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

Why do we have traditions? Why do we feel compelled to do things the same way every year, running around like crazy to get everything done just perfectly?

Does it have to be this way or can we take back control?

Even if you love traditions, it’s easy to lose touch with what they’re supposed to be all about. Suggesting changes doesn’t have to mean that you’re betraying your family or your culture. Examining old habits can mean that you value the real meaning of traditions more, because you’re focusing on togetherness and expressing love rather buying the perfect gift or making the perfect meal.

If tradition is becoming more stressful than fun, it may be time to consider some changes. If you are so concerned about the food you’re eating and what it may be doing to your weight that you’re forgetting to connect with family and friends, perhaps it’s time to tweak things.

And, if you can’t wait for the holidays to be over because the pace is too hard to take, it’s definitely time for an attitude adjustment.

Some tips to consider:

• Keep what you like best and change the rest. One of my clients decided she would find new versions of traditional dishes. Her objective was find recipes that took less time to make, were more nutritious, but still tasted great enough to make them worthy of new traditions.

• Simplify. Maybe you no longer have the time and/or money to shop for days all over town. If time is the issue, it’s not too late to shop online. If money is the issue, perhaps the new tradition should be that only the children get gifts. Or maybe you give something small and meaningful, such as a Christmas ornament, a favorite book or an herb plant. Side benefit:  The people you think you must shop for might be relieved to get off the hook.

• Give yourself a gift. Cook a memorable childhood treat, or take some time to relax in your pajamas, sipping a holiday drink.

• How about pot luck? One of the best ways to simplify holiday meals is to let everyone contribute. Less work for you, and you give everyone the gift of showcasing their favorite dishes.

• Ask the kids what they want to do. Maybe they don’t really like the holiday movie you feel compelled to watch every year. Maybe they have their own suggestion. Yes, It’s a Wonderful Life is a classic, but Elf is a lot of fun too. Why not give the kids the chance to make great memories they’ll cherish as adults?

• Get some help. If you can swing it, consider paying someone to help with cooking, cleaning or other chores. Bonus: You might be helping another family too.

• Do something totally different. Some families go camping on Christmas. Some go on a cruise or swap homes with another family that lives in another part of the country or the world. A new tradition can be as rustic or exotic as you want.

• Volunteer – Helping others can be a great tradition. Soup kitchens and food pantries always need help. Or see if your elderly neighbor could use your family’s labor to clean up the yard or make small repairs.

So think about your own traditions, and consider which ones you really love, and which ones no longer fit your goals for a joyful and fun holiday season.

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

Do people tend to gain weight after they “settle down” with a romantic partner?  This is a question that interests some researchers.  While there are still questions to be answered about this issue, a number of studies have found that obesity appears to be associated with romantic couples living together (married or not) and that there is a stronger association the longer the couple has lived together.

A study done in 2009 suggested that this relationship has less to do with having traits in common and more to do with environment.  The researchers found that living with a romantic partner for two or more years was correlated with obesity and sedentary behavior.

I don’t think this is terribly surprising to most people.  However, studies that find relationships like these don’t mean that weight gain and obesity are an inevitable part of living with the one you love.  It does mean that if you don’t want to be one of the statistics, you have to put some serious thought and work into the matter.

Creating a lifestyle of activity, nutritious eating, health, and weight management as a couple isn’t easy within our fast-paced, sedentary, and fast food-laden culture but, if it’s important to you, it’s, without a doubt, possible.

That’s exactly what my husband and I did when we got married and started a home-life together. We’ve lived together 13 years.  We have jobs that require a considerable amount of sitting – much like many other Americans.  These jobs, added to the other characteristics of the typical American lifestyle (such as amount of time required to drive to destinations, household time-saving devices like washers and dryers, and sedentary leisure activities such as television and the internet) would definitely get in the way of our health and fitness if we didn’t make sure that they didn’t.

Oftentimes, we hear ourselves say that we don’t have time to take better care of ourselves or that we have too many responsibilities to have the time to be fit.  When it comes to health and fitness, however, few people HAVE the time.  It must be important enough for us to make it a priority – important enough to make us WANT to MAKE the time.  Sure it will take some creativity and habit changing.  And maybe other people might not like our decision.  But, the time won’t magically appear and wishing won’t make it happen either.

Once you’ve made that decision, however, you can have a wonderful adventure together and, not only will you get leaner and healthier, but your relationship can be enhanced by it, also.

Here are some things that my hubby and I do to keep ourselves lean and healthy instead of growing fat and, maybe, sick together:

• Eating: We strive to improve eating by learning about cooking and shopping for nutritious foods.  We share the responsibility of grocery shopping, maintaining a grocery list, and shopping often enough to have good choices around.  We look for fast, easy ways to make nutritious meals.  Each specializes in dishes that contribute to the household.  My husband makes the hummus and salads.  I make pasta sauce, bread, and health cookies.
• Exercise:  We take a daily one-hour walk and make sure we leave time for it in our busy schedules.  This is when we talk about our day and future plans.  It’s a great way to have quality relationship time.  In addition, we each have individual exercise time.  He has a particular muscle strengthening routine and I have mine.  And we support and praise each other’s efforts.
• Leisure: We like to watch some TV programs but often use TV time to do catch up on other activities.  Commercials are good times to get clothes washed, dried, and folded, for example, and stretching can be done while watching a program. Sure, we sometimes just “veg out” but it’s not most of the time.
• Hobbies-I’ve been a gardener for years and now my husband has discovered the joys of gardening.  We split responsibilities in the yard and take walks through the garden to view our handy-work. Gardening is active but provides a lot of relaxation at the same time.
• Vacations –We prefer trips to places where we can hike and locations where we can walk a lot rather than ones where the focus is on eating.   Even airport time can be made more active by taking a walk around the airport together (or separately while one watches the luggage) instead sitting for hours at the gates.

You and your spouse don’t have to do things exactly as we do, but if you start with realizing that it’s up to you to make the initial decision and follow it with creativity, you won’t be one of the statistics.  And what if your spouse won’t join you down the road to health?  Well, don’t let that stop you.  Do it anyway.  Your spouse may join you later when he or she sees what it’s doing for you.

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.

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

Do you know a diet book junkie?  That’s a person who seems always to read
the latest diet books while making no apparent changes with respect to
weight, activity, eating, or other behaviors.
They seem to get a kind of high from espousing the wonders of their latest
discovery — “Well, in Dr. Skinny’s book, How to Get Thin and Rich in 24
Hours, it says drinking eight glasses of water before lunch doubles fat
burning!”
Maybe this sounds like you.  You get excited every time you buy a new diet
book, believing that its contents are going to somehow change your weight
and your life.  You remain excited throughout the book – each page seems to
make so much sense!  It’s so exhilarating, you can’t put it down. Some of
these books even have beautiful color pictures of healthful recipes that
you know will be great to eat and definitely produce the weight loss you’ve
been hoping for.
But eventually you get to the end of the book.  What now?
“Hey, I heard there’s a new Rocky Mountain Oysters Diet book out!” That’s
the ticket, you think – another diet book.  But, is it?
Not all books about weight loss have useful and accurate information. Some
are based on ineffective fad diets and gimmicks.  Even if the book is full
of sensible and effective methods, however, that doesn’t mean it will help
you. Only you can do that.
Lifestyle changes aren’t magically absorbed simply by reading a book. And
if, like a diet book junkie, you jump from book to book, expecting magic to
strike, it’s no wonder that your eating and weight problems don’t change.
Ineffective methods never work, but effective methods only work when you
use them.  The books are simply tools; and like a hammer or screwdriver,
they won’t fix anything if all you do is look at them.
Here are some suggestions on how to kick the diet book habit and get more
positive change in your life with respect to health and weight management:
1.      Become more selective about what you read. This means becoming a
better consumer of dieting information. If a weight loss book doesn’t
promise amazingly fast weight loss, doesn’t suggest you have to buy certain
products endorsed by the author, makes good logical sense, and teaches a
program that you can follow for the rest of your life, it’s a good place to
start. Skip those that are based on fads, prescribe a rigid diet plan,
instruct you to avoid the foods you like most, and say you don’t need to
exercise.
2.      Take your time savoring what you read. Stop and think, make notes,
highlight key points, and consider how the book’s suggestions can be
incorporated into your life.
3.      Don’t jump to another book immediately. Finish the book you’re
reading, and put it into practice.  Go back through the book focusing on
what you’ve highlighted and the notes you’ve made.  Follow through with the
suggestions that you would like to incorporate into your life.
4.      Continue using what works for you, and set aside whatever doesn’t fit
your life. If you feel you need more information, the next step may be
another book but, then again, it may not.  It may be trying a class,
searching for health information online, joining a group that does
something active (like hiking), or seeing a therapist for emotional issues
that have been too difficult to solve on your own.
Reading is generally a good habit to have.  However, if you’re reading a
book with the intent of having it help you change something in your life
you have to go beyond just reading it.  You have to use it.
Kick the diet book habit in favor of taking constructive action, and you’ll
notice real changes starting to happen.  Your library of diet books may
stop growing, but who cares?  Your body and mind will be getting fitter.
Isn’t that what you wanted in the first place?