Sue: Part 2

Sue has a very demanding job. She can’t predict when she’ll have time to eat or what food will be served. We talked about the necessity of always bringing a back-up meal with her on workdays, something that won’t spoil. If it turns out that the food that’s served is healthy, she can save the back-up food for another day.

I later emailed the following message to Sue: If packing food ever seems like a burden, realize that you’re not alone. Some people with metabolic problems have to do exactly the same thing because they have to eat certain categories of food and they have to eat regularly.

I also wrote: Do you think you could put packing a back-up meal in the same habit category as brushing your teeth or taking a shower? They are things you do daily, whether you feel like it or not. You don’t struggle with doing them because you’ve decided these habits are essential. You just do them. The sooner you put “packing a meal” in a “no choice” category, the less you’ll struggle and the more successful you’ll be.

Sue: Part 1

I started working with a new dieter today. Sue has already lost 50 pounds on her own. In fact, she has lost 50 pounds several times in her life—and always gained it back. She doesn’t want that to happen this time. She’s committed to learning the lifetime skills she’ll need so that this time, she can be successful.

Sue would like to lose more weight but understands that we won’t know what a reasonable maintenance weight will be until she gets there; that is, the weight she is when she’s eating a healthy diet she can sustain for life.

We haven’t talked much about what and when Sue eats. I don’t want to focus much on food until she’s learned the essential preliminary skills. It would be too hard to focus on learning these skills and changing what she eats at the same time.

Today we concentrated on the reasons Sue wants to lose weight. She’ll copy some reasons from The Beck Diet Solution and add as many more as she can think of. (She’s going to put the list in her iPhone.) I urged Sue  to turn a general reason such as “I’ll have more energy” into several specific reasons:

• “I’ll have more energy on the job”
• “I’ll have more energy to see my friends at night”
• “I’ll have more energy to enjoy bicycling on the weekend”

Since she’s already achieved a fantastic weight loss, she’ll also add to the list positive experiences she’s having day to day that relate to losing weight. For example, she told me she cried (for joy!) in the dressing room the other day when she was able to fit into size 10 pants. She’ll add every compliment she gets to the list, too.

We also developed a system for Sue to remember to read this list every morning and at her most difficult part of the day: 3 pm. Sue decided to set the alarm on her phone to alert her when it’s time to read the list. She said she was 100% sure she would follow through with these assignments—she didn’t think any “sabotaging thoughts” would get in the way (e.g., “I don’t have to read the list—I know what’s on it.”). Sue “gets” it. She may not need to constantly remind herself now why it’s so worth it to stick to her eating plan but she has to have these reasons firmly entrenched in her mind for the times when temptation is great.

I’m looking forward to more sessions with Sue!

Forget about Perfection

Many dieters have an interesting sabotaging thought: “Because I wasn’t perfect on my diet just now (i.e., because I just cheated), I may as well give up (and start again tomorrow).” It’s a cleverly hidden excuse.

Dieters who have read The Beck Diet Solution (or one of the other books) may also have a sabotaging thought about the program contained in it. “Since I’m not following the program perfectly, I may as well stop following it altogether.”

But these ideas really don’t make sense. After all, if you found you had made a mistake in balancing your checkbook, would you stop balancing it at all? If you forgot to call a family member on his birthday, would you not call at all? In what other context of life would you postpone or even abandon a goal that’s important to you, just because you made a mistake?

I think what’s really going on with dieters, when they eat something they shouldn’t, is the idea, “I don’t want to hold myself in check. I want to give myself permission to continue to eat.” After all, dieters know that there is a huge difference between eating an unplanned piece of cake (which is maybe 350 calories that won’t even show up on the scale in a few days) and eating the cake and ice cream and pretzels and chips and cookies—and anything else they desire—and starting again (at best) the next day. Just think, if every time in the past when you made a mistake, you limited it to one piece. You wouldn’t still be struggling with your weight after all these years.

And let’s say that you just don’t have the time right now to implement every step in the program. Isn’t it better to do as much as you can, rather than abandoning the program altogether?

One helpful way to respond to perfectionistic sabotaging thoughts is to think to yourself, “What would I tell my best friend if she were in this situation and had this thought?” I would bet that you’d be good at giving advice to her. Now you just need to give that same advice to yourself.

The “Right” Way to Weigh

People often ask me why I suggest that dieters (without eating disorders) weigh themselves daily, instead of weekly, monthly, or not at all. Here’s why:

 1. You need to be accountable. It’s too easy to let yourself stray from your plan if you know you won’t have to face the music right away. Many dieters have told me: “I think I would have cheated except I knew I had to weigh myself the next morning. It’s the only thing that stopped me.”

 2. You need to become desensitized to the number on the scale. It’s important for you to practice saying to yourself, day after day, “This number is just a piece of information, like my blood pressure or my temperature. It has nothing to do with who I am as a person.”

 3. You need to learn about weight variation. Many dieters think that they should lose at least a little weight every single day if they’ve been faithful to their eating plan. Here’s the truth: Your weight should NOT decrease every day. It’s biologically impossible. Even if you’ve taken in fewer calories than you expended, your weight may remain the same or go up due to hormones, lack of sleep, water retention, and so forth. You cannot lose weight every single day.

 4. You need to minimize discouragement. Let’s say you weigh yourself once a week. If your weight is up that one day (for one of the reasons listed above), you may want to quit because you assume it’s been up all week. “It’s not worth it!” a lot of dieters say. “Here I’ve been working so hard at sticking to my diet all week and the scale is up!” Weighing yourself daily—and especially graphing your weight changes– allows you to take the ups and downs in your stride.

Wait on Your Weight Goal

 

A new dieter, Alan, consulted me this week. He weighs 265 pounds and is 5’6”. He would like to weigh 100 pounds less. “It’s a mistake,” I told him, “to set a big goal like that. First, we really don’t know whether 165 pounds is a reasonable weight for you to get down to and maintain. Second, it’s too far away.” Alan immediately became discouraged and we had the following discussion (see pages 113-114 of the Beck Diet Solution).

 

Alan: But that was my weight 18 years ago. Why can’t I try for it again?”

 

Dr. Beck: Can I give you an analogy? You have a ten year old daughter, right? What if your daughter came to you and said, ‘Dad, I want to become a nationally ranked gymnast.’ Would you say, “Hey, that’s a great goal!”

 

Alan: No.

 

Dr. Beck: Why not?

 

Alan: Because I don’t think she has the genetics for it. She’s a big girl.

 

Dr. Beck: Any other reasons?

 

Alan: I wouldn’t want her to set her sights on something unreasonable and then feel badly when she couldn’t do it.

 

Dr. Beck: But what if she likes gymnastics? Do you think she shouldn’t pursue it at all?

 

Alan: No, but…..I guess I’d want her to just have fun doing it—and not try for something too hard.

 

Dr. Beck: Well, it’s the same with weight loss. I have no doubt that you can lose weight if you learn the skills you need, but I don’t know now how much weight you can lose. It’s not entirely under your control. I don’t know how big your natural appetite is, how fast your metabolism is, what your lifestyle is like, how much exercise you do consistently, what your favorite foods are, how much access you have to selecting your food, how much stress you’re under, how much time and energy you have for dieting, and so forth.

 

Alan: Oh.

 

Dr. Beck: You know, most people think, “I should just be able to set a weight loss goal and achieve it.” But like gymnastics, certain factors aren’t completely under people’s control. Now it’s possible that you can lose 100 pounds. It’s also possible that you could maintain your 100 pound weight loss. But to be honest with you, it’s not likely…..For one thing, you don’t have the same metabolism as you did 18 years ago….Now does that mean you shouldn’t try at all?

 

Alan: I guess not.

 

Dr. Beck: So are you willing to set a goal just to lose five pounds? When you do, you’ll celebrate and then you can see whether it’s reasonable to set a goal to lose another five pounds, and so on. How does that sound?

 

Alan: Okay, I guess.

 

Dr. Beck: I know, I know, it’s disappointing. I think the media usually makes it sound as if people can lose as much as they want, that they can override their biology. I can help people overcome their psychology, help them stick to an eating plan that’s reasonable for them, but biology is another matter. And I’d rather have you set your sights lower now, even if it’s disappointing, than have an unreasonable goal that you can’t achieve and get so disappointed later that you gain back whatever weight you lose.

 

Alan: Fair enough.

 

I hope this dose of realism doesn’t dissuade Alan from trying the cognitive behavioral approach. If it does, he may try another approach and end up back in my office within a year or two. Sometimes people just have to give other things a try before they’re ready to settle down and be realistic.

Reworking the Plan

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

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

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

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

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

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

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

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

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

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

Talk Back to Cravings

 

This past week, I met Jon socially, at a party. We had known each other slightly. He told me he had read my cognitive therapy books on dieting and wanted me to know which technique had helped him the most. It had been emailing his “diet buddy,” when he was tempted to eat something he wasn’t supposed to. With his permission, I cut and pasted below an old email he forwarded to me.

Okay, I really want to eat the pizza in the kitchen. Everyone (okay, not everyone) in the office is having some but I already had lunch. My sabotaging thoughts are back….It’ll be okay. I’ll make up for it later.
But I really know it’s NOT okay. Not if my goal is to lose weight. I don’t want to fall back in to the habit of eating extra food just because it’s there. It’s what I used to do.

Hey, it happened again. The craving went away as I was typing this email. I’m actually fine. I feel like…it’d be nice to eat the pizza. But I know I won’t. Back to work.

It was important for Jon to email his diet buddy like this. After doing so about ten times in a row (over the course of several days), he really learned that cravings do go away. He doesn’t have to eat. Now he doesn’t need to email his diet buddy very often, either. He knows that telling himself, “No choice. I’m not eating this [food] I hadn’t planned” and engaging in a compelling activity makes his cravings go away, every time.

Spring Holiday Eating

 

A number of dieters have come to see me in anticipation of the holidays. Here’s what I asked them:

 

When Passover or Easter is over, how do you want to feel about yourself?

 

Proud that you followed your holiday eating plan? Motivated and in control? Pleased with yourself?  Confident that you’ll return to your usual eating routine?

OR

 

Upset that you abandoned your plan, distressed that you gained a significant amount of weight, and unsure that you can get back on track? 

 

We then discussed, among other topics, four major strategies they could use to maximize the chance that they’ll feel good when the holiday is over. Here’s what I told them.

 

(1) Develop a reasonable holiday eating plan. 

 

For example, if you celebrate Easter, you might decide to follow your usual plan but add a specific amount of extra calories for chocolate eggs on several days during the holiday. Or follow your regular plan but allow yourself to eat 500 extra calories during your big family dinner. Your weight loss will slow (unless you’re exercising more) or you may gain a little weight, but so what? You may be able to stick to your regular eating plan better if you know you can splurge a little.

 

Passover is more difficult, especially if you follow the holiday dietary laws for eight days and have large ritualistic meals. Again, the most important guideline is to figure out in advance what variation of your usual eating plan is reasonable. Trying to stick to your usual plan for every meal is probably unrealistic.

 

(2) Continue your good eating habits

 

Even if you’re rushed and life is frenetic, take the time to eat ALL your food sitting down and slowly, while enjoying every bite. Plan your day so you have enough time to do so. Drink a glass of water before you eat and take a few deep breaths to calm down so you can fully enjoy what you’re eating.

 

(3) Watch out for too much or too little entitlement

A key sabotaging thought is: “It’s a holiday. I deserve to eat whatever I want.” Face the fact that you have a choice. You can eat whatever you want and feel badly about the consequences OR you can stick to your holiday eating plan and feel good about the consequences.

 

Another key sabotaging thought is: “I have so much to do. I don’t have time to….exercise, sit down to eat, prepare the food on my plan, read my Advantages Cards and Response Cards.” You need to build a sense of entitlement: “I deserve to take the time I need for my important goal of healthy eating, even if other people are momentarily displeased or inconvenienced.”

 

(4) Get right back on track when you make a mistake

 

It may be unrealistic to think that you won’t slip up at all during the holidays, especially if your new ways of thinking and your new behaviors aren’t firmly in place. If you eat something you hadn’t planned, tell yourself, “Big deal. I made a mistake. I’m only human. But I’m not going to fall into my old habit of waiting until tomorrow to start again because that has NEVER worked to my advantage in the past. I’m going to get away from food and distract myself in a compelling way until the urge to keep eating goes away.”

What a Relief

When Mark sat down in my office this week, he said, “Before we start, can I just tell you how relieved I feel?” When I said, “Of course,” Mark told me:

“I finally get it. I do. Cravings go away. I don’t have to eat to make them go away. When I’m tempted, the more I say, ‘Don’t worry, you’re going to eat again at ______ o’clock, the easier and easier it gets.’ ”

I asked Mark to give me an example.

“It happened again late yesterday afternoon. A vendor brought some cookies—really big ones—to the office. I really started craving one but I said to myself, ‘No, you’ve already had your snack and you’re going to have dinner at 6:30. So no choice. Get back to work.’ I had to make a phone call and by the time it was over, the craving was gone. It was like, “Well, it’d be nice to have a cookie but I know I’m not going to have it.” I can’t tell you what a relief it is to know that I can make a craving go away, that I don’t have to give in to it. I know, I know, you’ve been telling me this all along but somehow it really clicked yesterday.”

 I asked Mark if we should write something about this on a Response Card that he could read regularly to really cement the idea in his mind. This is what he wrote:

Cravings really do go away. I don’t have to be at their mercy any more. Remember the March 30th cookie situation. When I finished the phone call, the craving had gone away.

 Mark is typical of the dieters with whom I work. It makes sense to them intellectually that cravings go away, especially when they turn their attention to something else, but they don’t really believe it in their gut—not until they’ve had repeated experiences of finding this out for themselves. And when they do, like Mark, they tend to experience a profound sense of relief.

BACK TO BASICS

 

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

 

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

 

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

 

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

 

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

 

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