Solving the different behaviors that lead to obesity

All kinds of behaviors can have an effect on your weight, and the solution to each is different.

Maybe portion size is your biggest issue. Maybe it’s hard to get moving, even though you know you need to get some exercise. Maybe you have a sweet tooth that you can’t shake. Maybe you’re completely stressed out, and you never get a decent night’s sleep. Maybe you are a nighttime snacker. Or maybe it’s some combination of these.

How do you know which of these applies to you? Be honest with yourself. Check the ingredient list of everything you eat, and keep a log for a week. Can you actually say that there is very little sugar or virtually no corn syrup in your diet? It may be hard to believe, but it’s in yogurt, breads, ice cream, salad dressings, sodas and sports drinks, muffins, non-dairy coffee whiteners, and even some kinds of dark chocolate. If you’re doing a fairly good job avoiding it, then it’s not number one. But maybe it’s number two. I have no problem with a treat now and then, but I want to know when I choose it, and I don’t want to eat “hidden sugar.” It spikes your insulin levels, packs on the fat, and makes you crave more.

American portions are out of control, and not just yours. Bagels have tripled in size since the 1960s. There’s always room for dessert. You can get a bucket of soda for ten cents more, so why wouldn’t you? Just super size me, you know? But I don’t want people to feel hungry, or denied. Eating well and being satisfied are synonymous. Luckily, there are good solutions to hunger, and they are called fiber, fat, and protein. Fruits and vegetables and beans are delicious and filling. Fat is flavorful and satisfying. Protein keeps you going.

Exercising your right to free speech more than anything else? Getting exercise can be difficult, but it’s not impossible. First, remove as many obstacles as possible: Sleep in your T shirt and shorts, and put the gym shoes by your bed so you have to step over them to get up. Ride an exercise bike at home instead of having to drive to the gym. Commit to meet a friend and walk together, so you don’t keep one another waiting. Secondly, reward yourself, with a chart and gold stars if necessary, and then redeem those gold stars for something you’ve been dreaming about. Think about what it will take to get you moving, and do whatever it takes. Make it worth your while. If your knees bother you, then take a Tylenol beforehand. As I tell my patients, “I’ll pay any price to keep you mobile.”

On a scale of one (always relaxed and focused) to ten (frighteningly freaked out and finding it hard to think), how stressed out are you most of the time? Know that a very important part of being healthy is relaxation, in both daytime and nighttime. If you rate your stress level almost always as lower than four, keep up the good work, and continue to work on protecting your relaxation time. If it’s higher than four, you may find that walking helps, or meditation, or yoga, or talking about it with friends. If your stress level is higher than six, you may want to schedule an appointment to talk about it with your doctor. Your doctor should be able to refer you to a professional with expertise in stress management.

If you’re having difficulty sleeping, learn about “sleep hygiene” and see if you are doing something that is actually making it worse. Are you finding it hard to fall asleep because you can’t turn off your mind? Do you wake up in the early morning hours and have difficulty returning to sleep? Maybe you aren’t getting enough sleep, period. Any of these can derail weight loss efforts.

Have you been eating a big bowl of cereal before you go to bed? A peanut butter sandwich or a candy bar? That’s a problem. Start working on this issue by trying to eat a bigger breakfast and lunch, thereby getting in more calories earlier in the day. You may still want a nighttime snack, but it can be a healthier one. Eat berries, for example, which are sweet and satisfying, but low in practically everything else (except fiber).

See how these apply to you, and start thinking about the one that resonates most with you. One step at a time, one day at a time, one issue at a time. I don’t believe in quick fixes. I believe in slow, sustainable progress, so that someday you can say, “Wow, I really eat differently than I used to.”

Roxanne Sukol is an internal medicine physician who blogs at Your Health is on Your Plate.

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  • cmac611

    Kudos for emphasizing the ‘one step … slow sustainable progress …’ as there are no magic bulletts, no quick fixes!  Unfortunately our ‘sound bite’ society thinks a pill should fix their bad behavior. It just doesn’t (and will never) work that way.  First step is to look in the mirror (naked) and admit that ‘I did this to myself’, and only I can fix it.’

  • Tanya Gesek, PhD

    Psychologists are well trained and experienced to help with the many behavioral components of obesity!  Many people have flawed thinking when it comes to food and exercise.  There may be early life events that are creating challenges to lifestyle change and an expert like a psychologist is a great alternative to medications!  Unlike meds, the side effect of seeing a psychologist is a better life!

  • David Brown

    A pundit once observed, “We’re emotional creatures pretending to be rational.” In other words, how we feel is important; especially where weight control is concerned. A high-fat diet generally satisfies the appetite and when consumed with adequate supportive nutrition, promotes energetic feelings that make one more inclined to exercise. For example, in a 2002 LA Times article entitled “The Low-Fat-Free, Diet-Food-Free Diet” Emily Greene wrote, “I have long suspected that the best way to lose weight was to eat
    rich food in moderation, not diet food in abundance. During the last 52
    weeks, I put that idea to the test. And I lost 52 pounds. To my knowledge, not a single low-fat food passed my lips…”For me, the result of this diet was not simply weight loss, not
    simply fresh delight in rediscovering good, simple things; it was vigor.
    My eyes are brighter, my skin is better and–to the astonishment of my
    neighbors–I now bound out of the house in the morning wearing a
    sweatsuit. Which brings the story to the exercise part. I didn’t
    lose weight just by eating all this good stuff and tossing back Pinot
    Noir. I lost weight eating good, nourishing food that gave me energy to

    Sadly, for many years the incessant message has been to cut the fat (especially saturated fat) calories due to concerns about caloric density, cholesterol levels, and heart disease. This was a mistake. High-fat intake does not necessarily translate in to high caloric consumption when fat calories are consumed in the context of adequate supportive nutrition.  And high saturated fat intake does not translate into high triglycerides in the bloodstream.

    The fats you want to restrict are omega-6 industrial seed oils because they stimulate overeating behavior.

  • SchoolBoardLady

    Personally, I have never heard of a study that looks at 1. late maternal pregnancy1st child at age 32 or later and last child at 40 or older.  Menopause that follows that last child at 40, within 8-10 years. Huge weight gains during the late pregnancy of 50 lbs or more, followed by breast feeding and the appetite (satisfied by very healthy foods) that accompanies breast feeding for multiple pregnancies after age 32.  Peri-menopause immediately after completion of last breast feeding and all of the weight gain, hot flash, insomnia that results making energy to ‘exercise” truly at a low point.  Add to that, fibromyalgia, fallen arches, plantar fasciitis etc. that often accompanies menopause, especially now that women are scared to death to take hormone replacement therapy for fear of breast cancer and higher risk for heart disease (which was recently over turned by the study itself which focused on women over 60, not the women in the 50-55 group where menopause is the most intense and ‘damaging”.   Is there anyone looking at the metabolic syndrome and osteoporosis and even eventual cancer such as colon cancer, from the standpoint of the later pregnancy mothers?  A wholistic approach is necessary, even if such a study is ‘more difficult”.

    • SchoolBoardLady

      I describe the lack of recognition of the observations by many internal medicine physicians whose peri menopause and post menopause patients have been desperately trying to lose weight and it seems they are working against a new weight ‘set point” after their pregnancies.  Recently I read Leo Galland MD’s latest book, “FAT RESISTANCE DIET” which points to Leptin resistance (creating a ‘set point’)  which in my mind, links obesity, inflammation, osteoporosis (in heavy women), declining estrogen–no HRT, and metabolic syndrome–even cancer of the colon. Galland’s identification of inflammation as a precursor to cancer takes us full circle.  Again, a holistic approach is critical–helping to unravel the puzzle of seemingly unrelated (non-behavioral) factors.  A holistic approach would also force the ‘experts” to collaborate instead of expecting the lay person to unravel mountains of expert diet, medicine and exercise advice. Is there any wonder why we can’t budge obesity and its resulting diseases?

  • Seung Oh

    Great article!  I like the comprehensive approach to the problem.  It’s much more than “eat less and exercise more,” even though that’s the basics of it.  

    I think many people struggle with emotional eating, disturbed body image, and other eating disorders.  It really is a behavioral issue rather than medical… I see a lot of people struggle with their weight as a health coach and it’s definitely a mental struggle.  Thank you for the article, I am definitely sharing this one! 

  • Kristy Meyer

    I’d be interested to hear that the medical profession is starting to provide more resources for removing mental/emotional obstacles to change

    The hints you give at the beginning of your article are REALLY well-known ways to motivate oneself. But i think they are really for people who are already motivated to exercise and eat well. My sense (and experience) of obesity is the feeling of absolute resistance to making the change and a sense of helplessness at my inability to make ANY kind of change. It is not a matter of willpower or discipline…it’s often a matter of healing an emotional need to be fat.

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