Ice Cream and Regrets

Jamie came into session today and reported that she had a significant experience over the weekend at an ice cream parlor.  She explained to me that she had planned in advance to go and have a small size ice cream so that she could still have a drink with dinner.  However, when Jamie and her friend were waiting in line at the ice cream counter, they discussed what they were going to have and her friend said he was going to have a medium-sized cup. Immediately Jamie’s sabotaging thoughts started kicking in – “If he’s having a medium, then so can I; It’s not fair that I should have to get a smaller size; I’ll enjoy it more if I get the bigger size; I know I planned to have a small but it won’t really matter if I get a medium” and so on and so on. 

Jamie reported that she did not at that moment take the time to identify what thoughts she was having and come up with responses to them, and so she ended up ordering a medium despite her initial plan to get a small. I asked Jamie how she felt after finishing her ice cream and she said that she felt bad about herself and guilty because she went off plan.  Jamie also believes she would have actually been happier ordering the smaller size because then she would have been able to enjoy each bite knowing she had planned for it, instead of feeling guilty about the extra ice cream she was consuming.  And because Jamie continued to feel bad about the situation and let her sabotaging thoughts go unchecked, she also ended up eating more at dinner than she had planned.

Jamie and I discussed this situation in depth during her session to see what we could learn from it.  First I asked Jamie if she had done any preparing before she went out for ice cream, such as reading her Advantages List or Response Cards which would remind her how and why to not give in to cravings.  Jamie told me that she thought about the ideas but didn’t actually read the cards, assuming the messages were well-enough engrained.  I explained to Jamie we’ve found this to be true for the majority of the dieters we work with – that just thinking about the response cards is not good enough; something about actually reading them seems to enter the brain in a different and more substantial way. 

Jamie and I also discussed the paradox that she thought she would be happier with the larger size, and then ended up enjoying it less because she felt guilty about going off her plan.  I reminded Jamie of her previous experience with the french fries and how good it felt to eat a smaller, planned portion, and how much she enjoyed each one.  I asked Jamie if she regretted not eating more fries on that day and Jamie realized that while she did not regret not eating more fries, she did regret eating more ice cream.

Lastly, Jamie and talked about how this one experience of giving in to sabotaging thinking led her then to give in to more sabotaging thoughts later in the day.  I reminded Jamie that this experience wasn’t only significant because she took in extra ice cream calories, it was also important because this one time of giving in led her to give in again later that day.  Jamie agreed, saying that if she had stuck with the small ice cream, she thinks it would have been easier for her to stay on plan the rest of the day because she would be feeling good about herself and her eating and would already have experiences from that day of not giving in.

I asked Jamie to think about what she would away from this discussion and she listed:

1. It’s important to actually READ her Advantages List and Response Cards before going into a challenging situation

2. Make a new Response Card reminding her that when she sticks to her planned portion of food, she feels much better about it, is able to enjoy it more, and absolutely does not regret not eating more

3. Remember that every time does matter, and going off her plan earlier in the day strengthened her giving-in muscle and triggered her to eat off track later in the day.

I ended by giving Jamie a whole lot of credit for not allowing herself to continue eating out of hand the next day and for getting back on track.  I reminded her that even experiences where she doesn’t do as well are extremely important because we can learn as much from them (and sometimes more) as from successful ones.

5 Ways to Gain Weight When You Don’t Want To

How often have you noticed that formerly normal weight people have gradually gained weight throughout the years? Or dieters who have lost a significant amount of weight and then gained it back quickly? Should people even try to lose weight at all? The answer is yes, if they are already having weight-related health problems or if they are putting on extra weight every year and so are likely to have health problems in the future. On the other hand, studies that have examined how much weight people are able to lose and how much they are able to keep off long term are fairly dismal. Most people gain weight back. Here is a sure fire formula for gaining weight:

  1. Lose weight quickly.
  2. Go back to your old way of eating when you lose weight.
  3. Continue to eat and exercise exactly as you have been as you get older.
  4. Eat in the way “everyone else” is.
  5. Make excuses for why it’s okay to eat when you shouldn’t.

Each of these items is explained below.

  1. Lose weight quickly: One of the best ways to gain weight quickly is to drastically cut your calories. Research shows that the faster people lose weight, the faster they tend to regain it.
  2. Go back to your old way of eating when you lose weight: It’s plain biology. If you lose weight on 1200 calories a day, for example, and then your weight plateaus, you will start to gain weight back once you go up to 1300 calories a day. That’s the equivalent of one good sized apple or four crackers. And if you return to eating 2,000 or 3,000 calories, as perhaps you did before, of course your weight will increase.
  3. Continue to eat and exercise exactly as you have been as you get older: It seems unfair, but it’s true. Metabolism tends to decrease with age. If you don’t start eating less and/or exercising more, you’ll gain weight. Now it’s reasonable to gain a little weight, especially if you’re eating in a healthy way, but those pounds can really add up as the decades go by.
  4. Eat in the same way you assume everyone else is: It’s possible that you know the rare person who can consume a great number of calories a day and not gain weight. But it’s more likely that the people you know (especially if they’re over 40), are either restricting their eating in some way or are themselves gaining weight each year. In any case, it’s irrelevant. If you don’t want to gain weight, you’ll need to figure out what’s right for you to eat—which isn’t necessarily right for another person.
  5. Make excuses for why it’s okay to eat when you shouldn’t: Your body processes calories in exactly the same way, regardless of circumstances. It doesn’t care if you’re stressed, tired, or celebrating; if it’s a special occasion; if no one is watching you eat; or if the food is free. It may be reasonable to plan in advance to eat a little more in some circumstances but understand that if you don’t compensate by exercising more or cutting an equivalent number of calories another time, you will gain weight.

It seems unfair. It’s so hard to lose weight and so easy to gain it back. But once you learn the cognitive (thinking) and behavioral skills you need, the process of losing and maintaining a weight loss (it’s the same process!) becomes much easier.

Stress and Emotional Eating: Using Cognitive Behavior Therapy to Break the Habit

Most of the dieters whom I treat overeat when they’re feeling stressed or experiencing a negative emotion such as anxiety, sadness, anger, shame, and so on. They often have one or both of the following unhelpful ideas:

 “There’s nothing I can do to calm down when I’m upset.”

“I deserve to eat when I’m upset.”

As long as they hold beliefs like these, they will remain vulnerable to regaining the weight they have lost. They need to change their thinking. They need to learn how to accept and tolerate negative feelings and how to cope with stress in more healthy ways.

Katie, a dieter whom I saw last year, had been doing so well initially. Early on, she was highly motivated and was able to stay on track even when she was upset. When she became upset, she would tell herself, “NO CHOICE. It’s not time to eat. I CAN’T eat now.” She would turn her attention to something else, her negative feelings would slowly subside, and she’d feel proud that she had stuck to her plan.

But then Katie went through a particularly stressful period. Her father was hospitalized. Her youngest child started having problems in school. She got a new supervisor at work who was making unreasonable demands on her. Katie continued to follow her eating plan throughout each day. But come 9 pm, when her children were in bed, the permission granting beliefs above led to Katie’s consuming “all the carbs I can get my hands on,” until she went to sleep. She quickly started regaining the 22 pounds she had lost. She was frustrated and angry at herself but couldn’t seem to stop.

First Katie and I did some problem-solving. As soon as she got her kids in bed, she would decompress by doing deep breathing and then she’d have a cup of herbal tea. Next we did some cognitive work. Following our discussion, Katie composed messages on index cards which she was to read each day after work, just before she walked in the house. She was to read them again as she was sipping her tea. This is what Katie’s cards said:

“If I want to lose weight permanently, I have to stop eating when I’m upset—every time. People without weight problems don’t eat when they’re upset. They either tolerate their negative emotions or try to solve the problem or call a friend or take a walk or go online or read a magazine or watch television. But they don’t eat.”

“Negative emotions are uncomfortable but not dangerous. I don’t have to “fix” them. I’ve had lots of times when I’ve felt very upset but I haven’t eaten. I’ve never exploded or lost control. The worst thing that will happen if I don’t eat is that my distress will peak and then the intensity of my emotions will go down. “

“If I eat, I’ll be temporarily distracted from my distress but whatever problem led to my distress in the first place will still be there and then I’ll also have the problem of feeling badly that I ate and I’ll really feel badly when I see that the scale has gone up.”

Katie also started back on Day 1 of the cognitive behavioral program for weight loss and maintenance so she could sharpen her skills of re-motivating herself, gaining confidence by giving herself credit, tolerating cravings, and getting back on track immediately when she made a mistake. The incidence of her eating for emotional reasons declined sharply. She slipped a few times but the challenge became easier and easier as time went on. The chance that Katie will be able to maintain her weight loss into the future has increased exponentially.

Jennifer’s Struggle

Jennifer recently shared with me her struggle over whether to eat certain foods, particularly during evenings. Jennifer would finish dinner, and then, it was as if treats and desserts would start calling out to her from her refrigerator.  She would engage in the classic struggle:  

“Should I have that piece of cake? But it’s not on my plan. Oh, but it looks so good. But then I’ll be strengthening my giving-in muscle. But it’s just a little bit. It’s not about the calories it’s about the habit. But I’ve been good all day…” and so on, and so on.

I asked Jennifer if she ever engaged in this struggle when it came to healthier foods she should eat, food that was on her plan and was part of her diet. Jennifer answered, “no.” She only ever had this problem when it involved unplanned foods. Jennifer realized that although she was experiencing the “should I have this/shouldn’t I have this struggle” – the answer was clearly, every single time – NO, I shouldn’t have this!  I then helped Jennifer reframe the question in her mind. Instead of asking herself if she should or shouldn’t have that food, she should ask herself the real question, which is “should I cheat on my diet OR shouldn’t I cheat on my diet?”  And the answer to that question is obviously, “No, I shouldn’t cheat on my diet.” With this new mindset, Jennifer was able to stop the struggle in the evenings, because she knew that, absolutely, she did not want to cheat on her diet.

Inflexible Eating

When I introduced the notion of following a food plan inflexibly to Robert, he initially experienced both anxiety and skepticism. Robert asked me why he couldn’t just make substitutions when he felt like it as long as the calorie count remained the same. Here’s what I told Robert:

It’s essential for you, and all dieters, to learn the skill of inflexible eating before you move on to flexible eating. By inflexible, I mean making a plan ahead of time (either the night before or that morning) for the coming day, and learning how to stick to it exactly, with no substitutions. Once you can do this, you’re ready to start flexible eating—making a plan and then sticking to it but making substitutions if/when you want to. And to start to calm your [very normal and expected!!] fears, I can tell you that really learning inflexible eating is one of your best insurance policies against regaining weight down the line.  Once you become really get good at this (and of course it will take practice, but the more you practice the better and better you’ll become), you won’t have to worry about regaining weight. If five, ten, or fifteen years from now you begin to see the scale creep up, all you’ll have to do is return to making your food plans ahead of time and sticking to them, and your weight should begin to drop. It’s SO important to learn this skill now—so that you can use it in the future and for the rest of your life.

Hearing this, Robert understood why it is important for him to learn the skill of inflexible eating. He was still nervous about trying and failing, but I told him that every one makes mistakes when learning new skills; it’s what makes us human!  I expect Robert to make mistakes, but as long as he learns from his mistakes and keeps trying, he will eventually become good at this.

Amy’s Business Trip

Amy came in this week feeling quite defeated. Although she had previously been doing quite well with making food plans and sticking to them, she had been on a business trip earlier this week and hadn’t been able to write down her food. She viewed the trip as a complete “failure,” which left her feeling demoralized and unmotivated. As soon as I heard this, I realized very quickly that Amy was probably catastrophizing the trip, and viewing it as much worse than it actually was. I asked Amy what she had done right on the trip, and initially she couldn’t think of anything.  I then asked her if she had practiced any of her other skills during the trip. After thinking about it, Amy admitted that she was still very conscious of eating everything slowly, sitting down, and while enjoying every bite. Even though she ate at restaurants for every meal, Amy said that she always worked hard to make smart food decisions and never finished the whole portion she was served.  She also consistently resisted the cookies and muffins that were served throughout the day as snacks, and she always chose fresh fruit for dessert instead.  And because of all these things she was doing right, Amy didn’t gain a single pound on her trip.

It can be hard to believe that in light of all these things, Amy could have viewed this trip as a complete failure, but this happens often to dieters. They tend to focus only on the things they are doing wrong, or not as well, and completely discount all of the many, many things they are doing right. I asked Amy to take another, more objective look at her trip. When squarely faced with a list of all the things she deserved credit for, Amy was able to realize that the trip wasn’t a failure even a little bit – in fact, for the most part it was actually a huge success. Once she stopped catastrophizing and put the trip in perspective, Amy immediately felt better and even more confident about her ability to handle trips in the future.

Cindy’s Anxiety

Cindy has been having some anxiety about the future. She successfully lost 43 pounds and has been maintaining that loss for over 8 months, but she still has negative thoughts and images that pop into her head from time to time. The most common one is that she sees her future self standing in front of the mirror, trying to zipper her jeans, and realizing that they have become too tight. She experiences a sickening realization that none of her clothes fit anymore. Her heart sinks as she steps on the scale and sees how much weight she has regained.

I discussed with Cindy the fact that this visual in her head of trying to zip her jeans is making things so much harder for her! I helped Cindy replace that visual with a much more realistic one. In this picture, her future self steps on the scale and notices that it has gained 3 or 4 pounds. But instead of experiencing that sickening feeling in her stomach, she immediately becomes problem-solving oriented. Cindy breaks out her diet notebook and her Beck Diet Solution book, reads her advantages of losing weight list, reads back to the times when she was doing inflexible eating, and sets up an eating plan for that very day. Because she has already firmly mastered the skill of following a plan inflexibly, it is not difficult for Cindy to put herself back in that mindset, especially because reading her advantages list has concretely reminded her why it’s worth it to do this. Within a week or two, Cindy already sees the scale going back down. This is completely realistic, and helped put Cindy’s mind at ease.

When Did Special Treats become the Everyday Norm?

When did it happen? When did we Americans go from an occasional piece of pizza to having multiple slices throughout the week? When did we go from the occasional soda to drinking sugary soft drinks throughout the day? When did we go from a weekly overindulgence, such as a big dinner on Saturday night, to excess food every evening?

Now, I’m not against special treats. In fact, I advise people to have a moderate portion of a favorite food every day. But not more than ONE. And they have to make sure the rest of their food intake is healthy and moderate, too.

I asked Marc, a dieter who consulted with me, what a typical day of eating was like for him. Here’s what he described: He would have some kind of sweet pastry for breakfast; packaged cheese crackers and/or chips for a mid-morning snack; a large hamburger, fries, coleslaw and soda for lunch; cookies and/or a doughnut with another soda for a mid-afternoon snack; a large entree such as lasagna, bread, salad and two beers for dinner; and candy and ice cream for a snack. He knew that he was eating too much unhealthy food. But at some level, it felt “right” to him, even though he was borderline obese and suffering from health problems. He felt entitled to eat that way. After all, it wasn’t very different from how his brother and best friend ate—though he saw that they had gained a significant amount of weight in the previous five years, too.  

Over time, I helped Marc change his attitude toward food. He began to see that his way of eating was “right” if he wanted the negative health consequences of carrying around excess weight to continue—and to likely grow worse. He began to see that his way of eating was “wrong” if he wanted to be fitter and healthier. Even as he was losing a significant amount of weight, Marc still occasionally mourned not being able to eat as he had in the past. At these times, he needed to review his list of all the reasons it was worth it to stick to a healthier way of eating. And he needed to read a response card that reminded him that the excess and unhealthy food he had been accustomed to consuming was “right”, only if he wanted to be obese. The concept of “only one favorite food a day” eventually became Marc’s new norm; he stopped grieving and was able to fully celebrate how much better he felt.

Planning to Eat More and Gain Weight

Julie was feeling disgruntled. She was tired of following her eating plan. “You know, I’m still pleased when I get on the scale every day. But now I’ve been maintaining my weight for the past year and a half. It’s not a thrill like it used to be.”

I asked Julie what was the hardest part of sticking to her maintenance diet.  “I’m just tired of what I’m eating. I want to eat more. I want to eat different things for lunch and dinner. I want to have a glass of wine when I go out with friends and dessert every night. I want to have an afternoon snack, like pretzels or crackers or chips. But I know if I do,” she said glumly, “I’ll gain weight.”

Julie and I reviewed her food intake on a typical day. It looked as if she were eating about 1600 calories per day. “What would you think,” I asked her, “about making just one change for this week, instead of all the changes you want all at once. You could plan to eat 200 extra calories each day. Today, for example, you could have a higher calorie lunch. Tomorrow you might want an afternoon snack. The day after that, you might want dessert. Or maybe you want to have dessert every night and keep everything else the same.  You could try this for a week or two, and see how it goes. If it’s going well, you can keep on doing it. If you’re still unhappy, you could add another hundred or two hundred calories.

“But I’ll gain weight, won’t I?” she asked. “Yes,” I replied. You will. But it will probably only be a few pounds. And you might decide it’s absolutely worth it. I know you were proud when you lost 47 pounds. But what’s the big deal if you gain back three or four pounds and maintain there? There’s nothing magic about the number 47. And if you can feel more satisfied at a slightly higher weight, why not go for it?”

Julie decided to go for it. Over the next few months, she gradually added more calories to her daily diet. But she didn’t slip into it. She made conscious decisions to eat more and she planned in advance how she would use the extra calories. Her weight went up by 4-5 pounds and there were a few outfits that became too tight. But she recognized that it was worth the trade-off. She was happier being able to have more variety in her diet.

Calorie Counts on Menus

Earlier this year, Philadelphia joined New York in requiring that chain restaurants print calorie counts on their menus. Even I was astounded, when I ate out a few days ago. I was fascinated by how high the calorie counts were for almost every item.

The calorie counts didn’t change what I had planned to order. They just reinforced my choices. Even before I got to the restaurant (my first time at this chain), I knew I’d most likely skip the appetizers, caloric drinks, and dessert, and have some kind of protein (with minimal sauce), a vegetable, a starch, and a piece of bread. I knew I’d have to ask for my food without added butter or oil. And I also knew that I would probably eat about 2/3 of the protein, all the vegetable, and part of the starch. That’s what I did.

I knew I could have ordered anything on the menu but I would have had to eat much smaller portions and possibly tolerate hunger and cravings later on. I WISH I could have chosen different food and eaten larger portions, but I know that this is what I have to do to maintain my weight. And it’s worth it.

If I ate out at restaurants more often, I would have to eat even smaller portions. Restaurant food is simply significantly more caloric than the food I eat at home.

Or, if I ate at restaurants more often, or consumed more when I dined out, I’d have to accept the fact that my weight would be higher. I think the latter option is fine for dieters and maintainers to choose (as long as they can maintain a healthy weight).

What is not fine is for dieters to stick their heads in the sand and pretend that restaurant meals are lower calorie than they really are. I’m continually amazed by dieters who consume a couple of very caloric dinners per week and are then surprised when they don’t lose weight. I hope that more restaurants will include calorie counts so dieters can make informed (and better) decisions.