Systematize Before Optimize

In session this week with my client Tara, we discussed the trouble she was having staying in control on weekends. Now that Tara and most of her friends are vaccinated, she’s been able to safely start to socialize with friends again. While this is wonderful, resuming eating at restaurants and at friends’ houses has caused her a significant amount of trouble reining in her food and alcohol intake.

In session, Tara told me about a dinner she went to at a friend’s house this past weekend. Her plan was to stick to one glass of wine, have no appetizers, eat her main course, and have half a dessert. Instead, she wound up having three glasses of wine, plenty of appetizers, and a full dessert. I first gave Tara a lot of credit for even making a plan! That’s an important first step. I then discussed with her that while that plan might have been optimal in terms of curbing her caloric intake, right now while she’s still working on getting stronger in social situations, it probably wasn’t realistic (yet).woman writing notes

I told Tara about a concept I read about in the book Atomic Habits by James Clear. When you’re trying to establish a habit, you have to systematize it first, and then you can optimize it. After all, you can’t optimize a habit that isn’t in place. Tara and I decided that right now we need to first work on establishing the habit of sticking to her plan in social situations. Even if that plan right now includes more alcohol and food than she would ideally like to consume in the future, we have to get the “sticking to my plan” habit established first. Then, we can work on optimizing what the plan actually entails.

Tara and I discussed her social events this coming weekend and made plans for all of them. Because these plans weren’t overly limiting, Tara felt confident that she could stick to them. I had Tara write down the plans, and we made a Response Card about why it was worth it to her to stick to them. Tara agreed that she would read her plan and her cards right before leaving the house and bring them with her to reread if she started to lose focus while she was out.

Fantasy vs. Reality

My client Jeff was in the habit of eating a whole pizza several nights per week. While he knew this was sabotaging his health and weight loss goals, he found that he kept giving in to the lure of the pizza. In session, I asked, “What’s so great about eating a whole pizza?” Jeff thought about it and said, “I don’t know. It’s just so great. There’s so much sauce and cheese, and it’s so filling and satisfying.” I said, “Let’s look at this objectively. How do you feel psychologically when you finish eating a whole pizza? Are you thinking, ‘That was a great decision?’” Jeff answered that he often felt pretty regretful. I responded, “How do you feel physically when you finish a whole pizza? Do you feel pleasantly full?” Jeff responded that he often felt stuffed and somewhat uncomfortable.Pizza

This was very interesting to me: when asked what eating a whole pizza was like, Jeff said it was great and satisfying. When asked how he specifically felt psychologically and physically after eating a whole pizza, the answer was very different. No wonder Jeff kept eating a whole pizza! He kept buying into the fantasy of what eating a whole pizza would be like: satisfying and great. He would either not recognize or not pay attention to what the reality of eating a whole pizza was like: full of feelings of regret and being overly stuffed. Jeff made the following Response Card:

It’s true the idea of eating a whole pizza is great, but the reality is not great at all. I end up uncomfortably stuffed and mad at myself. In giving up eating a whole pizza, I’m really not giving up anything that actually feels good. It’s worth it to stop at a reasonable amount.

I’ve seen this fantasy vs. reality concept play out in many other ways in my clients throughout the years. When we first started working together, my client Jen would overeat ice cream every time she got very upset. We worked hard on building up alternate coping mechanisms for Jen to employ when she got upset that helped her feel better and continue to feel in control of her eating. In time, she saw that eating to soothe her upset feelings ultimately caused more upset: she ended up mad at the situation and mad at herself.

There was one instance a few weeks ago when Jen had a really bad day at work and fell back into her old pattern. She stopped at a convenience store on the way home from work, bought a pint of ice cream, and ate the whole thing. In session, I asked, “What were the thoughts at play?” Jen said she was thinking, “I don’t care. I had such a bad day, and I just want to feel better.” I asked, “And did you feel better? How did you feel when you finished the ice cream?” Jen answered that she actually didn’t feel better. She felt mad at herself for reengaging in old, sabotaging habits. But the reason she lapsed back into it was because she was thinking about how overeating ice cream used to make her feel, and not how it makes her feel now. Jen made the following Response Card:

It’s true that overeating ice cream used to make me feel better when I was upset, but it no longer does. Now that I know how great being in control of my eating feels, letting go of that control makes everything feel worse. Overeating ice cream no longer provides me the relief it once did.

Think about your own thoughts. Might there be times when you think something will be better than it actually is? If so, make a Response Card and start reminding yourself of the reality, not the fantasy!

All About Response Cards

Response Cards are helpful phrases written down on 3×5 cards or kept somewhere on your phone. They are one of the most powerful tools in the journey towards gaining control over your thinking, which will ultimately help you gain control over your eating.

CBT for weight loss and maintenance teaches us that it’s never the situation or the trigger that automatically leads someone to eat something, it’s their thinking about the situation. For example, my client Rachel got in a big fight with her sister and ended up going to the kitchen to eat a lot of cookies. It wasn’t the fact that Rachel got in a fight that automatically led to her eating cookies, it was her thinking about the situation. When she gets really upset, Rachel has the thought, “I’m so upset, I deserve to eat to help myself feel better.” Once she has that thought, of course she then goes and eats cookies.

In other applications of CBT, we call these “automatic thoughts” because they’re thoughts our brains make without deliberate effort on our part. In CBT for weight loss and maintenance, we call them “sabotaging thoughts” – thoughts that sabotage one’s overall eating, health, and weight goals.

While we can’t stop anyone from having these sabotaging thoughts (after all, they’re automatic), we can teach people to respond to them effectively so that they have a different outcome. This is where Response Cards come in. Whenever someone has a sabotaging thought, we ask them, “what would you like to say to yourself the next time you have thought? What might be helpful to hear?” Then, we have them write it down and read it every single day. Coming up with a great response to a sabotaging thought is wonderful, but it won’t do much unless you read it over and over and over again. The repetition of reading it is what will help it start to make new inroads into your brain.

In response to her sabotaging thought, “I’m so upset, I deserve to eat to help myself feel better,” Rachel made the following Response Card:

If I’m upset, I do deserve to feel better, but I also deserve to achieve my health goals. Instead of using food as a means to feel better, I can go call my mom, take a walk, do a mindfulness meditation or some yoga stretches, or listen to some music. These activities will help me feel better without sabotaging any other goals. Woman writing a Response Card

When I first started working with him, my client Mark was often going to a friend’s house and overeating pizza. He told me that his friends were all eating many slices of pizza, so it felt normal for him to do it, too. We discussed that Mark had to make choices that worked for him, based on his goals, not choices based on what other people were doing. Mark made the following Response Card:

My body doesn’t know or care what anyone around me is eating, it only knows what I’m eating. Just because other people are eating something, doesn’t necessarily mean it’ll work for me. I have to make choices based on my goals and what will work for me.

Read every day, these Response Cards are a powerful tool in helping you to shift your thinking and response to triggers in a different way. There are no right or wrong answers about what Response Cards should say; it’s only important to figure out what responses are persuasive and resonant to you. Any time you catch a sabotaging thought, make sure you think about what you’d like to say to yourself the next time you have that thought (because if you’ve had it once, chances are very high you’ll have it again), and write it down. Read it every day! That’s what will enable you to have a different outcome the next time the sabotaging thought pops up.

Planning in Advance

This week, my client Jennifer told me that while her days have been going well, things have been falling apart around dinner. The first question I asked Jennifer was, “Are you planning dinner in advance, or are you getting to dinner time and then trying to figure out what to eat?” Jennifer told me that most nights it was the latter. She often thought about making a dinner meal plan but resisted the idea because she didn’t want to feel hemmed in. She wanted to be able to eat whatever she was craving that night for dinner and not something she had predetermined earlier in the week.

While I sympathized with this desire, I reminded Jennifer that in-the-moment decisions are the hardest to make effectively. In-the-moment decisions require us to use our “hot” brains, an id-driven brain that mostly focuses on what it wants in the moment and doesn’t take other goals into account. Future-oriented decisions, by contrast, allow us to use our “cool” brains, a rational brain that thinks through big goals and consequences and makes decisions based on them. It’s not a guarantee that an in-the-moment decision will lead us awry, but it is far more likely.

It’s no surprise that dinners haven’t been going well for Jennifer. End-of-the-day Jennifer, when she was tired and worn out, was not a great Jennifer to be making dinner decisions. Morning Jennifer was a great Jennifer to be making decisions! Morning Jennifer was fresh and sharp and could formulate how a successful day should go. Even though Jennifer understood this intellectually, something was still standing in her way. She still didn’t like the idea of planning dinners in advance.Hand writing out a list.

I asked Jennifer if she ever planned in advance or if she always waited until the last minute to make dinner decisions, and she said that sometimes she and her partner would decide in advance what to have for dinner. “How does that usually work out?” I asked her. “Are you happy when you get to dinner, or are you resisting the plan?” Jennifer told me that usually she was fine with the plan, and it sometimes was helpful because she and her partner often get frustrated with each other trying to figure out dinner every night.

I said to Jennifer, “I wonder, then, if the idea of planning dinner in advance is actually worse than the reality of doing so. The idea of planning dinner in advance makes you feel trapped, but the reality is that it keeps the peace between you and your partner, and it means you feel on track all evening long.” We discussed this idea more, and Jennifer was able to see that this was probably the case, at least some of the time. The idea of not being able to make spontaneous dinner decisions was worse than the reality. She made a Response Card to remind herself.

Jennifer also admitted that even though she resists making dinner decisions in advance, she often ends up eating the same things anyway, so it wouldn’t be that much of a hassle to make the plan more formalized, and that way it would cut down on tensions with her partner, she could make sure to have the food that she needed, and she increased her likelihood of staying on track all day. We also agreed that she should have an escape clause: for the first week, at least, if she really doesn’t want what she planned to have for dinner, then she didn’t need to have it! We decided that she would put some backup meals in her freezer that she could pull out if this happened.

I reminded Jennifer of one more thing: the reason to start planning dinners in advance was not to take away her freedom. It was because not planning in advance wasn’t working for her, and doing so would be in the service of a greater goal: achieving everything on her Advantages List. She would be doing it for hugely important reasons. Jennifer made a Response Card to remind her of this idea, too.

Evening Treats

In session this week, my client Lisa told me she was struggling in the evenings. While she found it fairly easy to stick to her plan of healthy meals and snacks during the day, in the late evening (usually around 9pm) she was going into the kitchen and eating treats, telling herself, “It doesn’t matter.”

The first thing I asked Lisa was, “What’s in your kitchen? Do you have a lot of treats in the house right now?” Lisa said that she did. She had a lot of leftover holiday desserts, plus she loads up on groceries (including junk food) when she grocery shops, since she now goes less than usual. I told Lisa that having a house full of a variety of desserts would be hard for anyone, no matter how long they’ve been working on these things. The greater variety of treats there are, the more it tricks people into thinking they should eat.

Lisa said, “That’s true. When I think about having the ginger snaps I have planned, that doesn’t sound as appealing as all that other stuff.” I responded, “Exactly! But if ginger snaps were the only dessert you had in the house, chances are they would sound more appealing. You would eat them and feel satisfied.”People eating and drinking outside

Another reason having so many treats in the house was sabotaging Lisa was because whether or not she was fully aware of it, she was probably actively resisting eating them all day. The more times in a day she tells herself, “No, you can’t have that,” the more decision fatigue starts to set in, in addition to real fatigue in the evening! Saying “yes” starts to feel more reasonable.

I told Lisa, “It’s not as if your body tells you, ‘You said no ten times, so the eleventh time you can say yes and I won’t process the calories.’ Unfortunately, it doesn’t work that way. Saying ‘no’ ten times doesn’t necessarily mean it’s okay to say ‘yes’ the eleventh time, especially if it’s not on your plan.”

Lisa and I discussed her thought, “It doesn’t matter.” I said to her, “Actually, I’m wondering if it’s just the opposite. I’m wondering if those late night decisions actually matter the most because by giving in in the evening and taking in too many calories, it’s stopping you from being able to lose weight. So, it does matter; it matters the most.” Lisa and I discussed that by staying on track all day but giving in late in the evening, it’s like she’s run 24 miles of a 26.2 marathon. It’s still a huge achievement, but she won’t get the finisher’s medal without the last 2.2 miles.

Lisa and I made some Response Cards for her to read in the evening, and we agreed on a three-part plan: First, she’ll get rid of most the treats in her house. Second, she’ll make a strong plan for what she’ll eat in the evening, and third, she’ll read Response Cards to remind herself exactly why it does matter.

The Holidays

While some aspects of the holiday season are easier to manage this year (no office kitchens stocked to the brim with holiday goodies, no parties or get-togethers, no out-of-town trips), there are still very difficult challenges. I’ve been discussing some of them with my clients over the past few weeks.

My client Rachel found that she was overbuying holiday treats for her kids in an effort to make the holidays feel special. Even though she didn’t have to contend with an office breakroom full of temptations, however, she just moved that hot zone into her own house and sabotaged herself. When we looked at the situation objectively, Rachel was able to realize that loading up on sugary treats wasn’t good for anyone in her household – not her kids, not her husband, and certainly not herself. Rachel and I made a list of new holiday traditions she and her family could institute this year that had nothing to do with eating and would enable them to celebrate safely.Vacation Plan 2

My client Lisa got off track during the beginning of the pandemic and ended up gaining about 20 pounds back from the 60 she had lost. Lisa doesn’t live close to her parents or her sister, and she said that not seeing them this holiday season made it harder for her to get back on track and lose the weight she had gained. In the past, knowing they were going to see that she had gained weight back would have been a huge incentive for her to get refocused. Lisa and I discussed that, at some point, she will be able to safely travel again. Lisa made the following Response Card to help her get back on track:

Even though I’m not seeing my family this year, at some point I will see them again. If I keep going down this off-track path, I’ll gain even more weight than I have now. Getting back on track right now is worth it because not only will it help me lose the weight I’ve regained, but I’ll feel better about myself and more in control. I need to do this for myself, not for them.

My client Jason was feeling disappointed that the holidays weren’t going to look “normal” this year, and he was overeating to help him cope. With many feeling deprived of many of their usual pleasures (dinners out, movies, museums, trips, coffee dates, etc.), it makes sense that these feelings would be more acute during the holidays. Jason and I discussed that since he wasn’t going to get joy from many typical holiday sources – most notably time with family and friends – he had to be very deliberate about finding joy in other ways to avoid turning to food to fill that need. Jason made a Response Card to help remind him of that:

Even though the holidays will look different this year, there are still things that bring me joy. I have to be intentional about filling that need, or it will come out through overeating. Overeating to bring myself joy is a trick, not a treat, because it makes me feel out of control and jeopardizes my hugely important weight loss goals.

Eating Pizza

I’ve been working with my client Emily for a few months now. In session last week, she told me about an experience she had eating pizza with her family in which she got off track, ended up eating too much, and felt overly stuffed (and mad at herself). She said, “I can’t seem to control myself around pizza, so I don’t think I should have it anymore.” I reminded Emily that just because she doesn’t yet know how to eat pizza in an on-track way, doesn’t mean she can’t learn.woman writing notes

In fact, it is critical for Emily to prove to herself that she can do it. She loves pizza, has no medical reason not to eat it, and at some point in the future she will want to eat it again. If she doesn’t know how to eat it in a controlled way, she will likely get off track.

This is a notion we try to build with all our clients – that there’s nothing they can eat when they’re off track that they can’t also eat when they’re on track. And it’s important for long-term success for them to prove to themselves they can enjoy their favorite foods while also enjoying staying on track and feeling in control. Otherwise, they’ll always be at risk for getting off track while around foods they think they “shouldn’t” eat (but likely love!).

In session last week, Emily and I made a plan for pizza. We decided that she would have it the next night and since the slices weren’t very big, we decided two pieces was a reasonable amount. Emily and I discussed what would help her stick to her amount and she made this card to read before and after her pizza:

Pizza Action Plan

  1. Eat two pieces
  2. Eat them slowly and mindfully and give myself LOTS of credit for stopping.
  3. When I finish my two pieces, remember: I just go to enjoy pizza! And I didn’t have to feel guilty about eating it! But don’t fool myself into thinking that if I eat more it will taste nearly as good as the two I just had. Whenever I eat beyond a reasonable amount, I feel guilty even as I’m eating it, and I wind up physically feeling stuffed. It’s 100 percent worth it to stop here and prove to myself I can eat pizza in an on-track way.
  4. Set a timer for 10 minutes. During those 10 minutes, I will: call my sister, organize a drawer, pick out the kids’ clothes for the week, do a five-minute stretching routine or a five-minute meditation, or go for a walk.
  5. When the timer goes off, assess my level of pizza cravings. Most likely, it will have gone away!

When I met with Emily this week, she was so proud of herself! Tor the first time in a very long time, she was able to stick to her pizza plan and felt great about it. She felt empowered and realized that she now had tools in her arsenal to help her enjoy her favorite foods and still stay on track. She even made a similar card for herself and experimented with having chocolate for the first time in a while (she had been avoiding it due to fear of getting off track). This was successful, too!

Emily was starting to prove something critical to herself: with the right plan and the right tools, eating any food and staying on track is not only possible, it’s important.

The Scale

This morning, I had a session with my client Rob, who has been having a hard time with the scale. Rob has been weighing himself every day (which we recommend most of our clients do). One day this week, his weigh-in was much higher than he expected, which made him feel demoralized. He got off track, and it took about three days for him to get back on track. Rob said that now that he’s back on track, he can see how irrational it was for him to be off track for several days. In the moment, he felt powerless to stop it.Weight Scale

I discussed with Rob that what happened made total sense. He got on the scale, saw a higher number, and it immediately triggered a sense of helplessness and hopelessness. And because he felt helpless and hopeless, of course he got off track. I told him that my goal for next time would be for him to regain access sooner and continue whittling away at the amount of time he gets off track. I asked Rob, “Now that you’re past it, back on track, and the scale is once again trending down, what do you want to remember next time the scale goes up? Because it will go up again! It’s part of the process.”

Rob and I made the following Response Cards:

The scale going up is part of the process. Nothing bad or wrong is happening. Keep doing what I’m doing, and the scale will go down again.

Just because the scale is up, doesn’t mean it will stay up. I’m not helpless, and this situation is not hopeless. The last time the scale went up, I was off track for three days. Once I got back on track, I was so glad I did. The scale going up didn’t matter in the long run because it went down again. Don’t get off track this time. Prove to yourself that you can overcome the discouragement, stay on track, and the number will be down again in no time.

Rob and I also discussed that part of the reason he felt so discouraged by the number on the scale going up was because he was relying on the scale as a reward for his hard work. I reminded Rob that the scale is a very unreliable reward! Sometimes it goes up when we think it should be down, and sometimes it goes down when we’re shocked it’s not up. Even though the scale isn’t a reliable reward, his sense of control when he’s on track is a reliable reward. His not feeling overly stuffed after meals and feeling good about the choices he’s making is very reliable.

Rob made one last Response Card:

I can’t rely on the scale to be a reward for my hard work because it’s unreliable. That’s just the way it is. But what I can rely on is how great it feels to be in control. How great it feels to leave a meal not feeling sick and stuffed. How great it feels to go to bed at night knowing I made good choices. Those things are reliable.

Halloween 2020 Do’s and Don’ts

While this year’s Halloween will undoubtedly be different from years past, one thing remains the same: Halloween treats everywhere you look. If you have weight loss or weight maintenance goals, don’t let Halloween derail you! Even though it may be difficult, it can be done. Here are some strategies to help you stay on track during this year’s Halloween:Halloween

  1. DON’T buy candy early. Just don’t do it! Having it in the house ahead of time will do nothing but tax your resistance muscle. Keep your home a craving-free environment. It will make staying on track so much easier
  2. DON’T buy your favorite candy. Why would you buy the thing that’s hardest for you to resist? Just because it’s your favorite, doesn’t mean it’s everyone’s favorite. Buy candy that you don’t like as much, and you’ll have an easier time resisting it.
  3. DO plan to have some candy. But the key word is plan. Maybe you get a big bag of candy you don’t like as much to give out to trick-or-treaters (if there even are any this year!) and then get one of your very favorite. That way, you get to enjoy candy you love and won’t mind not eating the candy you don’t love.
  4. DO make a plan for the leftovers. There’s nothing harder than having a house full of candy and no idea of where it’s all going to go. If you think, “I can’t deprive my kids by getting rid of their Halloween candy,” remember that kids don’t need to be loaded up on sugar, either. It’s doing them no favors in the same way it’s doing you no favors. And no one is saying you have to get rid of all of their candy. There’s a big difference between getting rid of all Halloween candy and saving every piece. Maybe you save enough for them to have a few pieces every day for two weeks. And then donate/throw out/give away the rest. And maybe you save some for yourself, too, and keep it in a different spot. That way, it’s clear that their candy is their candy, and yours is yours.

Think about how you want to feel when you go to bed on Halloween night. Do you want to feel overly full, in a sugar haze, and regretful of overdoing it? Do you want to feel proud of your ability to enjoy some candy and still stay on track and make progress towards your goals? We’re guessing it’s probably the latter! If so, consider making a Response Card to read on Halloween. It could say something like:

Remember, enjoying Halloween and staying on track/making progress on weight loss are not mutually exclusive goals! I can enjoy some candy and still enjoy feeling on track, feeling good physically, and feeling proud of myself. It’s true I won’t be eating every bit of candy that I would like, but doing so doesn’t make me feel good, anyway. It will be such a triumph to go to bed tonight feeling good in my head and my body.

What I Want

In session this week, my client Michael told me that in the evenings he keeps having the nagging thought, “Maybe I should just go into the kitchen and eat whatever I want.” While he has not been giving in, he told me he’s had this thinking pattern in the past, and it’s making him nervous about his ability to continue to stay on track.piece of cake

I first asked Michael, “In the past when you’ve given in to that thought, how long did the good feelings from eating last? Ten minutes? An hour? All evening?” Michael said he probably felt good while he was eating, and then for an additional five minutes after. I asked him, “How did you feel after those five minutes? Were you happy about what you had eaten and thinking it was a good decision?” Michael told me that of course he wasn’t happy once the food pleasure had worn off. He was always mad at himself, regretful, and worried about what it would do to his weight. I asked him how long those feelings lasted, and he said usually the rest of the night. With this in mind, Michael first wrote this Response Card:

Eating “whatever I want” feels good for about five minutes and then makes me regretful for five hours. It’s not worth it.

I asked Michael if he was hungry while engaging in eating whatever he wants, and he said he usually wasn’t. We discussed that in the evening his body was telling him he wanted something, but since hunger wasn’t the source of the problem, food wasn’t the only possible solution. Michael thought about it and realized that this thought usually arose when he was feeling a bit bored and lonely. Although he thought he wanted to go eat whatever he wanted, he was actually craving entertainment, human connection, and some form of pleasure. Michael and I made a list of other things he could try in the evening to get what he really wanted, and Michael made the following Response Card:

Food is not actually what I need in this moment, so by not eating I am not depriving myself of what I really want. What I need is entertainment, pleasure, and/or connection. Instead of eating, try: calling, texting, or sending an email to someone; drinking hot tea; playing a game on my phone; reading an article; going for walk; or connecting with someone on a dating app.

Last, Michael and I discussed that though he would like to be able to go eat whatever he wanted, there are other things he wants more. He wants to lose weight. He wants to feel in control. He wants to not worry about his health. He wants to have a steady wardrobe and not worry about his clothes fitting. He wants to have more self-confidence and higher self-esteem. Michael made one last Response Card:

Even though I want to eat right now, there are so many things I want more than that. Focus on what I am getting – progress towards my goals, feeling in control, going to bed feeling proud of myself – and not on what I’m not getting – extra unplanned food I don’t need.

We agreed that for the next week Michael would read these three cards every evening after dinner to help bolster his ability to stay on track.