Sue: Part 11

Sue has been weighing herself daily and graphing her weight loss. She has now proven to herself several times that the number on the scale goes down some days, stays the same some days, and goes up some days—even when her energy input and output is the same! Nevertheless, she continues to be disappointed, and a little worried, when her weight is up, even by only a pound. I had her compose two Response Cards. She’ll choose which one to read before her daily weigh-in.

If I’ve Been Following My Plan It will be nice if my weight is down today but it’s fine if it’s up. Look where I am today compared to where I started! If it’s up, it doesn’t necessarily mean I did anything wrong and if I keep following my plan, it will come down again, until I hit maintenance. History has shown me that the number definitely goes up and down. I don’t need to worry unless my weight goes up and continues to go up for several days in a row. If I Haven’t Been Following My Plan Okay, my weight will probably be up today and I will probably feel disappointed. I need to make this an “Oh, well,” experience. “Oh, well, I don’t like the fact that my weight is up but I need to accept it—without criticizing myself—and get problem-solving oriented.” It’s impossible to lose weight without making some mistakes along the way. Let me figure out what led to my going off plan—especially the sabotaging thoughts that got in the way—so I can avoid the situation in the future. If I get right back on track now, following my eating plan and using all my Beck Diet Solution skills, I’ll lose weight again. If I use this weight gain as an excuse to give up, I may never achieve the advantages of weight loss—feeling better, being healthier, etc. (Now go read my list of reasons to lose weight and ask myself how important each one is to me.)

Sue: Part 10, The Tyranny of the Scale

Sue has been weighing herself once a week. She was confused and disheartened that her weight had gone up a little this week. After all, she told me, she had stuck to her plan and, on top of that, had done considerably more exercise than usual.

I asked Sue if this was a typical reaction for her—feeling disappointed when the scale didn’t go down as expected. She acknowledged that yes, this was a long-term problem. She also told me that in the past, if she expected the scale to show a higher weight (because she had eaten more than planned), she often avoided the scale altogether. The scale avoidance had often led to her gaining a LOT of weight because she didn’t have to face the consequences of abandoning her eating plan.

I told Sue that I thought she suffered from “tyranny of the scale,” that is, her mood was way too dependent on the number it registered. I told her it was difficult to get over the problem unless she started weighing herself every day. In fact, I told her, I not only wanted her to weigh herself, but I also wanted her to start graphing her weight.

Sue needs to see, over and over and over again, that daily fluctuations in weight are NORMAL. She had thought that the scale should go down every day or every week as long as she was sticking to her plan. She didn’t know that the scale is supposed to register a higher weight some days. It doesn’t mean she’s become fatter. If she’s stuck to her diet and exercise programs, it means she retained water, had some hormonal changes, ate saltier foods, ate later than  usual the evening  before, or experienced some other normal physiological change that we couldn’t identify. In fact, I told her, “Don’t look for why your weight is higher on any given day—unless you didn’t stick to your eating plan. Just assume it’s a normal fluctuation and that the scale will come down again within a few days.”

I told Sue that if she’s only weighing herself, without making a graph, it’s more difficult to prove to herself that daily fluctuations are normal—and that if the scale goes up or stays the same, it will come down soon. But this is crucial! It’s also hard to prove to yourself if you’re only weighing and graphing once a week. That’s why it’s worth the effort to weigh yourself daily. After 15 or 20 episodes of seeing the fluctuations, you won’t worry any more. You’ll know the ups and downs are normal and you’ll get over your fear of the scale.

Sue: Part 9, Self-Criticism

Today Sue and I touched on the topic of self-criticism again. She was able to see how “beating herself up” every time she made a mistake undercut her motivation and her sense of self-efficacy. We reiterated how important it is to become problem-solving oriented, instead. “Okay, I made a mistake. What can I learn from this for next time?” Unfortunately, Sue is not only critical of her eating, she’s generally highly critical of herself, in her work, at home, socially, and so on. Her standards for herself are just too high. Fortunately, though,  she doesn’t have the idea, “I have to be self-critical or I’ll let myself go.” (If she did, we’d have her try some experiments to see if that belief were true.)

For this week, Sue’s going to make a concerted effort to note her self-critical thoughts about her eating, her body, and exercise. That’s the first step. The next step will be learning how to respond to herself in a compassionate, problem-solving way. And we’ll continue to work together so she can learn how to set reasonable standards for herself.

Sue: Part 8

Sue is doing so well, but I wanted to prepare her for making mistakes.  We reviewed the concept that mistakes are normal, and that everyone makes mistakes from time to time.  While it’s impossible to avoid mistakes altogether, I explained to Sue that what she tells herself about her mistakes is crucial to success.

I explained to Sue that if she says to herself, “This is terrible. I can’t believe I ate that. I’m so weak. I thought I could do this [stick to a diet] but I can’t,”  she’ll feel demoralized and helpless and she’ll  be likely to abandon  her efforts. But if  she says, “Big deal, I’m human, I made a mistake, I’m going to get back on track this minute, and I’m going to give myself a LOT of credit for getting back on track,” she’ll  quickly recover and it will be NO BIG DEAL. Everyone makes mistakes, whether it’s ruining a nail you’re polishing or deviating from your eating plan. I helped Sue develop the attitude:  “I can recover from mistakes—AND LEARN FROM THEM.”

Sue: Part 7, Fear of Losing Control

Sue is still afraid that if she eats something wrong, she’ll lose control and not be able to get back in control. We had the following discussion:

Sue: I’m just afraid that one false step will be the beginning of the end.

Dr. Beck: How many times in the past few months have you taken a false step?

Sue: A fair number, I guess.

Dr. Beck: And how many times did you start on the path of serious weight gain?

Sue: Never.

Dr. Beck: And why is that?

Sue: Well, it’s because I’m learning to see something as an isolated mistake. I’m learning how to get back on track right away. I’m still motivating myself by reading my list of reasons to lose weight. And other stuff.

Dr. Beck: That’s exactly right. It’s because you now know exactly what to do when you stray, and you know how to get yourself to do it.

Sue and I agreed that she needed to keep track of all the instances in which making one mistake did NOT lead to her losing control. We also agreed that this month, Sue would reread The Beck Diet Solution. She plans to take notes in the margins about what she can do if there ever does come a time when she starts to gain weight back.

This exercise will serve as a good reminder for Sue that all the skills she needs to stay on track are there in black and white, for her whole life. I think this will also provide her with a good measure of relief.

Sue: Part 6, Perseverance

Sue and I were talking about times in the past when she had started to gain weight. It appeared as though each time started with a small weight gain; then she started thinking that dieting was too hard, then she abandoned her plan.

I wanted to prepare Sue in case this same kind of thing happens in the future. I asked her whether there was anything else in her life that had been very difficult, but that she had managed to push through anyway. She gave me a perfect analogy:

Sue explained that several years ago she was headed toward being a professional singer. But she had a teacher who taught her incorrectly, and Sue actually damaged her vocal cords. Singing became very difficult and she thought about abandoning it. But she didn’t. She persevered. Eventually she found a really good teacher, who taught her very important lessons. Sue returned to practicing very hard, and was able to achieve a good measure of success as a singer.

Now Sue is going to create a Response Card to remind herself that she had the necessary perseverance and the right tools to reach her goal of becoming a singer—and this same perseverance, coupled with the tools she was learning from The Beck Diet Solution, will allow her to reach her goal of maintaining her weight loss.

Sue: Part 5

I told Sue that it was great that she has become so much more aware of when she’s tempted to eat standing up. For example, this past week, unprompted by me, Sue made the decision not to eat at her kitchen counter. She has decided for this coming week to eat everything sitting down this week. I offered to have her email me if she does eat standing up, because this may help motivate her: “I don’t feel like sitting down but I’m going to because I don’t want to have to email Judy and tell her I ate standing up”. We decided the one exception will be this weekend when she’s making (healthy) pizza with a friend. But if she finds she’s not enjoying every bite, she’ll sit down. If she makes a mistake, she’ll tell herself, “Okay, I’m just learning this. I forgot this time; it’s okay.”

Sue: Part 4

Sue is getting good at giving herself credit—saying “That’s good!” every time she reads her list of advantages of weight loss, every time she stops herself from eating while standing, every time she chooses healthy food to eat, every time she packs food to go (as a backup), and every time she withstands temptation. She especially gave herself credit for ordering a very healthy vegetarian meal which she said she would have “gagged on” a year ago, once for ordering the dish and once for successfully changing her tastes!

Sue: Part 3

Sue did a great job of reading her list of reasons to lose weight twice a day, every day this week. Doing so really prepared her for the tempting French fries on a communal serving plate at lunch with her coworkers. When everyone but her temporarily left the table, Sue said to herself, “I want to have thinner legs!” and she covered the fries with a napkin, so she wouldn’t have to look at them. Had she not been reading the advantages of losing weight regularly, she may not have been motivated to forego the fries.

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.