Reworking the Plan

Melanie, a dieter who consulted me a few months ago, recently contacted me for a “booster” session. She was doing great, still losing about 3 pounds a month. She was no longer writing down her food plan in advance, nor did she need to. Instead, she was able to decide at each meal and snack what she wanted to have and to eyeball her portions instead of measuring her food. She made sure to have plenty of (usually) lean protein and vegetables for lunch and dinner (along with a portion of healthy fat and a grain or starch). She mostly ate fruit or nuts for snacks. And she continued to eat whatever junk food she wanted (about 200-250 calories) at night. Melanie wanted to branch out in her selection of dinner entrees. Her husband wanted her to start cooking some old favorites such as lasagna and corned beef brisket. We had the following conversation:

Melanie: I’m afraid if I start to eat foods like that, I’ll gain weight.

Dr. Beck: Not if you keep your portion small.

Melanie: I’m afraid if I have less protein, I’ll be hungry.

Dr. Beck: And what are you afraid will happen if you’re hungry?

Melanie: I don’t know. I guess I just don’t like the thought of it.

Dr. Beck: Do you remember when you did the hunger experiment? (pages 121-125) What did you find out?

Melanie: I know, I know. Hunger is never an emergency. I do remind myself of that some times. But, I don’t know, it seems worse at night.

Dr. Beck: Well, do you want to do some experiments? For example, you could use your protein calories for corned beef. It will be a smaller portion than chicken. But here’s what I want you to do. Don’t linger at the table when you’re finished. Plan an activity beforehand to do right after dinner. And set a timer for 20 minutes. When the timer goes off, check your hunger level. If you’re still hungry, just tolerate it—leave the house if you think you need to. And the next day, do a similar experiment. But this time, skip your morning snack and have it sometime after dinner (immediately if you want to or later on). Plus you’ll still have your regular evening snack. What do you think?

Melanie tried the experiment with various dinner entrees, and to her relief, found that she wasn’t overcome with hunger. But she really liked the idea of eliminating her morning snack so she could have two evening snacks. She’s been sticking with her new plan for a couple of weeks now and is glad to be able to branch out and eat more in the evening.

BACK TO BASICS

 

Marta was dismayed. After 20 months of maintaining her weight loss with relative ease, she had gone off track and had gained back five pounds.

 

“I wouldn’t mind it so much if I had decided in advance to eat more,” she said, “but that’s not what happened. A couple of weeks ago, we had company for the weekend. I was fine at first, but then everyone else was eating and drinking so much, that I wanted to, too. I just stopped using my usual weekend plan. So by Monday morning, I had gained two pounds. I felt really bad about that, and I was okay for the next couple of days. But then, for some reason, I started snacking too much after dinner. I’d have that old sabotaging thought, ‘I’ve eaten too much. I might as well start again tomorrow.’ I didn’t go way overboard the way I used to, but I did eat more than usual for the rest of that week and this week, like larger portions at meals, bread and butter at dinner, and extra snacks at night. I keep promising myself that I’m going to get back in control but I can’t seem to do it. My weight is up and I’m afraid I’ll just keep gaining more.”

 

Marta and I talked about the two choices she could make:

 

  1. She could plan to eat extra food, including bread and butter at dinner and an extra snack at night. It would be planned eating, though, not spontaneous deviations from her plan. Depending on how many extra calories she planned to have, she might gain a little more weight, plateau at her current weight, or lose a little.
  2. She could go back to her previous plan and lose the five pounds she had gained.

 

Either plan was completely legitimate and either way, she’d need to go back to practicing her daily CT skills (e.g., reading her Advantages Deck and Response Cards right after dinner, going to her Distraction Box if she felt the urge to eat unplanned snacks).

 

Marta called me several days after our “booster” session. She was back on track, felt in control, and didn’t need another appointment. I asked her what had made the biggest difference. She said going back to the basic CT skills had done the trick.

Dieters Need a Complete Diet for Life

I’ve been bombarded with questions about how my new book, The Complete Beck Diet for Life, is different from my first diet book, which did not contain a diet (eating plan) but did contain a six-week program to teach people how to diet. Most obvious is that the new book has a healthy eating plan that is flexible and enjoyable so people can modify it and stay on it for life.

Why did I include a diet? After publication of the first book, I received a couple of thousand emails and read a couple of thousand postings from online support communities who were following the program. I found that a cognitive behavioral approach just wasn’t enough. Although I urged people to find a healthy, well-balanced, nutritious diet, I found that people weren’t following that advice. They were choosing fad diets, unbalanced diets, diets that didn’t include their favorite foods, diets that allowed them to skip breakfast, diets that incorporated way too many carbs (and not enough foods to satiate their hunger), diets that were unnecessarily restrictive in choices or provided too few calories. Inevitably, dieters would stray from their eating plan, gain weight, get discouraged, and give up—then, after a few days or months, would try again with another inadvisable diet, and the cycle continued.

I also found out that many dieters should ease into making changes in their food intake, for example, changing just one meal at a time. They need to be guided in modifying a basic eating plan so it suits their tastes and lifestyles. They need to learn how to handle challenging eating situations where they don’t have control over the food that’s available or where others are pushing food on them. They especially need to learn exactly what to do when it’s not time to eat but they’re experiencing hunger, cravings, or want to soothe their distress with food.

In short, to be successful, dieters needed a complete program for weight loss, that incorporates a psychological approach (e.g., what to do when you’re feeling discouraged, disappointed, or deprived), dieting skills, an enjoyable eating plan, and techniques for keeping motivated for life. Most people think that just following a diet will be enough. I had previously thought that just learning essential skills was enough. But now it’s apparent—you need both.

Back to Maintenance Weight

Our veteran dieter, Brian, came in for a booster session this fall. He had maintained his sizable weight loss for over a year but had recently gained back 4 pounds. Because he had developed a general plan of what to eat everyday, he was no longer writing down meal plans and so wasn’t sure where the extra weight had come from. We discussed what he had been eating and asked him if he was doing any unplanned snacking.  Brian realized that over the past few weeks he had slowly started eating more snacks.  The problem was that as he became accustomed to eating more frequently, it began to feel normal to him to eat all throughout the day.  After a little while, Brian got into the habit of eating whenever he felt a little bit hungry or just felt like eating.  At first he didn’t even realize that he had made this shift because it was a gradual but steady process. He had stopped weighing himself daily, too, and the 4 pound gain came as a surprise.

We discussed with Brian all of the skills he had initially learned that helped him stick to his food plan:  telling himself “No Choice,” reminding himself that he would be eating again soon, that hunger is never an emergency, and that he can’t have it both ways – he can’t snack whenever he feels like it and lose weight and keep it off (Days 12 and 16 of The Beck Diet Solution).  Since maintaining his weight loss was still a very important goal to Brian, he knew that it was worth it to start practicing all of his skills again, including making food plans. 

For a couple of weeks Brian wrote food plans each night and made sure to include a reasonable number of snacks (Day 15 of The Beck Diet Solution Weight Loss Workbook).  Because he had practiced it so much in the past, Brian was able to stick to his food plans and cut out the unnecessary snacking he had been doing.  Brian reported that since doing this, the 4 pounds have come off easily.  But more importantly, not only is Brian back to only eating at planned times, but he has also proven to himself that if he does in the future gain a little bit of weight again, he has all the necessary skills and techniques to get back to his maintenance weight. 

Making Decisions

During this week’s phone session, our dieter Liz told us how overwhelmed, stressed, and tired she’s been lately, especially since she and family members are experiencing health problems.  And for the past three weeks, Liz hasn’t been losing weight; she’s just lost and regained the same two pounds.  So we agreed to evaluate whether it’s reasonable for her to keep trying to lose weight at this time, or whether she wants to work on maintaining her already impressive 53 pound loss. 

We asked Liz to think about the past week which she had told us was “extremely difficult.”  We asked Liz whether it was difficult for every hour of every day, or whether there were some hours or even days that were easier (Day 24 of The Beck Diet Solution). One common trap many dieters fall into is letting the memory of a few hours from a few days tinge their sense of the entire week.  Liz realized that some mornings were easier than others, and that it was really a few difficult days, off and on, not the entire week. 

Liz reported that making food plans and trying to lose weight seemed like a big burden at the moment, on top of everything else she was dealing with.  We asked Liz to think back to the time before she started working with us. She realized that while she wasn’t making food plans then, she was actually quite burdened by her weight.

We then discussed her options.  It’s very possible that right now she does have too much going on and now is not the right time to keep trying to lose weight.  In that case, Liz can simply work on maintaining her weight and she can reevaluate her situation in a couple of months.  Or Liz can decide that in spite of everything, she does want to keep working on losing more weight, but either way the choice is hers to make. 

It’s important for Liz to make this decision because for the past few weeks when she’s seen the scale continue to go up and down two pounds, she’s been beating herself up about it and feeling down.  If Liz decides to maintain her weight, then she can feel good about always being within 2 pounds of her maintenance weight, instead of feeling bad about it.  And she can decide at any point to actively try losing again. Liz has decided to take the rest of the week to think it over.

Recapturing Confidence: Rose

Rose has returned to diet counseling after having been away for two and a half months, dealing with a family crisis. She regained 5 of the 21 pounds she originally lost. She can’t wait to lose the 5 pounds again, predicting that she won’t feel good about herself until she does. We discussed with Rose that what shows up on the scale is just a number and that part of her feeling so good before was not only feeling thinner but also feeling confident and in control. We decided that it would be good for Rose to immediately recapture the confidence she had three months ago. We made a list of all the things she had been doing but is no longer doing, or no longer consistently doing.  In this spirit, Rose is going back to the basics. She has committed to reading her Advantages List and other response cards at least twice a day every day and she’s also going to go back and reread measuring1.jpgsections from The Beck Diet Solution.  Although she has returned to making food plans, this week she’s going to start measuring her food again to ensure that her portion size hasn’t crept up and she’s committed to at least a five minute walk every day.  Finally, Rose is going to try to give herself credit for all the dozens of small things she’s doing right every day to raise her awareness of how well she is doing. 

With these strategies in place, Rose is already feeling more confident and in control, even though she’s five pounds heavier. 

Holiday Sabotage

Our dieter Eric was having a tough time committing to making a holiday plan.  We went over with him how important it is to have a plan and learn how to follow it. We reminded Eric that it’s fine if his holiday plan calls for eating a set amount more each day or at each event. He probably won’t lose weight, but he’ll maintain or gain only a little—IF he sticks to his plan.  We told Eric that our experience with dieters has been if they don’t plan at all (“I’ll just try to limit myself”) or if they have too loose a plan (“I’ll just have a little bit of everything”), they just gain too much weight. Or if they have a reasonable plan but decide not to follow it (“It won’t hurt if I have this food I hadn’t planned. I can always start again tomorrow”), they gain too much weight. In any case, they feel SO sorry afterwards. 

wine.jpgHis plan is to add one glass of wine and half a dessert, whenever he goes out this month, to his usual intake. He’s also going to add 100 extra calories to his nightly snack any night that he wants to. We think these planned indulgences will keep him from going overboard on any given day.

We have found that dieters sometimes get angry or sad or rebellious at the idea of having to curb themselves during holidays. We always give them the choice. They can decide to eat whatever they want, whenever they want, and have a poorer long term outcome OR they can learn essential holiday planning and eating skills that they can use for the rest of their lives to maximize the chance of a good long term outcome.

Thanksgiving Plan: Rose

thanksgiving.jpgWe’ve talked before in this blog about the importance of always having a plan, but we think it bears repeating, especially with Thanksgiving just around the corner.  We were reminded of this during a session with our dieter Rose last week.  We asked Rose, who is having Thanksgiving with relatives a couple of hours away from her house, what her food plan was for that day.  She responded that she didn’t really have a formal plan but was sure she’d just stay within her normal 1,500 calorie diet that day. 

We asked Rose what would be the disadvantages of making a written plan for Thanksgiving Day (it’s important to make a plan for the whole day, not just Thanksgiving dinner).  Rose admitted that one of the downsides would be that she wouldn’t feel as free to try different foods.  We discussed with Rose the fact that she can’t have it both ways – she can’t eat whatever she wants when she wants it if she wants to lose weight and keep it off.  We asked her if she thought she’d be more likely to stay within her calorie limit if she had a written plan and Rose answered yes, it was much more likely if she had a plan.  Because Rose reaffirmed that her goal is to lose weight and keep it off, she decided she wanted to do everything she can to reach that goal – including making a Thanksgiving plan.  As part of her plan, Rose decided that for this one day she would plan to eat an extra 300 calories, which would allow her to eat a little bit of everything she wants and not feel deprived.  Rose recognized that if she didn’t plan to eat this extra 300 calories, she might not stick to her plan and could end up eating hundreds more than she had planned. 

We also asked Rose to imagine stepping on the scale the day after Thanksgiving.  If she didn’t make a plan, it is likely that she could have gone over her limit by a couple hundred calories (if not a couple of thousand).  Rose envisioned that in this scenario she would feel guilty and weak, and angry with herself for overeating.  If Rose did make a plan, she was likely to stick with it and not over eat. Then Rose saw herself stepping on the scale and feeling proud and happy – and incredibly glad that she hadn’t overeaten. 

With these powerful images in mind, and also with the resolve that she would do whatever it takes to reach her goal, Rose made a written plan for Thanksgiving Day and feels confident that now she will handle the situation with ease.