  It’s also where we can experience some of the best times in our lives.  However, we mustn’t forget that, for some, it’s a place where emotional development can come to a standstill.  Let’s be aware of signs in our children that they may be going through difficulties at school that they may not be able to get through without our help.  Let’s help them get through the bumps in the road and come out of it feeling it was a good trip – one where their feelings of worth will remain intact despite the bumps.

A version of this article was previously published in the St. Petersburg Times

“My experiences at the doctor’s office have not been good.  No matter what symptoms I present, or even if I am there for a well check, my weight is always an issue.  I have had recurring headaches for four years now and I can’t count the number of times that I have been told that maybe if I lose weight and exercise more my headaches might go away (this, despite the fact that exercising frequently results in a headache). I do have high blood pressure and have had some difficulty keeping it within normal limits.  I am always told to lose weight, eat more vegetables.  However, my mother, who weighs 115 pounds, has also had difficulty over the years keeping her blood pressure within normal limits.  She is never made to feel like it is her fault.”

These are the words of a client who came to therapy with realistic goals.  She wanted to manage her weight in a reasonable way in order to improve her health but her blood pressure was still too high despite blood pressure medication.  When I asked why she hadn’t returned to her doctor she gave me the above story.  She felt that, when visiting her doctor, her weight overshadowed everything and she was not getting the help she wanted.  This made her feel embarrassed and hesitant to pursue her medical concerns any further.

My client is not alone.  According to the Rudd center for food policy & obesity at Yale university (Rudd Report, 2008), 69% of 2,449 surveyed overweight and obese individuals had experienced weight bias by doctors.  The report states that overweight patients are reluctant to seek medical care, delay medical appointments, and put off preventative healthcare screenings due to this bias.

Apparently one of the factors behind weight bias by some doctors has to do with believing that if someone is overweight or obese it automatically means that they are not eating healthily and exercising.  Another factor appears to be that if someone is overweight it means they don’t care about their health and aren’t trying to do something about it.  However, in reality there are many factors that can explain someone’s weight and there are plenty of thin people who eat poorly don’t exercise.

Some overweight individuals already eat a nutritious diet, some work out regularly, others don’t eat much more than thinner people and many have tried diet after diet putting enormous amounts of effort, time, and money into trying to manage their weight with little success.  Another subset of patients has diagnosable eating disorders, which are emotional disorders – not problems of mere lack of discipline.

We know that overweight doesn’t necessarily mean unhealthy.  It appears that focusing less on weight and more on indicators of health is the best approach in addressing any patient’s concerns regardless of whether they are overweight or not.  A healthy diet and activity level is good for everyone and whether these two factors are being practiced by the patient can be considered in all cases.  If diet and exercise need to be addressed, the subject is best approached with sensitivity.  Finally, an honest and compassionate exchange between doctor and patient might lead to the knowledge that the patient needs direction about where to get help with behavior change rather than just being told they need to lose weight.

Not all doctors are weight biased, however.  Patients can be responsible for making sure that they do not become victims of weight bias by any professional.  Here are a few things you can do to make sure that your medical concerns are addressed in the right way:

• Let the doctor know what healthy behaviors you engage in. You might be prepared with a list of the things you already do to take care of your health.  The doctor won’t assume you don’t exercise if you let him or her know from the start that you walk for thirty minutes daily, for example.
• Ask the doctor if your problem can be caused by anything other than overweight and ask how these other things can be ruled out.
• Think of your doctor visit as an information gathering session.  You have control over what happens. You are seeking answers to your questions and you are screening the doctor to see if you would like having him or her on your team of professionals to help you manage your health.
• If you disagree with the doctor, respectfully say so. Then explain why you disagree. “I can see why you might think this but…..”
• If, despite your efforts to communicate respectfully, your doctor doesn’t respond in a way that makes you feel he or she will make a valuable member of your team, change doctors rather than avoid going to the doctor.  Your health depends on it.
• Make your needs known.  I referred my client to a doctor I know whom I thought would be sensitive to her needs.  Even so, I made sure to contact the doctor to tell her about the patient’s concerns and experience.  I even talked to the doctor’s nurse to make sure that she was sensitive also.  The appointment worked well and my client is happy with her new doctor.

Previously published in the St. Petersburg Times