by Stephen Sinatra, M.D.
Psychological Aspects of Losing Weight
 Whether you want to shed 15 pounds or
215 pounds, if you want to be successful
at long-term weight loss, you must
examine your attitudes, beliefs and behaviors
around food. Otherwise it is almost guaranteed
that you will backslide into old eating
patterns at the first sign of emotional stress.
Theoretically, losing weight is one of
the easiest things to do—you simply
expend more energy (measured in
calories) than you take in. But as you
probably know from experience, the
process is not that straightforward
in practice.
This was evident when
I directed the Optifast
program, an intensive,
hospital-based regimen
where patients dieted for 16
weeks on shakes prepared
under strict medical supervision.
What other medical
personnel and I observed was
that the leading root causes of
weight gain are a lack of discipline
and a lack of support.
No Support System
The combination of poor discipline and
inadequate support is a disastrous one for
weight loss. By support I mean that
coworkers, friends and family help reinforce
you in the process of weight loss or whatever
personal goal you are trying to reach.
Sadly, many overweight individuals lack
support, often from the time they were
children. They usually come from families
where achieving was more important than being
and where there was little acceptance of the children
as they were. Their parents let them know in
one way or another that they didn’t measure up.
But the truth is that too much pressure, for adults or
children, only tempts people to rebel or to loathe their
shortcomings, and consequently themselves. What they
need more than anything is acceptance and encouragement.
The supportive atmosphere among the
participants of the Optifast program, for
example, was a big factor in their individual
successes. The group met once
a week but members would also call
one another when in danger of “slipping”
and get encouragement to
make healthier choices. By contrast, if
a woman cooks for a family and family members put their
desires for unhealthy foods over her needs, then it is almost
impossible for her to lose weight.
Of course we all need to support ourselves from within, too,
and have the courage of our convictions in interactions with
others. But some people back away from such confrontations,
externally acquiescing to everyone else’s wants and needs while
padding themselves with fat rather than dealing with their
anger at their own self-betrayal.
Stuffing Emotions
For people who are chronically overweight, food becomes a
vehicle with which to block uncomfortable emotions—
usually anger, fear, shame, frustration, guilt, loneliness and
sadness. In their book Overcoming Overeating (Random
House, 1998), Jane Hirschmann and Carol Munter distinguish
between “stomach hunger” (when you eat to fill your
body because your stomach is empty) and “mouth hunger”
(when you are reaching for something to put in your mouth
because you are experiencing a difficult emotion).
People who eat from stomach hunger have a healthy
relationship with food, whereas those eating from mouth
hunger do not. Some of you may find yourself doing
both at different times but it is an important detail to acknowledge.
For many of us it is hard to take in love but easy to take
in food. So in a cruel irony, we can be physically full, yet emotionally
starved. The fact that obesity is rising in the United
States means that we all must have something in common
when it comes to abusing food . . . and yes, that is a strong
statement but I believe many of us do abuse food.
Get a Handle on What’s Eating You
To help understand what role emotions play in my patients’
eating patterns, I have them ask themselves some tough questions
(see the sidebar “Are You Eating Your Way Out of
Emotions?”). Try it yourself. Any “yes” response indicates a
situation where you are eating out of mouth hunger.
If so, then you need to take an honest look at your
relationship with food. To help uncover your own unconscious
drives I suggest writing out answers to the following questions:
- Am I able to take in love from my partner? My children? Family? Friends? Or do I keep certain thoughts and feelings to myself to avoid possible rejection?
- When in pain, do I turn toward loved ones for support or do I push them away and isolate myself? Why do I react this way?
- Am I getting something out of being overweight? Does it get me off the hook for sexual intimacy? Is it an excuse not to be more active? Does it get me help and sympathy from others?
If you have identified that emotions are ruling your eating,
then you can start to change the way you think. For example,
are you a card-carrying member of the “Clean Plate Club”?
Many of us are. It may have started in childhood, when you were
pushed to clean your plate out of guilt for the “starving children.” If you
still feel that it is somehow wrong to leave food, even if your body signals
that it is full, then this unconscious belief is probably part of what
is driving you. Bring it to consciousness and you are then free to choose
whether to clean your plate.
Are you eating your way out of emotions?
Any “yes” response to the questions below is a clue that you eat to deal with problematic emotions—at least sometimes.
- Have I ever found myself looking for something to eat within an hour or two of eating?
- Do I sometimes overeat?
- Do I feel guilty or have thoughts of self recrimination after eating?
- Do I overeat to “treat” myself after a long, hard day?
- Do I feel less anxious after eating?
- Do I rush through meals, not even tasting the food?
- Do I need to have large helpings of food to feel full?
- When I dine with loved ones, am I more concerned about the food than the company and surroundings?
- Is food replacing something that is missing in my life?
- Do I make excuses for being overweight?
- Do I know that I will feel better (calmer, more relaxed, more energetic) after I eat?
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This is what needs to be done at every turn. Especially when you get
the urge to dig into your favorite comfort food. Stop and ask yourself
what is really going on. Writing about it for a minute or two is even better.
If you keep a journal like this for a few weeks, patterns will start to
emerge and I think you will be happily surprised at the insights you gain.
Nuts and Bolts of Losing Weight
Today we have more fad diets, diet pills and low-fat foods on the
market than ever before and yet we also have more obesity and
obesity related illnesses than in decades past.
The only way you can lose weight is to combine increased
physical activity with healthy eating. The goal is to gradually and
consistently lose because if you lose any more than one to two pounds a
week, your body will be shedding lean muscle mass rather than fat and
that is not good at all.
In fact, the more lean muscle mass you lose, the more your basal
metabolic rate (BMR) drops, which means your body becomes
better and better at existing on very little food. (BMR is a measure of the
body’s ability to burn calories at rest—sleeping, reading a book, watching
television, etc.) This is what happens to most dieters who achieve
their goal weight very rapidly and it is why so many are unsuccessful at
maintaining their weight loss.
Haul Your BMR Out of the Basement
Those of us over age 40 are also familiar with steep declines in
BMR. Part of it is just the aging process but the vast majority of
people in this culture also tend to be more sedentary as they
age and all that uninterrupted sitting around really sends BMR
into the basement. Hormonal imbalances can also play a role
and they result from a variety of factors, from thyroid dysfunction
to drug side effects to excess carbohydrate intake.
Therefore, if you are serious about weight loss, you need to
look for every opportunity to increase BMR. Exercise is going to
give you the biggest most noticeable payoff. There is just no
getting around it, so you might as well find activities you like
to do. As you probably know, I am a big advocate of walking,
combined with a little weight lifting and regular stressreducing
activities such as yoga, t’ai chi or qigong. But that
may not fit with your lifestyle. Maybe you would rather work
out to an exercise tape and then garden when the weather
permits. Or perhaps you like to take classes at a gym.
Whatever you prefer, schedule at least some of your sessions
for the morning because research shows that individuals who
exercise early in the day are much more apt to stick with it.
That is not surprising. The later in the day your workout is,
the greater the possibility that life’s events will intervene.
Mountain Climbing
as an analogy for weight loss
Which is more difficult—ascending a mountain or
descending it? If you have climbed mountains or read stories
about people who have, you know that more climbers die
on the descent than the climb. So often, in both mountaineering
and life, we view reaching the summit as the victory
but it really is not. It is only half the story. Experienced
mountaineers know this and that is why they do not celebrate
until they return to base camp.
Losing weight is similar in that attaining your goal
weight is the mid-point. Maintaining this ideal weight is the
part of the story we often do not hear about, partly because
so few are successful at it. What I would like you to consider
as you embark on your weight loss journey is the second
half of the story.
Keeping your sights set on maintaining a certain weight
and level of fitness, rather than on simply reaching a target
weight, will change your perspective. So instead of focusing
on how to get down to a certain clothing size as fast as possible,
you will be more concerned with what enduring
lifestyle changes you can make. It is the difference, for example,
between telling yourself you will give up white bread
with every meal just until you reach your goal and finally
deciding to make more nutritious carbohydrate choices
from here on out. |
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