Change Your Ways Change Your Weight

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It never fails. Every Friday, Ginny plans a million different activities over the weekend--everything from giving herself a pedicure to checking out the local craft shop. Yet by 3:00 or 4:00 on Saturday afternoon, she always finds herself alone and totally bored and ends up spending what's left of the weekend overeating.

Ellen has had another phone fight with her mom, over yet another trivial issue. And, as usual, Ellen ends the conversation by slamming down the receiver and heading straight for that carton of almond fudge ice cream stashed in the fridge.

Bob wants very much to lose 45 pounds. He'd also like to meet a nice woman and get married. But right now he believes that no woman could possibly like him looking the way he does. So, even though his doctor put him on a low-fat diet and even though he just bought himself a rowing machine, Bob's going out tonight with his buddies for some pepperoni pizza and three or four beers.

These folks aren't doing anything evil or criminal. But what is criminal is the way they've fallen into the habit of mindlessly doing what they've always done, month after month, year after year and, in the process, blocking any chance of getting and staying slim. Food has become an all-purpose pill to help them through life's ups and downs--the fatigue and the boredom, the loneliness and the anxiety, the anger and even the joy. Half the time, they don't even realize how much or what they're eating!

Sound familiar?

What all of them (and perhaps you?) could use is a hearty dose of behavior modification. If that seems like a scary concept, it isn't, really. All it means is modifying your behavior, making an adjustment in the often-unconscious habits that have kept your weight at its current level. And we can help! Our triple-A program involves three keys to positive behavior change.

* Awareness

* Attitude

* Action

Cure Those Cravings! You're walking along, minding your own business, when out of the distance it appears, golden and sparkling in the sun: the bakery. And suddenly you tell yourself that you'll die if you don't go in and buy one or two of those sticky buns right now. Before you know it, an empty bakery bag is in your hand, and the buns are down the hatch. It doesn't have to be that way. Cravings can be cured, insists Laura Stein, author of The Bloomingdale's Eat* Healthy Diet. Stein has taught behavior modification in her EAT (Effective Appetite Training) Healthy workshops in New York City. "What you want to do," she explains, "is to break up your automatic response to a food craving." She suggests that you ask yourself four key questions before you go ahead and eat that unplanned-for food. 1. Am I really hungry? 2. Did something just happen to trigger that craving? 3. Would something else, something less fattening perhaps, satisfy me just as well? 4. What do I care about more--the food or having a slimmer, healthier body? After you have answered all four questions and you're still craving that tempting hot dog or candy bar, delay the action a bit longer by telling yourself: * First I'll try an alternative activity from my list. * I can always eat that food later. (And with any luck you'll forget about it or won't want it then.) * I'll eat it after I exercise today. The goal, she explains, is not to forbid yourself from ever eating the things you want, but to make certain that you want to eat when and what you think you do. "Choose your food. Don't let the food choose you," she urges. Perhaps her best advice of all, though, is to gradually wean yourself off those no-no foods that are interfering with your weight-loss plans. "You don't crave what you don't eat," she insists.

Opening Up Your Awareness

Simply being conscious of your behavior is an important first step. Here are some keys to paying attention to the things you eat and do that have an impact on your weight.

Open your eyes to your eating. You can't change your poor habits if you're not even aware of what they are. But, says Dean Ornish, M.D., head of the Preventive Medicine Research Institute in Sausalito, California, "when you learn to eat with awareness, you'll find you won't need the excessive amounts of food that can lead to overweight. Even the tiniest amounts become pleasurable--one teaspoon of a rich, chocolate dessert you really focus on can actually be more satisfying than a whole bowl of something you've mindlessly downed while watching TV. Whether it's a spoonful or a bowlful or a half gallon, at some point you finally have enough, and when you pay attention to what you're eating, that point comes much sooner."

"To change unwanted behavior, you must first observe it," says Laura Stein, author of The Bloomingdale's Eat* Healthy Diet. Stein has taught behavior modification in her EAT (Effective Appetite Training) Healthy workshops in New York City.

Pay special attention to your feelings. If you've ever tried to drown your sorrow in a bag of cookies or a bowl of ravioli, you know that overeating is ultimately an ineffective way to handle unpleasant feelings. "Many people use food as a way to cope with the loneliness and pain they feel--in a way, the fat 'coats' their nerves and numbs the pain," says Dr. Ornish. Yet you know what always happens: As soon as the food's gone, the problems--along with a few additional pounds around your middle--return.

Dr. Ornish has a better solution: meditation. "If you can quiet down your mind," he says, "you can experience a greater sense of inner peace and well-being. Meditation is really the art of paying attention, and when you pay more attention to your eating behaviors, many good things start to happen." Such as losing the urge to overeat and becoming increasingly aware of how what you're eating affects you, for better or worse.

Says Dr. Ornish: "When you really pay attention to how your body is reacting after having a steak or a cheeseburger, you might find that you're feeling sleepy and sluggish, and that your thinking is fuzzy. Once you cut the fat from your diet, though, you'll probably feel so much better right away that the wise food choices will seem obvious to you."

If you're a frequent victim of the oh-my-God-did-I-really-eat-that? syndrome, you might want to tune into your feelings more by giving meditation a whirl. Inexpensive classes are available around the country; check with your local Y or university extension program.

Write on. Another way to start developing your eating awareness is by filling in and regularly reviewing "Your Perfect Weight Success Diary," on page 275.

"Write down any unplanned eating and the circumstances under which it occurred," urges Ronette Kolotkin, Ph.D., director of the behavioral program at the Duke University Diet and Fitness Center in Durham, North Carolina, and co-author of The Duke University Medical Center Book of Diet and Fitness. Review your notes so you can start anticipating food triggers and plan smarter ways to deal with them. "Our research at Duke and other research have shown that writing down what you eat is helpful to weight loss," says Dr. Kolotkin.

Hold that thought! Another aspect of awareness means recognizing your impulses--and deliberately not acting on them. "Just because something is in your mind doesn't mean you have to do it," notes Howard Rankin, Ph.D., a psychologist and clinical director at the Hilton Head Health Institute in South Carolina. "It's a powerful notion, that you have the ability to make a decision about how you'll manage an idea. It's impulse control, and eating is a good example of it. Some people always say to themselves, 'When cheesecake is in front of me, it's inevitable that I'll eat it. I want to eat it, I deserve it, and I'll start my diet again tomorrow.' But if you keep thinking that way for five or ten years, you're not likely to lose weight."

So, how do you break the pattern? The answer, again, is through awareness. "You must become very aware--as most people are not--of the long-term consequences of your behavior," says Dr. Rankin. Eat that cheesecake every time the spirit moves you, and it's only a matter of time before your stomach will start to feel like a big, squishy cheesecake. Take your mind off your cravings with some diversionary tactics. (See "20 Alternatives to Eating," on the opposite page, and "Cure Those Cravings!" on page 91.) And practice saying no to yourself a bit more often. "At some point, it's critical to get tough with yourself if you want to see results," says registered dietitian Judy E. Marshel, director of Health Resources of Great Neck, New York.

20 Alternatives to Eating You're bored. You eat. You're depressed. You eat. You're stressed out from your job. You eat. What's wrong here? Nothing, if you like looking at that expando version of yourself in the mirror. If you want to see your slim, trim self, however, this kind of behavior has to stop. "Most people don't think about managing their eating behavior as they manage other things in their life. But you need to apply the same principles so you can be prepared for those specific situations that cause problems for you," explains Howard Rankin, Ph.D., a psychologist and clinical director at the Hilton Head Health Institute in South Carolina. Let's say the coffee-and-doughnut wagon at work seems to call out your name every afternoon at 3:00--and you're trying to lose 25 pounds. So, how 'bout dipping into your list of alternative activities instead of diving headfirst into a jelly doughnut? What list of alternative activities? This list, the one you should always have nearby at times like these. Add any other suggestions you think will work for you. AT HOME 1. Drink a glass of water or two. 2. Brush your teeth and/or gargle with mouthwash. (People report that this kills cravings.) 3. Take a walk. 4. Take a nap. 5. Take a bath. 6. Call or write the person who's making you angry. 7. Go to a movie (but bypass the candy counter!). 8. Buy yourself a nonedible gift for under ten dollars. 9. Have sex. 10. Snack on something with zero or little fat, such as an apple, a rice cake, a carrot. AT WORK 11. Call a friend. 12. Meditate. 13. Have a piece of fruit at your desk. 14. Leave the building for ten minutes. 15. Play with your computer. 16. Catch up on office gossip with a co-worker. 17. Have a drink from the water cooler. 18. Go to the restroom and splash cool water on your face. 19. Check your appointment book next week. 20. Walk up a few flights of stairs.

Adjusting Your Attitude

Simply paying better attention is not enough, however. You have to want to make positive changes in your behavior.

Forget about "dieting." Changing your bad eating habits is essential to weight loss and maintenance, to be sure. But, says Dr. Kolotkin, "attitude modification is actually more important than behavior modification."

What does she mean? "Most people develop a diet mentality," says Dr. Kolotkin. "They look at what they're doing as a weight-loss program, but they're missing the big picture--that this is a lifestyle-change program forever. It's not just a matter of doing certain things until you lose weight, but rather examining how the way you live your life contributes to your weight. Take a broad view. Don't think of what you're doing as simply dieting, with the typical all-or-nothing perfectionist attitude, because that usually leads to weight yo-yo-ing. The fact is, you won't be perfect--you will overeat and you won't exercise sometimes. What you need is to develop strategies to pick yourself up, to learn how to forgive yourself and keep going."

Stein stresses a similar principle: to think in terms of changing your diet, not dieting. "There's a big difference between the two," she says. "When you change your diet, you focus on progress, not on perfection, the way people do when they're dieting. And when you think in terms of changing your diet, you can view an eating setback as a learning experience. You'll say, 'Why did I have all that pie at my mother's house? How can I avoid doing that the next time I visit her?' instead of saying, 'I've blown it!'--and maybe compounding the problem by eating some more."

Firm up with affirmations. "We believe what we tell ourselves," says Stein. Therefore, the more positive messages you send to yourself, the more you'll want to do what's needed to slim down. Each day, she suggests, write or say aloud these kinds of affirmations.

* I'm losing weight now.

* I'm enjoying how I'm feeling now.

* I love the food that makes me thin.

* I love the feeling of making progress.

* Losing weight is effortless.

* I'm making things easy for myself now.

* My body is getting stronger, slimmer and healthier every day.

It's important, she adds, that all your affirmations be in the present tense to give them a greater sense of power and immediacy. Talk about the ways you hope to be and feel in the future and you'll be less apt to take action today.

Oh, grow up! Think about the way you've dealt with your dieting self in the past. Chances are you've assumed the role of strict parent, telling the little boy or little girl in you, "No! You can't have that!"

"That's how people have typically dieted--'Mustn't eat that chocolate! Bad! Bad!'" says Dr. Rankin. "But after a few hours or days or, if you're particularly strong-willed, after a few weeks, the child in you rebels and says, 'So, I can't have that candy bar? We'll see!' And then you have three." However, Dr. Rankin says that changing behavior should be viewed as a choice.

"You're responsible for your own behavior," he asserts. "Adults have to realize that every action has a price and a payoff--every action, whether it's eating three candy bars now or eating 1,200 calories a day and exercising five times a week. Act from a position of choice, as opposed to feeling like the parent of an unruly child."

Be a buddy to yourself. "The bottom line is liking yourself--that's a powerful motivator," says Marshel.

Similarly, Stein has taught her workshop clients to assimilate this powerful message: "No matter how I feel, I always treat myself well."

Bad moods and bad days will come and go--that's the reality of life. You'll always have challenges to face, even after you're thin! But once you make the commitment to be your own best friend and treat yourself accordingly, you'll eventually stop looking to food to solve your problems.

Don't Leave Home without It It's so easy to skip breakfast--grab a cup of coffee and your car keys and zip out the door. That should save you about 350 calories. Right? Wrong! "Eat a good breakfast," Mom always said. Turns out she was right, especially if you want to lose weight. At least that's the picture that emerged from a study on the role of breakfast in successful weight loss conducted at Vanderbilt University in Nashville, Tennesee. Researchers placed 52 moderately obese women on a 12-week diet, in which some ate three meals a day including breakfast while others passed up their morning meal. The women who ate breakfast tended to snack less during the day on high-fat, high-calorie goodies. In other words, they were less inclined to cheat on their diets. The moral of the story? Get out that cereal bowl and dig in!

Taking Appropriate Action

"You can analyze your weight problem forever, but unless you take action, forget it. Action is critical," says Marshel. "And, your overall goal should be to learn to act and not react, so that you come from a positive place."

What that means is getting in the driver's seat of your own life. It means planning for daily success and therefore minimizing your chances for failure.

Every day you're going to plan on having three low-fat meals, with a healthy snack or two if you want them, and that you'll do some form of pleasant exercise. Whatever surprises crop up, you'll plan on dealing with them, too. So whether it's a sick baby or a less-than-glowing report from your boss or a fender-bender or a check that's lost in the mail, you do not spell relief F-O-O-D. You now have a program for weight-loss success, and this time you're going to see it through.

Make a contract with yourself. Perhaps you work for a company that rewards you for achieving your six-month or yearly goals. You can successfully apply the same principle to your weight-loss goals. Decide--on paper--what you hope to achieve and when, giving yourself small but meaningful rewards as you reach each minigoal.

"Contracts should be short-term, and should focus on increasing healthful behaviors associated with weight loss, rather than on weight loss itself," say John P. Foreyt, Ph.D., and G. Kent Goodrich, Ph.D., weight-loss experts at Baylor College of Medicine, Houston, Texas, who have studied the effectiveness of various behavior-modification techniques on dieters.

Marshel agrees. "I focus on self-care goals, not weight-loss goals, with my clients," she says. "So if, for example, part of someone's contract is to exercise three times a week and he does it, then he might reward himself by going to the movies on Sunday afternoon."

Why avoid establishing weight goals when, after all, you're trying to lose weight? "Because weight-loss goals are difficult to control and predict," she points out. "And anyway, weight loss is simply a by-product of other positive changes you make. In the long run, it's not the exact number of pounds that counts as much as making adjustments in your behavior and attitude. If you make consistent changes and meet your self-care goals, you will inevitably experience weight loss."

Get the lowdown on high-risk situations. "Different people have different vulnerabilities," notes Joyce D. Nash, Ph.D., a clinical psychologist specializing in weight control and author of Now That You've Lost It: How to Maintain Your Best Weight. You might, for instance, do fine at an ice-cream stand but lose all control at a buffet table. Someone else might handle buffets like a pro but go to pieces at the sight of Reese's Pieces.

"Ask yourself what your high-risk situations are," suggests Dr. Nash. "Is it going out with friends? When you're feeling down and sorry for yourself? When you're in a bakery? Do a personal analysis. Once you know your eating triggers, you can focus your efforts and determine which strategies you can use to cope better."

For some people, this might mean not eating at restaurants, or at least not until they have had some success with their weight-loss program. Other restaurant-coping techniques include not looking at the menu (simply order the low-fat items you know are available) and asking the waiter to serve your fish or chicken broiled, with the sauce on the side.

The key is to figure out your most effective strategies. "You can't draw up a list of 12 things that will work for everybody. It must be personalized," says Dr. Nash.

Make believe you're motivated. The day's going to come--if it hasn't already--when it's just too cold (or too hot, or too something) to go out for your 30-minute walk. Or there's some leftover pizza hiding out in the back of the refrigerator, and you can't think of a single good reason why you shouldn't eat it at 4:00 a.m.

"Even if you're not motivated to continue your weight-loss plan, act as if you are," says Marshel. "You may not feel like exercising, but don't give yourself the luxury of negotiating the issue with yourself--just do it. What we're talking about here isn't willpower, it's acting as if. Simply cut off that negative line of thinking." Marshel guarantees that, within a few minutes, you'll feel better and more motivated.

Don't wait if you deviate! Don't let one binge or a week without exercise lead to a what-the-hell-now-I've-blown-it attitude from which you may never recover. "If you've deviated from your plan, write down what happened and the ways in which you might learn from it," says Dr. Kolotkin. "Identify your destructive thoughts and reactions--for example, exaggerating how bad the eating episode was and the all-or-nothing thinking. You've got to start replacing those destructive thoughts with constructive strategies."

How? Dr. Kolotkin suggests you recall, and pat yourself on the back for, your previous weight-loss successes. Reevaluate and maybe modify your goals--you might be expecting too much, too soon. And create a controlled environment. "What are the things you can change that can put you in greater control of your eating?" she asks. "Maybe it's throwing out the peanut butter and ice cream from the fridge, or keeping more veggies handy, or rearranging your schedule if working late means bad eating habits, or asking the kids to keep their candy in their room."

"Monitor your behavior day to day, but not obsessively," adds Dr. Nash. "If you haven't exercised for the past two days, get yourself out there today. Take action sooner rather than later."

Recruit a diet buddy. Maybe you need more support than you can give yourself. Fine. There's plenty of help available if you just look around. You can try a formal weight-loss support group like Weight Watchers or Overeaters Anonymous (check the phone book for locations), or simply ask your spouse, your teenager or your friend to be your exercise or low-fat-dining buddy. A helping hand does help when it comes to weight loss: One study at Purdue University reveals that dieters with supportive partners lost 30 percent more weight than those who attempted to diet on their own.

"Having someone who knows you and understands what you're going through can be very inspirational," says Ronna Kabatznick, Ph.D., psychologist with Weight Watchers International.

Say goodbye to perfectionism. "When I talk to patients about behavior-changing techniques, I tell them they won't do it right 100 percent of the time, but you don't have to," insists Dr. Rankin. "If, for example, you're now successfully managing your food temptations 20 percent of the time, and then you go up to 60 percent, it will make a huge difference. What you want to aim for is just enough of a change to make a significant improvement. The quickest way to kill off your chances of weight-loss success is to demand perfection of yourself."

Midnight Bites It may not be just what you eat that determines the number on the bathroom scale, but when. A preliminary study indicates that midnight snacking may slow down what in metabolic lingo is called diet-induced thermogenesis (DIT)--the food's natural ability to boost metabolism and burn more energy. This means you'll burn off fewer calories after the meal and you'll pack on more weight. On three separate days over five weeks, nine men ate either a morning, afternoon or late-evening (1:00 a.m.) snack. Every other aspect of their diet was controlled. Researchers found a big difference between the DIT of the morning and late-evening snack. (The afternoon snack had no significant effect.) "Eating at night produces less heat and burns fewer calories than eating a snack in the morning," says registered dietitian Judith Stern, Sc.D., professor of nutrition and internal medicine at the University of California, Davis. "Over a period of time, it may mean trouble. By eating the bulk of your food late at night, even in one year there might be a substantial increase in body weight." The bottom line: Lay off the midnight snacks.