I am often faced with clients who tell me they are not losing weight as fast as they want to or expected to for the effort they are putting out. The frustration is real and can lead to returning to old eating habits. My first response is usually, “if you go back to eating the old way, you are likely to regain all the weight you have lost thus far. We don’t want that.” That remark keeps the value on what the scale is saying and I am beginning to realize that is not the most important piece.
If you are at a plateau and are feeling like you want to throw in the towel, consider this….
1. Has your exercise regimen improved? Try keeping an exercise log and witness, on paper, how your fitness has grown.
2. Has your mood improved? Try keeping a log of how you are feeling emotionally. It can be a simple symbol on your calendar or a paragraph of your day.
3. Has your sleep improved? A good night’s rest can mean more than any chocolate eclair can taste.
4. Has your energy level improved? Remind yourself of all those slumps throughout the day you experienced in the past. The 3:00 pm low that a cup of coffee or a Snickers bar pulled you through.
5. Have your food cravings lessened? Or better yet, do you think about a crisp apple now like you use to about that bag of Doritos? I suspect you are pleased to be fueling your body with healthy fare.
6. Have your blood values improved? Has your blood pressure gone down? Have your anxiety levels reduced? Has your sex drive increased? Is your foggy mind now clearing?
There are so many ways we can measure the success of improved eating without stepping on the scale. Think outside the box (or the scale) the next time you wonder if eating regularly spaced, moderate portioned, and wide variety meals are “worth” it.
All too often the holidays add a few extra pounds to our waistlines (on average 7 – 9 lbs) from Thanksgiving through New Years. Do something different this season and aim to enjoy each holiday party and dinner without experiencing holiday weight gain. Wouldn’t that be crazy good? Here are some ideas to make that happen.
- Plan your eating strategy ahead of time. Drink a glass of water and eat a little something before leaving home for that holiday party or dinner. Check in with your feelings about this gathering and decide who will be in control before you leave the house. Getting plenty of rest during the holidays will help you stay on track.
- When you arrive to your holiday destination and get settled, take your focus to something outside of yourself. Look out the window at the snow, the clouds moving across the sky, the blush of sunset. Or listen to the sound of your children playing in the living room, a favorite song. Focusing on sensory input calms the mind, gets you back in your body and helps you stay present. It’s also a fast, simple way to break the chain of negative self talk.
- If you’re presented with a holiday buffet, scope out your favorites before diving in, and eliminate choices you don’t really care about. Choose lower fat offerings such as shrimp with cocktail sauce, skinless grilled or baked chicken. Offer to bring a low fat appetizer such as colorful cut-up vegetables and dip. Don’t float around the buffet or the kitchen. After you’ve had your fill, find someone to talk to and focus on the conversation instead of the food. Keep your hands full with water.
- As you load up your plate, watch portion sizes. A serving size of meat is 3 ounces, about the size of a deck of cards. If you’re having more than one type of meat, like ham or lamb, take smaller portions of each. Reach for the lighter pieces of meat; they have fewer calories and less fat than the darker ones. And make sure to take off the skin.
- Fill half your plate with the green stuff: salads, broccoli, Brussel sprouts, asparagus, peas, or whatever. This may be the one day you get your allotment of vegetables in for the day!
- Pass on the rolls and butter when they are offered. They may be hot and tempting, but we can eat those any old day. You really can do this!
- Dressing is intended to be a complement to your meal. Aim for about half a scoop with a serving spoon if the dressing is filled with fatty meats (sausage and pork), or looks greasy or buttery. Better options would be dressings that look drier and have whole grain or cornbread, lean meat (or no meat), nuts (like almonds or walnuts), and lots of veggies and fruits (celery, grapes, cranberries, carrots, onions).
- Limit gravy to one tablespoon, and keep it off other items beyond the meat. Let’s face it; there is plenty of fat on that plate without it! Cranberry sauce doesn’t contain as much fat or sodium, but it can be high in sugar, so limit yourself to 1/4 cup.
- Now that your plate is full, decide to eat slowly and savor the flavors. Watch how others in the room are eating. See if you can figure out their relationship to food. Perhaps you could find one good trait about all those around your table. You may find the need for seconds has passed if you give yourself time to recognize that you are full.
- One way to enjoy dessert without losing control is by sampling. Have one bite of pie, half a cookie and one small square of fudge. Find a friend or family member who will stick to the sampling rule with you. If you feel you cannot eat small amounts, choose one small dessert you will enjoy and forget about the others. Try a flavored cup of coffee or tea to curb the temptation for more sweets.
- Pace your holiday drinking. Limit your intake to one to two alcoholic drinks for men and one drink for women. To reduce the amount of calorie-laden drinks you consume, drink a glass of water between each beverage and have a half-wine/half-seltzer spritzer. Or have a mock-tail. No one has to know what you are drinking.
- Don’t be coerced into eating more when a well-meaning hostess encourages you to have seconds or thirds. It’s okay to graciously refuse by saying “Thanks. Everything is so delicious. I’m really quite satisfied!”
- When it is all over, notice how good it feels to not be overstuffed. Enjoy the rest of the evening visiting with others, rather than feeling uncomfortable, or worse, falling asleep. Acknowledge your success. Make it your norm from here on out.
- Be happy now. We think that once we get thin, or give up sugar we’ll be happy. The crazy thing is that it works just the opposite. Once you allow yourself to be happy, you’ll have a better chance of achieving your goals. Happy people are less likely to eat from stress, depression or anxiety. So, enjoy the ride.
- If you do eat more than you planned, don’t beat yourself up. Just set your sights on eating moderately the next day.
- Step up the physical activity and keep moving through the holiday season. It can offset the extra calories and blow off some steam. Things like going for a family walk after each meal or shooting hoops, jumping rope or playing catch are good family activities. Make time to have fun.
I have been thinking a lot about eating habits for weight loss lately. A recent Salt Lake City client suggested that the reason that she was having trouble implementing the nutrition recommendations I had given her was because of her ingrained eating habits. She has a habit of eating late at night once her husband has gone to bed and can’t seem to stay away from the kitchen. She went on to say that she is not used to exercising regularly and is having difficulty creating this new habit. So I started researching how habits are formed and how hard it would be to change the ones we don’t like in order to achieve weight loss. Is there a recipe for this difficult task?
To get a better handle on understanding eating habits for weight loss, I started with a book I heard about on NPR which was written by New York Times business writer Charles Duhigg called, the Power of Habit. His book explores the science behind why we do what we do. Neuroscientists have traced our habit-making behaviors to a part of the brain called the basal ganglia, which also plays a key role in the development of emotions, memories and pattern recognition. Decisions are made in a different part of the brain called the prefrontal cortex. As soon as a behavior becomes automatic, the decision-making part of the brain goes into a sleep mode of sorts. Parallel parking, exercising, brushing your teeth and every other habit-forming activity all follow the same behavioral and neurological patterns.
Exploring the intricacies of habit formations are also the specialty of a team of neuroscientists at the Massachusetts Institute of Technology (M.I.T.). According to their research, the habit creating process in the brain can be viewed as a “three-step loop.” The forming of a new habit requires:
- a cue that triggers the brain to go into automatic mode,
- a routine or automatic reaction that follows in response, and
- a reward, which also helps the brain to decide whether a particular experience is worth remembering for the future.
Over time, this loop – or cue, routine, and reward – becomes more and more automatic and neurologically intertwined. The results can range from a simple tendency to cravings to a full-blown addiction.
Here’s an example of a 3-step loop and how it can affect the formation of a new eating habit for weight loss:
After work (cue) , you arrive to your Salt Lake City home and reach into the freezer and pull out the ice cream (action) and you sit and lose yourself in the cool, sweet taste of your favorite ice cream and forget about the bad day you had at work (reward). What exactly turns an event into a cue and what constitutes a reward depends on the individual as well as the situation.
Studies have shown that people will perform automated behaviors — like pulling into the driveway— the same way if they’re in the same environment. But if they take a vacation, it’s likely that the behavior will change. That’s one of the reasons that taking a vacation is so relaxing: It helps break certain habits.
Needless to say, the cue (pulling into the driveway after work) is where the change has to begin. Now that you are on a weight loss regimen, you have to find a way to interrupt what the M.I.T. scientists identified as your “loop.” Instead of continuing to expose yourself to the cue that will inevitably trigger your routine response, you have to plan something else after work. Stop at the park and walk for 10 minutes while listening to your favorite music on your iPod. It may take several months until you are able to come home without heading for the freezer – but eventually you will succeed. Just how will you succeed? Your cue is still there, but you have developed a different routine in response. The long term reward is self mastery and a thinner physique.
The good news as Duhigg puts it is that, “Habits aren’t destiny,” “They can be ignored, changed or replaced.” The bad news is that old eating habits die hard and never fully disappear. They can rear their ugly heads at any time and really mess with your weight loss plans. To help you with this daunting task, I have collected several ideas for you to think about and try on one of those pesky habits you are trying to rid yourself of. Start with something small. Many of these ideas come from Steve Pavlina, a self-help author and motivational speaker. Check out his website http://www.stevepavlina.com/.
Eleven Ideas for Sustainable Eating Habits for Weight Loss
Create a Trigger – A trigger (or cue) is a short ritual you perform before a habit. If you wanted to wake up earlier this might mean jumping out of bed as soon as you hear the sound of your alarm. If you wanted to stop smoking this could be snapping your fingers every time you feel the urge for a cigarette. A trigger helps condition a new pattern more consistently.
Replace Lost Needs – You obviously get something (rewards) out of your deeply ingrained habits so you will have to find an alternative. You can’t just get rid of habits without replacing the needs they fulfill. Giving up television might mean you need to find a new way to relax, socialize or receive information.
One Habit at a Time – Try not to change too many things at one time. A month may seem like a long time to focus on only one change, but trying to change more than a few habits at a time could be confusing. Pick the one that is going to give you the most bang for your buck. Your successful outcome will stir you to tackle the next one more easily.
Balance Feedback – Listen to reason. If your change creates more pain in your life than joy, it is going to be hard to stick to. Don’t go to the gym if you hate it. Find diets, exercise, financial plans and work routines that are more to your liking and support your uniqueness.
Kill Bad Thoughts –Anytime you feel yourself thinking negatively about yourself, use the word “but” and point out positive aspects. “I’m lousy at this job – but – if I keep at it I can probably improve.”
Write it Down – Don’t leave commitments in your brain. Write them on paper. This does two things: first, it creates clarity by defining in specific terms what your change means, and second, it keeps you committed to breaking the habit since it is easy to dismiss a thought, but harder to dismiss a promise printed in front of you. Put these papers on your fridge, in your card, and on your office desk.
30, 90, 365 Day Rule – I’d like to say most habits go through a series of checkpoints in terms of conditioning. The first is at thirty days. Here it doesn’t require willpower to continue your change, but problems might offset it. At ninety days any change should be neutral where running the habit is no more difficult than not running it. At one year it is generally harder not to run the habit than to continue with it. Be patient and run habits through the three checkpoints to make them stick.
Get Leverage – Give a buddy a hundred bucks with the condition to return it to you only when you’ve completed thirty days without fail. Make a public commitment to everyone you know that you’re going to stick with it. Offer yourself a reward if you make it a month. Anything to give yourself that extra push. Not only does it create accountability on your end (the heaviness of living up to expectations is a massive motivator for taking the right action) but it also gives you that “ra-ra” pat on the rear just when you need it.
Keep It Simple – Your change should involve one or two rules, not a dozen. Exercising once per day for at least thirty minutes is easier to follow than exercising Tuesdays, Wednesdays and Fridays with yoga the first day and mountain biking the third day, except when it is raining in which case you will do… what? Simple rules create habits, complex rules create headaches.
Consistency Is Key – The point of a habit is that it doesn’t require thought. Variety may be the spice of life, but it doesn’t create habits. Make sure your habit is as consistent as possible and is repeated every day for thirty days. This will ensure a new habit is drilled in, instead of multiple habits loosely conditioned.
Experiment – You can’t know whether a different habit will work until you try it. Mix around with key habits until you find ones that suit you. Don’t try to follow habits because you should, but because you’ve tested them and they work in your life.
I just finished reading the book Why We Run and found it to be an interesting read about human and animal evolution relating to movement. The author, Bernd Heinrich, is a biologist with a unique background that would make an interesting story in and of itself. His parents, also biologists, raised him and his sister in the Maine woods in a somewhat primitive manner. For six formative years, the two kids lived in a boarding school while his parents lived in Angola doing field research. It was at school that Heinrich became interested in running. He realized that succeeding at cross country would give him the possibility of going to college on scholarship.
He went to the University of Maine and excelled in running and in his studies. During his final year of college he had the opportunity to join his parents on their last great expedition. His job during the fourteen months he was in Africa was to hunt birds for a museum collection. While hunting for specimens, he did a lot of running – barefoot. He fancied the notion that many African and Native American tribes had hunting traditions of chasing down animals until they tire. He wondered how that practice fit into our evolutionary changes.
Much of this book examines different animal species and how they have adapted to move and feed themselves. Heinrich is convinced that we are born to run, hence the topic of the book. He talks about how we evolved from lobe-finned ancestors that crawled onto land with four limbs and evolved to become adept bipedal savanna hunters. Some interesting questions addressed by Heinrich include, does multipedalism increase or decrease speed? Cheetahs are considered fast runners and they are quadripedal, and cockroaches (a six legged insect) are one of the smoothest and fastest moving insects. Yet we have just two legs. What advantages, if any do we have with just our two legs?
He discusses the body’s ability (be it a frog or dinosaur) to deliver a continuous supply of oxygen to muscles with the support of lungs, hemoglobin and myoglobin, and the role of fast and slow twitch muscle fibers. He compares how heat production is managed by different species during exertion. Humans have evolved to get rid of heat through sweating, but how do bumblebees and butterflies stay cool when exerting? He compares the ability of a variety of species to fuel muscles during an endurance event. Have you ever wondered how birds can travel 3500 miles without eating or drinking? What about bulky bears that hibernate for six months and eat nothing? How do camels go for days in blistering heat without drinking a drop of water? Why are animals for the most part not prone to obesity like we are? These and a number of other interesting questions are explored by Heinrich in this book.
My favorite parts of the book, of course, relate to Heinrich’s inferences to biochemistry and nutrition. He points out that in our evolutionary history, we were forced to be continually active in order to survive, and therefore never had the necessity to deal with the effects of prolonged idleness. One of the obvious byproducts of our idleness is obesity. This is because our bodies are evolutionally programmed to store excess calories as fat in preparation for lean times. When was the last time you had a lean time? Not only can this make us fat, but trying to get weight off once stored is very difficult. He advocates that we should try to lose our excess fat stores with a gradual caloric reduction to avoid the body’s metabolic response to plummet as if in a starvation mode. This is hard for us to accept as we want to lose weight fast and are disappointed when we don’t experience immediate results. He shares the idea that regional differences in body composition abound today due to this evolutionary safety net, like the Polynesian people of the South Pacific. These remote islands were colonized by a specific subgroup of survivors-people who had been adrift for months at sea. During these long distance movements that resulted in chance colonizations, those leaving on their journeys with the largest buffer of energy reserves would have lived longer and plausibly more likely reached land than those starting off lean. This ability to store fat was passed on as a survival trait.
Another interesting aspect that I had not thought of that Heimlich points out is the effect that contemporary idleness has on our bones. Running had become a constant in our past lives in the form of hunting and gathering. Now that we are much more sedentary, our bones have suffered. Data show that our bones become brittle and weak (osteoporosis) if they don’t receive normal everyday stress. We see an accelerated form of this effect with astronauts who live at zero gravity for just a short period of time. Heinrich points out that bears that are completely inert during hibernation suffer no such bone loss. They are not programmed for constant movement. We may need to consider movement as a supplement for optimum health, like we do vitamin and mineral supplements.
To carry out his theme of being born to run, Heinrich weaves his personal running experiences throughout the book. Upon his return to college, he was fit and anxious to letter in track and break the school record. His final race of his college career, however, was disappointing and he did not achieve his goal. He was crushed, but not defeated. Twenty years later, Heinrich decided to use his knowledge of animal physiology to attempt to win the U.S. National 100 kilometer championship. He was 41 years old and felt he was passing his peak. He calculated he would need to run this 100 km race in 6.5 hours to beat the record; an average pace of 6:17.
Heinrich reports his running efficiency improved dramatically. As he trained, he gradually increased his weekly mileage. Early on, he could barely make it home without bonking. As his fitness improved, he found that he ran out of fuel less often and at a later time during a run. He surmises that his body learned to burn a combination of carbs and fats and/or that he had trained his muscles and liver to store more glycogen. Both are most likely true, but it doesn’t solve the puzzle completely. As he became more fit and was often running 20 miles per day (120 miles per week), he reports that he was not eating much more than he used to, and his weight stayed fairly constant. At 100 kcals per mile, that is 2000 extra kcals he needed to take in per day. He claims he ran more mileage with the same number of calories. I see this with my clients who are ultra-runners all the time. You would think they could eat an ox with the miles they run, but they can’t and don’t. Perhaps, he was becoming more efficient with his stride, his gate and his respiration (resting heart rate went from 60 to 34 bpm), all of which can affect calorie expenditure. I would love to hear about anyone’s personal experiences with this as it continues to be a mystery to me. Please share your ideas.
Overall, I found this to be a very interesting book. As a runner and a nutritionist, I agree with his simple approach to run and eat what his body told him to eat (antelope seem to have figured this out). No Gu, Nuun or protein powders for him. I believe the overall take home message for us is that we are meant to be continually active and mobile (read run) and that when we do we are healthy, both mentally and physically. So get moving!
It is not secret that we have an epidemic of obesity in America among adults and children alike. Nor is it surprising to know that we have a huge problem with an increasing incidence of diabetes and cardiovascular disease, both due to their relationship to diet and weight. It is with great disappointment that Registered Dietitians are not covered by insurance companies for services provided in any but renal disease and in some incidences of diabetes.
I have hoped that our increased awareness of our flawed and extremely expensive health care system would lead to an increased emphasis on preventative health care where Dietitians can really have an impact. Unfortunately, the Centers for Medical and Medicaid Services (CMS) decided that it will cover screening and intensive behavior counseling for obesity (BMI > 30) ONLY by primary care providers in a physician’s office. It seems strange that they would authorize a higher billing fee by someone less qualified, but I guess the insanity continues. Here are some comments by other disappointed dietitians (source: Sports, Cardiovascular, and Wellness Nutrition Blog):
This is a call to action for all RDs! We need to interact on multiple levels with other providers and government officials to add us as providers for obesity care. We are 70,000+ strong and we are being denied the ability to bill for a service that we routinely provide. Enough with documentating outcomes. It’s time to descend on CMS with our outrage and concern that our inability to bill for this service will hinder the appropriate care of obese individuals. I wonder, would CMS expect MDs and NPs to perform and bill for physical therapy and not allow PTs to do so?
This decision is mind numbing. Clearly no logical argument will sway decision makers because logic isn’t being used to make these rulings.
I am pleased to see at any level that obesity is being viewed as an epidemic that needs qualified professionals to assist patients with this disease. I do believe that it will fail as without a complete team effort which includes the RD most patients will not get the education and direction they need on a one to one basis to make this trial program work. As amazing as doctors are they do not have the time to personally coach and support this disease. The behavioral therapist does not have a nutrition background to discuss specific meal plans for the patients with medical issues such as diabetes or heart disease. As a dietitian for over 20 years I have learned one thing. It takes a team to promote wellness. Each team member playing their part and not 2 team members trying to perform everyones role. This current trial period will not be successful in my opinion. And by the way, CMS better pay well. The therapists in my area charge between 150 to 350 dollars an hour and most do not want to accept any insurance at all for disordered eating behaviors.
Natalie Taylor said…
I am discouraged that the outcomes were based on weight loss vs. wellness/health outcomes (i.e. blood pressure, lipids, A1c, etc.). The obesity epidemic is an extremely complex issue involving hormones, genetics, environment, behavioral factors, coping skills, etc. I agree we need a team consisting of a physician, exercise physiologist, RD, and psychologist to have the best outcomes. However, I feel we should use the “Health At Every Size” approach (similar to Canada’s Vitality Program) and the focus should be placed on a healthy lifestyle/wellness/health and lab values vs. the number on the scale. Since the weight loss outcomes are extremely poor (i.e. 95% of people regain after 5 years) and the dangers of weight cycling are many (i.e. increased risk of mortality, gallbladder disease, high cholestorol, compulsive or deprivation-driven eating style, etc.), this program goes against the rule of “first do no harm”.
Marla Heller, MS, RD (marlahrd) said…
1. Where is the grade A or B evidence that primary care practitioners in a primary care setting can have successful outcomes?
2. When we have a critical shortage of primary care physicians and midlevels, why would we try to give them new time-consuming therapies? This is counterproductive for increasing the availability of primary care to the millions of Americans who need it.
3. Would anyone promote primary care physicians and midlevels to do respiratory therapy, physical therapy, occupational therapy, mental health counseling? Then why would we expect them to do medical nutrition therapy?
Jaimie Winkler, RD, LD said…
I am pretty appalled at this decision by medicare. Especially as the nutrition care process specifically highlights the behavioral modification strategies dietitians are expected to employ. I am curious about the training differences between those deemed to be qualified and the dietetic education that the CMS feels creates a distinction.
Nora Norback, MPH, RD, CDE said…
NOTE TO SELF:
Align with PCPs in new ways
Market to PCPSs and Medicare beneficiaries in new ways. (IDEAS??)
Advocate for comprehensive and coordinated model of care, articulate what the RD can/will do.
Create spreadsheet for with initial assessment (this is big!), triage options, and columns for re-assessing rx, clinical AND behavioral outcomes.
Contact ADA to see if they have a spreadsheet to build upon. Might be nice for standardization if all RDs had it
Most importantly, collect, report, and publish outcomes data to strengthen the foundation of clinical evidence used by CMS and others in making coverage decisions.”
It takes a village. Ranting and raging won’t win this. RDs ARE ahead of the curve in thinking this thru. MDs will need time to catch up. Ahh, aligning in new ways includes educating MDs on MNT.
I work in 2 Primary Care settings were MD’s, PA’s and NP’s routinely will refer Medicare patients for MNT for weight issues. I have offered patients without Diabetes or Renal Dx the option to see me under a fee for service structure, which in many cases they agree to pay. My ? is whether now that we could use the “incident to” criteria under Medicare, to bill for MNT for Obesity; can we switch to the “Incident to” designation depending on the diagnosis? I have not used the “Incident to” due to the fact that it appears as if the MD is providing the service and not the RD’s, and I feel strongly that we need to continue to make our services visible to the insurance companies. Any thoughts on my ? would be appreciated.
Life Focus Nutrition said…
The answer I got directly from the nutrition services coding team is the yes incident to MD services will be considered but more comments after a meeting last week in DC will be forthcoming. That does not help any of us who work outside of that business model, nor will provide evidence that our independent services and produce successful long term cost savings to the healthcare system.
As former coding and coverage chair this comes as a blow for all of us who have worked against this. I agree with all the above comments that we should be the front line providers. As I had shared to those involved in this outcome, would medicare suggest PT to be conducted strictly in an MD office by an MD?
I am involved in a program that truly assesses health risk based on clinical labs( BP,lipids, HgA1C, etc) and proven outcomes that go beyond the number on the scale independent of MD services. The MD driven business model continues to reduce our profession it “incidental.” Research demonstrates that RD’s could be the leaders for achieving lowered health care cost of all if given the tools to allow it! Linda Arpino, MA,RD,CDN
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