Mindfulness has become a popular topic in relation to weight control. Many are suggesting that learning to eat more mindfully should lead to healthier eating, and possibly to better weight control. That of course has not been proven yet, but it does seem like a logical prediction. So what is mindfulness, how do you get more of it, and how does it improve weight control?
Mindfulness refers to a state of mind in which we have a higher degree of absorption in the present moment, noticing the features of the environment, and our own reactions to the perceived situation right now. Also considered part of mindfulness is a type of detachment or equanimity, such that impulses are calmed and frustration and suffering are decreased.
To increase our level of mindfulness we may give ourselves a focus of attention, such as the breath. We watch the breath and notice when our attention drifts, and where it goes, and then we bring attention back to the breath. Breathing serves as a very useful focus of attention because the qualities of the breath are good measures of our physical and mental state, while the increase in mindfulness that we achieve through training exercises modifies our breathing patterns to produce beneficial effects on our state.
Mindfulness alters how we act
By practicing deeper levels of mindfulness to a sufficient degree (the amount needs to be defined for each individual) we slowly modify our more general personality traits. For example, the trait of anxiety, or negative emotionality, also known as neuroticism, will be attenuated and reduced over time, while traits of positive affectivity (the general tendency to experience positive emotions) and openness of cognition increase; and potentially also effects on levels of agreeableness, conscientiousness, and extraversion.
Engaging regularly in some form of mental practice, such as mindfulness meditation seems to have beneficial effects on the quality of our mindset. To get the most out of our efforts in pursuit of our goals, such as to get in better shape or to increase overall life satisfaction, it helps to deal with the behaviour change process in a mindful manner.
When it comes to weight control, the concept of mindfulness has many implications and applications:
We need more research on the effects of mindfulness training on the outcomes of weight control (e.g., % of ideal weight achieved; % maintenance of weight loss; % improvement in medical risk factors; % improvement in fitness). But the ideas are certainly worth exploring further.
Let's start with Eating. How does mindful eating relate to the type and amount of food that is eaten? After a period of mindfulness training, what is the impact on caloric intake, or the % of macronutrients eaten, or the circadian rhythm of eating (during which hours of the day is food typically eaten)? Can you learn mindful eating directly (i.e., by practicing mindful eating) without practicing meditation? There is no research comparing mindful eating vs. general meditation vs. a combination of mindful eating and general meditation, but that would be an important study.
We define mindful eating as paying attention to the sensations of hunger, fullness and desires to start eating and stop eating. The bottom line is, does the act of being more mindful of sensations and thoughts around eating alter the behaviour of eating? do you eat less/more (quantity) or differently (quality) as the result of increased mindfulness? does it have a significant effect on weight?
When we think about the decision making process for eating, we realize that along with being mindful about our impulses to eat or not eat, we also need a rational analysis of our eating decisions, and this requires some sort of standard(s) for comparing choices.
A useful strategy is what I define as "moderation". We need to look at mindful eating in relation to the mental "strategy" of moderation. The question is how do mindfulness and moderation relate to each other? Moderation starts with the intention to eat the "right way", eating the optimal amount and types of food. What is "right" or "optimal" is hard to define, so we think of it more as a general strategy, like a meta goal. There is not a specific requirement to follow a particular diet or an eating plan, but more like a strategy to eat reasonably and intelligently. I sometimes refer to moderation as "intelligent restraint." There are as many variations on what this looks like as there are individuals, because we have our own individual preferences and biological need for food. The strategy has to map on to what we need to support our health and wellness.
Intelligent Restraint contrasts with what has often been called "restrained eating," which is closer to the prototypical "diet mentality," a type of "rigid" restraint, based on narrow eating rules ("eat this, not that"), anxiety about breaking the rules, and guilt and loss of confidence if and when (it is inevitable) there's any lapse in the restraint.
Intelligent restraint is being a smart and reasonable eater. It does not mean being inflexible. For example, taking a small ice cream cone instead of a medium or large one, realizing that the first 10 bites are the best, after which the satisfaction per bite decreases rapidly, and also remembering that there will be other occasions to eat ice cream and this is not the last time. This mindset leads to a significant reduction in unhealthy eating, and an increase in healthy choices, while satisfying taste preferences at the same time.
So the mindset that we want to cultivate is best referred to as "mindful and moderate". The operation of this mindset works on the principles of sensitivity to internal signals, in tandem with an attitude of moderation.
To summarize, you need to learn to pay attention to your body's signals and you also need to sharpen your intelligent restraint. Mindfulness is necessary, but so is good judgment.
In our program, we work to help you move from the stage of rigid restraint, to intelligent restraint, to mindful and moderate. These principles apply to the way you eat, and also your physical activity, stress management, and general self-regulation of health and wellness. In other words, it's kind of an all-purpose strategy, perhaps even a way of life.
I look forward to continuing this discussion next time, looking at mindfulness and moderation in physical activity.
Stephen Stotland, Ph.D.
Think about a simple goal, say "take a walk, each day". In the way we have stated the goal, there is no anchor for how long to walk for, when, where or with whom to walk. It's simply, walk or don't walk, each day. Over time you will be able to judge if there is an improvement in your daily walking. You will not need to quantify it, or provide a percentage improvement, but you will have a clear sense of whether you've made a small, medium or large improvement since the last benchmark.
If you have a strong sense of walking better/more, it will likely be accompanied by some improvement in your overall self-rating of fitness, and other changes that you notice.
Now, imagine there is a progression over time. Picture yourself walking more and more (or better and better), and how much fitter you feel in general.
Let's branch out a bit and think about a second goal, to "eat some veggies", each day. This is another seemingly simple task. Think about it some more however and you will realize how much room for improvement there is in the eating of veggies. This is not an endorsement of veganism, since eating veggies is important no matter what else is included or not included in the diet.
Think about a gradual improvement in your veggie eating, and how much better that makes you feel in general.
After focusing on these simple goals for a while, you might add other simple goals, such as "do something to relax". Or add other eating and physical activity goals. Gradually you will gain a new set of healthy habits.
All of that probably adds up to some big changes in your health and wellness, especially over longer periods of time.
Think small, and remember that a journey of 1000 miles begins with a single step.
Stephen Stotland, Ph.D.
My previous blog post discussed the basic ideas around "readiness". Hopefully, that inspired some people to think about what it means for them, and perhaps they took our Weight Management Readiness Test to give themselves a baseline measurement. In this post I will explore the concept of readiness more deeply, to explain how we can use it to accelerate the process of behaviour change. SPOILER ALERT: if you have not yet taken the test, this would be a good time to do so. Then come back and read on.
To communicate to people about Readiness, it was helpful to find a way to summarize all of the various factors into a single readiness score. The score gives us an overall sense of our current strengths vs. our weaknesses in regards to achieving our weight management goals. However, in summarizing this way we lose some of the more specific information that explains the differences between two people who may have arrived at the same score in different ways.
As it is currently organized, the readiness score ranges from -4 to +4. A score of -4 means that perceived obstacles to change are at a maximum, while confidence in change is at a minimum. Conversely, a score of +4 implies the reverse scenario, with maximum confidence and minimum obstacles. Those situations are perfectly clear. For the -4 person, the task seems quite hopeless at present, while the +4 person sees it as smooth sailing.
The further we move away from the extremes the more ways there are to achieve the same score. For example, a score of 0 means that the individual judges perceived obstacles to be equal to their confidence in overcoming those obstacles. But that same result can occur at all points on the scale: 0 obstacles & 0 confidence, max obstacles & max confidence, or moderate obstacles combined with moderate confidence, all produce a score of zero. It is not clear that these different scenarios are really equal.
The readiness test can be used in two ways, and one is probably more valid and useful than the other. First, we can use the scores to compare people, to judge how ready one person is compared to the average person. The second use of the test is to explore an individual's various ideas about weight management, and to see how those ideas change over time. While both strategies have their place, it is the second that is most useful in a coaching context and can help us get started in the process.
Let's look deeper.
We'll start with the first question on the test. It asks how much you agree with the statement, "It's very important for me to lose weight, but I'm having trouble making it a top priority", on a 5 point scale from disagree completely to agree completely. What is this question getting at? What does it mean to make weight loss a "top priority"? Does it have to be the top priority, or can it just be a high priority? Most people answering the test respond with agree completely or somewhat with this statement. This implies that they feel they will need to put most of their focus on this task. Exactly what they will need to do is not specified. Is it to get on the scale each morning? Is it to take more time in deciding what to eat? Is it taking a walk each day? When we say that achieving a goal requires it to be a top priority, it seems we are saying that it will take a lot of effort, that it will take time and energy away from other activities, and that we will have to sacrifice to achieve this goal. As you can see, there can be a lot packed into the response to this one question. The more we perceive the task as heavy, demanding, costly, effortful, the bigger a mountain we see ahead of us, the less likely we are to get started. Becoming more psychologically ready means deconstructing what it means to prioritize the goal, finding smaller tasks to focus on, to reduce the emotional burden of commitment.
Now let's look at the companion question from the second half of the test. This one asks how confident you feel that you can "Make weight control a top priority", on a 5 point scale from not at all confident to completely confident. What we typically find is that the same person who agreed somewhat or completely that they have trouble making weight management a top priority, now says that the are quite confident or completely confident that they can do so. They're saying it's been hard to prioritize weight control but they are confident they can. Where is the newfound confidence coming from? Is it because they feel something has changed in their circumstances? The time is somehow right? Their mind is more made up? The stakes have changed and the goal is even more important now than it was before? They plan to join a program which they think will provide them the support and direction that will change things? In wondering how these two apparently opposing thoughts can exist at the same time I am not doubting that the person really feels this way. What I think is important is to explore a little deeper beyond the multiple choice responses, to understand why the person thinks this time is the right time?
As we go through the rest of the questions, we get some ideas about what the specific challenges are for each individual. For some it is related to the place of food in their life, for others it's learning to incorporate exercise, and for many it is how to organize this process and how they can persist over the long-term. When we look closely at the responses to each question, we get a picture of the individual's current set of beliefs about weight control. Our goal, like our clients, is to find a formula that works and that does not feel like a huge burden. As their program progresses, clients become more and more "ready," not to begin the journey, but to keep taking steps each day, until it is no longer a question of change, but simply continuing what has become natural, automatic and intrinsically rewarding.
It is this that we wish for all of our clients, and all those who embark on their own journey of self-development.
Stephen Stotland, Ph.D.
When we begin any new project, it makes sense to ask ourselves if we're ready? Before leaving on a road trip, we check that the car is in good working condition, that the tires have air and the tank is full, that we have clothes, money, and an interesting itinerary. This is a simple, obvious example. Sure, there are dramatic and entertaining examples of people who launched themselves into great adventures without thinking or planning and somehow succeeded, but that's probably not how we want to model ourselves.
When the change we're talking about is a change in ourself, we should take the time needed to consider the implications and the commitment that will be required. First, why do we want to change? If those reasons are so clear to us now, why hasn't it already happened; what has been keeping us in our old pattern? Second, if we make the change, what consequences will that have? How will it affect other things and other people in our life? There is a maxim (from Benjamin Franklin) that "failure to prepare, is preparing to fail," and in the case of personal, behaviour change, a good part of the preparation is getting clear on the Why, before we get into the How.
An important insight from psychology in the last 40 years is that change occurs over a series of stages. Changing habits is overcoming the "law of inertia" (Newton's first law), which states "if a body is at rest or moving at a constant speed in a straight line, it will remain at rest or keep moving in a straight line at constant speed unless it is acted upon by a force". What is the "force" that gets us to change our habits?
A smoker who is not thinking about quitting is in a stage called "pre-contemplation". If we were to see into their thoughts we would find that the Pros of smoking (it's relaxing, fun, cool...) are a lot greater than the Cons (unhealthy, expensive, smelly...). To get this person to begin thinking about quitting (which we call the stage of "contemplation") something has to change the balance of Pros and Cons in their thoughts. As the balance tips towards the Cons being greater than the Pros, the person is closer to a change.
But that's not enough to make change happen. In addition to strong reasons to change, we need the belief that the change is not only possible, but within our capacity to make it happen now. Let's unpack that a bit, and use a relevant example to make it more real.
Are you able to change your eating and exercise habits enough to lose 10 pounds? Are you able to maintain those changes to ensure that the 10 pounds stays off for the next 5 years? If you answered differently to the two questions, then you may believe that short-term behaviour changes are easier than long-term changes. Perhaps you think that over time other factors may counteract your efforts (maybe you think your metabolism will slow down in response to the weight loss)...
There is a complicated matrix of thoughts and beliefs in our minds, some conscious and others less so, that determines our motivational state. That's why asking a simple question like "do you believe you can lose weight and keep it off?" is not very informative. To really understand how psychologically ready you are to accomplish this goal, or any other behaviour change goal, we need to dig deeper.
In order to help explore this I created a questionnaire called the Weight Management Readiness Scale, that presents the kinds of thoughts that seem both common and central to this process. This is based on my decades of working with people at all stages of this journey. Please give it a try, but as you do so, be honest with yourself about what you actually believe, not what you think you should say to get the best "score" or what you wish you were feeling.
Click here for the Weight Management Readiness Scale
Best wishes for a safe and successful journey!
Stephen Stotland, Ph.D.
You need to stop sometimes. Coming back to the present moment is a gift to yourself.
You may be the most productive and creative person, with a head filled with new ideas, important tasks to complete, people to talk to, etc. Or you may be someone with a lot on your mind that you wish wasn’t there, worries, regrets, resentments, that you can’t seem let go of. You may spend a lot of time thinking about your next meal, what you should or shouldn’t eat, what you would like to eat, your mouth watering in anticipation. You may be excitedly thinking about your exercise routine and the great progress you’re hoping to make and next challenge you want to accomplish and can hardly wait to do more. Or you may be thinking about the dinner party you’re arranging or invited to attend, and what to wear, what to bring, and how much you want to go, or not go…
Your mind is filled to overflowing with all the good and bad things you’re engaged with, and it’s difficult to put them aside, even for a brief moment. It seems the only time you rest is when you’re asleep, and even that is not so restful. What is going on? Where’s the fire? What’s the emergency?
As you proceed on your weight and wellness journey, you are of course working actively to improve your ways of eating and moving your body, which takes planning and practice, so good for you for sticking to it. But you also need to learn to rest sometimes. To release the burden. Put down your baggage. Find peace in the moment. Be kind to yourself.
Imagine you’re in charge of the process for someone else, perhaps a close relative or friend. You help them devise their plan of action, you monitor their progress and celebrate with them as they move closer and closer to their goals. Will you be a harsh task-master? Will you criticize them if they skip a workout, or indulge in a small piece of cake from time to time? Will you push them to do more, even when they’re exhausted? Probably not, at least we hope not! More likely, you will act like a responsible parent, who loves her child unconditionally but knows what’s best for them. You will instruct, model, encourage, push, explain, persist, give constructive feedback but also lots of hugs, and make sure he or she gets their rest.
Almost everything will work again if you unplug it for a few minutes… even you. Alice Lamott
Talking about weight control, or talking about life, we need to find the balance between “go, go, go/onward and upwards,” and “stop and take a break.” Is there a danger that resting turns into backsliding and complacency? Not if the rest periods are effective, meaning that they provide the rest, relaxation, recuperation and letting go that brings wellness and restores the motivation to get back to the action.
Stephen Stotland, Ph.D.
Many people lose weight but remain “fragile” in the sense of being at risk for regaining the weight. This article explores the reasons for this fragility, and ways to help you prevent relapse.
A glass is a great example of a stable but fragile structure. A glass may survive for a long time if you handle it with care and avoid dropping it, but it’s always a moment away from destruction. Time does not make the glass any less fragile. Let’s explore why some dieters seem to be as fragile as the glass, and the potential solution.
A central issue in weight control, as it is with every other type of behavioural problem, is how to reduce the risk of relapse. In fact, it’s not an exaggeration to say that reducing the risk of relapse is the primary task of treatment. Many methods can initiate change, such as a week at a health spa (fun!) or a 21-day diet and exercise plan (not fun!), but these short-term interventions do not fix the long-term problem. Of course, the initial focus of all treatment is symptom reduction (losing the weight, stopping drinking, recovering from depression, etc.); this is the necessary first step. You must lose the weight before you can confront the challenge of maintenance. However, you need to start preparing for maintenance before you get there and not take it for granted.
Thus, we often see people launch themselves into an intensive program – the more stringent the better – and get dramatic results. They feel happy, proud, and confident, but unfortunately, they go off course at some point, feel defeated and discouraged, lose focus, and find it difficult to get back on track. No matter how well it seems to go during the initial intensive, “boot camp” phase, these individuals remain “fragile” with respect to their risk of relapse.
The reason for the dieter’s fragility is two-fold: First, the intensive regime is not physically or psychologically sustainable and does not represent a real lifestyle change. Real lifestyle changes are built from less dramatic small shifts in daily life that add up to big changes over time. Real lifestyle change requires you to deal with all the stresses and strains and competing demands of “your” life. Second, diets do not teach people how to master the relapse crisis itself. This is another key challenge in long-term behaviour change, and where psychology plays a very important role. It’s learning to deal with, and indeed to learn from, the relapse crisis that is the key to lasting change and successful weight loss maintenance.
The most well-established model of relapse and relapse prevention was proposed about 40 years ago by a psychologist named Alan Marlatt. His initial work was with alcoholics, but the model has since been applied to all sorts of behaviour change. In the relapse prevention model, the first question is how one copes with a “high risk” situation. High risk situations are those that increase the likelihood of an initial “lapse” (a slip back to the old behaviour) for an individual; these high-risk situations often involve negative emotions and interpersonal situations, but may also involve positive events such as parties, holidays, and celebrations. When we face such a situation we are challenged to find a way to cope. If we manage to cope successfully, we gain knowledge and confidence, and reduce our future risk of relapse. On the other hand, if we fail to cope, giving in to temptation and deviating from our plans, we may lose confidence and become even more prone to relapse.
Importantly, even a failure to cope can lead to learning, as we come up with strategies to avoid or cope with similar situations in the future. Thus, it is not just the occurrence of a lapse that is important, but how it is interpreted. If a lapse is interpreted negatively (“I knew this would happen, changing my bad habits is impossible!”), it can lead to a spiral of bad behaviour and loss of motivation (“what the hell, I’ve blown it, so I may as well continue….at least I’ll have the pleasure of eating”). If one’s confidence is shaken beyond a certain point of no return, we are likely to conclude that further efforts are pointless and quit. It is as if each time we face a high-risk situation we meet a fork in the road, offering the choice between learning or quitting. We need to develop what’s called a “growth mindset,” which is thinking that we can learn through trial and error, and practice.
Most of the patients we see tell the story of having lost and regained weight many times. One of the first questions we explore is what were the causes of the weight regain? If we can pinpoint the causes of past failure we can turn them to our advantage. For example, one lady described having lost 50 pounds with a combination of better eating and regular exercise; nothing unusual or extreme in her approach and it was going great…. until she fell back into her usual pattern of caring for everyone else and not making time for herself. Thus, she reverted to her old habits of not planning or organizing her eating and not exercising, and inevitably regained the weight. In embarking on another attempt to fix her weight problem, she needed to be very clear from the start about what it will take to avoid a repetition of what happened. She will need to truly address her lifestyle issue of not making herself a priority in her own life.
In the world of business, leaders are advised to get their teams to do a “pre-mortem” before launching into a new program. The idea is to imagine that the program has failed and to think of all the reasons why it did. This is to provide insight into all the pitfalls that should be avoided. The reason this exercise is a good idea is because of the natural tendency for people to be overly optimistic when in a highly motivated state, and to ignore potential risks. We really want to achieve the outcome, so we convince ourselves that we are bound to succeed. That’s a dangerous attitude, and one which makes us more “fragile.” Better to start by facing the risks that lie ahead and using our past experiences to teach us. That is the key to relapse prevention!
Stephen Stotland, Ph.D.
It’s obvious that you don’t have to be “hungry” to eat. We eat for all sorts of reasons, such as the time of day, the availability of food, seeing other people eating, as a distraction, reward, coping mechanism, or “just because” we feel like it.
Let’s define hunger as a state in which we experience physical sensations resulting from a lack of food energy. We may or may not initially pay attention to those sensations, or label them as signs of hunger. As the sensations intensify, we are likely to become increasingly conscious of the empty feeling and rumblings in the stomach, perhaps a feeling of fatigue, and a growing need to eat. Eventually, we may become irritable and have a hard time concentrating on work or other matters.
We might think of a Hunger Scale with ‘extreme hunger’ on one end and its opposite – ‘extreme fullness’ – on the other end. Let’s define extreme hunger as 0 and extreme fullness as 10. Those states are easy to imagine, but what about all the steps in between? What does a 2 feel like? Or a 4? Where does fullness begin? At what point does fullness shift into overeating? Is the middle ground between hunger and fullness a “neutral” state? When you say you are “hungry” an hour after supper, what sensations are you actually experiencing?
Thinking about the hunger – fullness continuum we realize that these are complex concepts. Neither hunger nor fullness are straightforward, or easy to define. They are partly physical and partly psychological, depending on attention, interpretation, and situation. The implication is that there is only a loose association between these internal states and our eating behaviour. Sometimes we eat because we’re hungry and stop because we’re full, but not always.
The psychologists Peter Herman and Janet Polivy discussed this some time ago in what they called their “Boundary Model” of eating. In their model, individuals have well-defined hunger and fullness boundaries, which are the points on the continuum beyond which the person feels strong physical feedback indicating hunger or fullness. This feedback is in some sense painful or unpleasant, and it motivates us to eat, or stop eating. What is interesting is that each person’s boundaries may differ, so that given an equivalent physical state (degree of energy depletion) one person would describe it as a 4 (little or no hunger) and another as a 2 (strong hunger). The same is true, they suggested, for the fullness boundary, so that the same amount of food may produce a 6 (little or no satiety) for one person and an 8 (very full) for another. These differences may be due to learned perceptions, or inborn sensitivities.
An open question is what is the effect of eating less, does it eventually cause our stomach to “shrink?” The stomach is a small organ (about the size of a fist) but can stretch to accommodate large amounts of food. In fact, the stomach is always stretching and shrinking as we eat and digest food, allowing the stomach to empty, but it is true that if we stop overeating the stomach is, by definition, less often in a highly stretched state. More importantly, if we start eating less we may eventually adapt to the sensations produced by the smaller meal and come to define that as fullness. It is not so much that the stomach has shrunk, but our expectations that have been retrained. That is the kind of learning that we hope for, and that will make healthy eating choices “easy,” and not forever a matter of restraining oneself.
What about the part of the continuum between strong hunger and fullness, say the 4, 5 and 6 on the scale. Herman and Polivy called this the physiological “zone of indifference” (ZOD) meaning that the body’s homeostatic systems, those responsible for motivating us to eat or stop eating, are indifferent to whether we eat or not when in this neutral zone. We receive no strong feedback signals, and so we are “free” to choose to eat “if we feel like it.” Thus, in the ZOD, we are especially prone to eating in response to emotional, social, and food cues. It is interesting that people usually say that they eat because they feel hungry, in effect mis-labeling the real reasons, because we have been taught that the only good reason to eat is because we are hungry. A good step is to be honest with oneself about one’s motives and admit that one eats for other reasons than hunger.
Several writers and clinicians tell people that the way to eat better and be healthy is to listen to signals of hunger and fullness and base their decisions on trying to satisfy their physical needs. While this is a nice idea, there is no evidence that it works as a method of weight control. As we have discussed, hunger and fullness are complex and confusing signals. In our view, using hunger and fullness signals to guide eating decisions is an “advanced” strategy, one that we introduce to our patients months into the treatment process. For the vast majority of obese individuals, preliminary work based on creating reasonable eating routines and structures is necessary to get the process started. Once the individual has learned to do that, and has gained confidence and flexibility in weight management, we can begin to shift to a more internal awareness-based type of self-control. If you’ve read our earlier blog post on the stages of weight control, you know that this shift from external to internal control strategies takes place in stages 5 and 6. It’s important to keep reminding ourselves that you need to walk before you can run, and to run one kilometer before attempting a 10K – in other words, you need to be a novice, before you become an intermediate, or a master. Keep working at it!
Stephen Stotland, Ph.D.
Let’s go a little deeper.
Step back from the edge and look out, up, and down.
See the empty spaces.
Realize it’s almost all there is.
And you’ve been trying to fill up the emptiness.
Not even wanting to acknowledge that it’s there.
So, you keep talking, joking, buying stuff, eating, and drinking.
Don’t stop, never stop.
Crashing into sleep, but not resting even then because you wake every minute or two.
Gasping for breath.
Not able to fill the lungs and needing a machine to help.
No rest for the weary.
Would you like to stop now?
Embrace the emptiness.
See the beauty that lies within.
The lake smooth as glass.
The forest so quiet without even a breeze to rustle the leaves.
The sleeping baby untroubled by worry.
What is better than a moment of peace?
If you stop you won’t disappear.
You can rest for a while and then get back to the action.
Enough is enough.
You are more than enough.
Stephen Stotland, Ph.D.
Tears run down his cheeks as he asks me why he seems to be set on a slow suicide. Why, he asks, would he go down this self-destructive path when he has so much to live for? He’s talking about how he let himself get so obese, why he let it go so far. I hear him and see the smart and jovial man in front of me, and I’m not sure if his theory is correct. In effect, his behaviour is indeed a slow suicide, since as the years go by and the weight keeps increasing, he becomes less and less healthy, with diabetes, hypertension, sleep apnea, and joint problems, but does he really have the intention or wish to die? Is he really on a mission of self-destruction, or is there a better explanation?
This forces us to consider some deep questions, such as “is chronic overeating and the severe obesity that it produces a voluntary act, or due to an addiction completely outside the individual’s control?” I have a couple of tests for this: first, imagine you have a choice between overeating and saving the life of someone you love…which do you choose; second, less dramatically, imagine you have a choice between 10 million dollars and overeating, which do you choose? The answers are obvious, but you might still doubt that the person will stick to the commitment.
“Slow suicide” is a harsh judgment, but one I’ve heard before. A slightly less extreme version is “am I self-destructive? Why do I sabotage myself?” Psychologists have defined three types of self-destructive behaviour: 1. The person foresees and desires to harm himself, 2. The harm is foreseen but not desired, and 3. The harm is neither foreseen nor desired. Research suggests that the second type is most common, and the first type is rare except among individuals with severe emotional disorders. The common form of self-destructive behaviour among normal individuals is due to disregarding costs in favour of immediate pleasure or relief; this means to favour short-term benefits (e.g. the momentary pleasure of eating) despite long-term risks, and this is especially likely during negative mood states.
Thus, unhealthy behaviour can result from impulsive choices based on the desire for immediate gratification, or what behavioural economists call “delay discounting” (delayed outcomes are perceived as less valuable than immediate ones). Unhealthy behaviour can also be the result of routinized, automatic behaviour (“bad habits”) – see the food, want the food, eat the food… We are all creatures of habit, and it takes effort, or at least “intention plus attention” to override those habits.
A useful analogy for the dilemma one faces in trying to change an unhealthy behaviour pattern is the following: a boat is cruising along in the ocean and the crew suddenly realizes it is heading for an iceberg (for want of a more likely obstacle!). The captain orders the boat to begin turning and the necessary actions are taken to produce this effect. Slowly the boat begins to turn, first slowing its momentum in the original direction and then gradually changing course. The boat in motion can not stop on a dime and jump course; it’s a gradual process, with the time needed to make the change proportional to the momentum that must be overcome. So too, a person with a long history of bad habits will need time to reverse course. Hopefully, the corrective actions were begun in time!
My patient and I have been meeting weekly for a couple of months, and we have a good rapport. He’s talked about many things, while losing about 40 pounds so far. We still don’t have “the” answer to his question. I resist the impulse to tell him his theory of “slow suicide” is incorrect and leave the question out there. Perhaps it will help him dig deeper and motivate him to find the will to live. We have a long way to go, both in terms of his weight, and to arrive at a satisfying explanation for how he got so big and, perhaps more important, why he won’t go back.
In developing our theory, my patient and I work as collaborators with a shared mission. In this case, because he comes from the business world, we say that he is the CEO (of the weight management company) and I am the executive VP of strategy. We work together to set up goals and plans, and monitor implementation and results. We are working to create momentum in the right direction, and we seem to be moving that way. Now we must stay the course…
Stephen Stotland, Ph.D.
It has been almost a year since my last blog post, and I'm almost reluctant to write this one. You see, so much has been written about weight control and healthy habits, perhaps it has all been said before. I don't want to waste my time (or yours, good reader) with another exposition on "how to set SMART goals" or "how to stick to your New Year's resolutions." Know what I mean? Personally, I've read enough of those....yup, I still get sucked into reading them sometimes, because of the catchy titles no doubt ("7 steps to total freedom and happiness....and p.s. you can make a million doing so!!!").
In counseling people (patients, clients, fellow human beings) on how to achieve their goals, the problem is rarely a lack of knowledge, and when it is that is easily fixed with a visit to Mr. Google. The real issues lie at deeper levels. My job is to help my patient settle down, look at him/herself, pick a direction to move toward, and keep going when times get tough. There's no secret formula, but the process is always exciting, creative, and it's always my privilege to witness.
Does it always happen? Do all of my patients achieve their goals? Yes, and no. Sometimes the journey never gets started, as there is no "click" between he or she and me. I have the experience to know that I can't get through to everyone. But all who show a real willingness and desire to change get somewhere. Those who are seeking transformation without any effort will have to look elsewhere.....Hey, I'm sure there's an article (or 10, or 1000) that has the "7 steps to effortless change."
All the best for 2018!
Stephen Stotland, Ph.D.
This blog presents some of our ideas about the key issues involved in achieving successful long-term weight control.