Chapter 9

Setting Weight-Loss Goals

"If you don't know where you're going, you'll probably end up somewhere else"-Quote from Lawrence J. Peter

 

How much weight do you want to lose? How fast? By what date? Your answers to these questions matter more than you might think, and if you're like most of us, you probably haven't thought about any of it much at all.

You might argue that "wanting to be thin" or "wanting to lose weight" are worthy goals; and they are. But they are also vague and the problem with vague goals is that they are a lot like no goals at all. At any rate, and in nearly every endeavor of human ambition, simple, precise and realistic goals offer people a yardstick by which to measure their success and allow them improve their performance. Knowing where you want to go really is the best guarantee that you'll get there.

So with that in mind, let's focus on defining your weight-loss goals.

 

Good Goal Setting:

1.     Be realistic in the short term. Major life-changes (and weight loss certainly is one of them) don't happen overnight.

2.     Be optimistic in the long-term: Think about it this way: in ten years, anything is possible. Anything at all.

3.     Choose a rate or speed of weight-loss. How many pounds per month (on average) are you aiming to lose?

4.     Choose an ultimate amount: What is your final "target" weight?

5.     Choose a health goal: What sort of physical being are you aiming to become? If you have health problems now, do you want to resolve or improve them through weight loss?

6.     Choose a fitness goal: Do you want to run marathons or just climb a flight of stairs without being short of breath? Either answer is equally good, but be clear about what YOU want.

7.     Choose a life-goal: How does weight-loss help you attain the life you want?

8.     Choose a self-reward: When you achieve a goal, how will you "pat your own back"?

 

Your Personal Weight Loss Goals

People can and do lose hundreds of pounds and people can and do keep it off forever. But that is not the norm and it requires extreme focus and effort. For you personally, too much effort may not be worth the result. Too much deprivation may take a lot of the joy out of life. Or, on the other hand, weight loss may indeed be worth it for you. These are very personal decisions that only you can make.

It is important though that you think long and in great depth about exactly how much time and effort you CAN and actually will make and that you then, in turn, adjust your weight loss goals accordingly. A single mother of three with a full time job who is going to night school simply does not have as much free-time as a retired person whose children are grown. While it is true that important goals require sacrifice and in some cases weight loss may mean delaying other goals like education, its hard to make those decisions without carefully considering one's priorities. With that in mind, let's focus on your priorities in life and see where weight loss fits in.

Typical High Life-Priorities (roughly in order of importance to most of us):

1.     Personal health. We can all probably agree that without our health we cannot attend to any other priorities, so health comes first. But what is health? Well, it's many things including

a.     Avoiding serious illness when possible. Some risks can be managed through lifestyle, some cannot. A healthy lifestyle is thus a high priority and weight is, of course, a part of that.

b.    Avoiding serious injury: Most of us care about driving safely and avoiding foolish risks on the road. Likewise we should not take foolish risks to lose weight or to achieve most other goals. Weight loss is about health, but it does not matter more than health.

c.     Mental health: When we are at peace with life we tend to be physically healthy. We should therefore strive for emotional balance. Again, weight loss should not come before emotional well-being.

2.     Health and well-being of loved ones: Few of us would be willing to harm others, especially family and children in order to lose weight. This can become a real problem for parents with young children. Too often they are faced with a choice between going to a gym for exercise or spending a precious few hours with their kids. Kids matter more. Fortunately, the choices aren't always mutually exclusive.

3.     Sleep: It might be tempting to try to sleep less in order to exercise but it is foolish. Your health and your weight will suffer. There are only so many hours in the day and most of us need eight of them for sleep.

4.     Money: People are willing to pay for weight loss provided that the price is reasonable and the service is reputable. But what if the only way to lose weight was to quit a well-paying job or delay schooling to achieve one? That is a much harder decision to make. It might be worth it, it might not be. Depends on your personal priorities.

5.     Friends: Are you willing to give-up time with friends to make time for weight loss? Many people are, some are not. Again, there is no right or wrong answer, it's personal.

6.     Activities: Is television time more important than weight loss? Probably not. What about going to the movies or musical concerts? You should be very clear with yourself where your priorities lie.

 

 

To put all this another way, if the only thing in the world you cared about was weight loss and everything else came second, this would be easy. But obviously weight loss is seldom one's absolute first priority. Carefully assessing exactly how big a priority it is and where it fits in with other priorities will help you set realist goals.

How Much and How Fast?

If you lose weight rapidly for a little while but never reach your goal-weight, you will probably get frustrated. If you lose weight very slowly but consistently, you will probably become frustrated too. So with weight loss, people generally need to set two goals: an ultimate long-term goal and a week-to-week or month-to-month goal. It's basically just mathematics. If your long-term goal is to lose sixty pounds in one year then your month-to-month goal should be five pounds-per-month or a little more than a pound per week. It's not always this simple since weight loss tends to slow-down as people approach their goals, but you get the point. Know where you want to go and know how fast you want to get there.

Setting a Long-Term Goal: Think Big and be Optimistic

Human beings, all of us, can achieve miracles when we have a clear vision and when we apply dogged determination. Do you want to lose 100 pounds? You can. I am here to tell you that other people, patients of mine, have lost that much and more and better still, they have kept it off. Long-term goals should be visionary and they should inspire you.

 

Setting Short-Term Goals: Think rationally and be realistic:

You are less likely, not more likely to achieve your long-term weight loss goal if your month-to-month goals are slow and steady. This is not a race, "The Biggest Loser" notwithstanding.

 

Integrating Weight-Loss Goals with Other Life-Goals:

Weight loss changes many other aspects of people's lives, often in good ways, sometimes in ways that are uncomfortable. Let's examine a few of these weight-related issues in people's lives:

1.     Health: done right, weight loss improves health

2.     Physical fitness: see above

3.     Physical "Attractiveness":  In America today, generally thinner people are considered more attractive. Thus losing weight usually improves self-esteem and increases "romantic" attention. The attention can be enjoyable for some people, troublesome or even scary for others.

4.     Employment: Numerous studies confirm a sad truth in America: thinner people tend to get better jobs. Deplorable as this is, it is also a fact.

5.     Fertility: Weight loss often improves one's chance of becoming pregnant. For women who struggle with infertility, weight loss and having children can segue perfectly.

6.     Athletic Goals: Maybe you have always wanted to compete in a marathon. You'll find that much easier to do if you are thinner and of course, conversely, running marathons (or performing any athletics) will help you lose weight.

7.     "Bucket-List" Goals: Some people promise themselves a trip around the world once in life. For others it might be climbing Mount Everest, scuba diving with sharks, learning to fly an airplane, attending the Bolshoi Ballet or writing a book. In nearly every case, the goal will be easier to achieve with thinness. 



From Goals to Plans:

Changing your life.

Insanity is endlessly repeating a behavior, always getting the same result while ever expecting a different one.

 

Lifelong weight loss requires lifelong changes in eating habits and activity. This is a tall order and also an unusual one. Most of us have very little experience thinking about living life differently forever. The idea is frankly terrifying. The reality is not. The sorts of changes needed for weight loss are neither hard nor painful, just different. We'll take it step by step starting with the science of human behavior.

"Reasoning" With the Unconscious Mind:

The idea that we are unaware of much of our behavior, many of our perceptions, beliefs, prejudices and motivations is old. Sigmund Freud transformed this idea into a comprehensive theory of human psychology that is both enduring and useful. Sometimes called the "subconscious", the unconscious mind, Freud argued, is vastly more powerful than our consciousness and is at the root of all of our behaviors. Thus, Freud argued, if we want to change our important behaviors, we must change our unconscious mind. He developed the field of "modern psychoanalysis" that, he believed, allowed people, guided by a trained psychiatrist, to get "under the hood" and tinker with and alter the workings of their unconscious mind. The ultimate goal was to help people lead better lives.

Whether Freud was right or wrong is still, to this day, a subject of some debate among clinical psychologists, but there is near universal agreement that his idea of the unconscious mind is useful and that generally, long-term behavioral change must involve rooting-out thoughts, ideas and memories of which we are not normally aware. To give a real-world example, in order to stop binge-eating as a response to stress, a person would generally do well to explore the earliest origins of that response which probably lay in forgotten events of childhood.

Behavior, Operant Conditioning and Change

Freud's ideas are ultimately a theory that cannot easily be tested. Behaviorism is a more modern set of theories that CAN be tested, have been tested and are widely held to be valid. Operant conditioning is a technique for altering human behavior that is based upon the science of behaviorism and it deserves your understanding.

Operant conditioning is familiar to most of us, if not by name, by design. It involves using a stimulus (a taste, a sensation, an image, a sound or an idea) in response to behaviors. A perfect example are "stop-smoking" clinics from the 1970s that gave a small but unpleasant electric shock to people's fingers every time they inhaled tobacco smoke. The idea was that over time, people's unconscious mind would associate smoking with pain and "learn" to stop wanting a cigarette. Judging from the fact that such clinics do not exist today, and in fact, it didn't work very well. But other forms of operant conditioning can and do help people effect long-term changes to their behavior.

Behavioral Psychology and Weight Loss

I will outline several ways that we can use our understanding of the unconscious mind to help us lose weight. They are:

1.     Self-bargaining

2.     "Controlling the Beast"

3.     Tricking the "Eye"

4.     Tricking the Nose

5.     Tricking the Tongue

6.     Sublimation

 

Bargaining with Yourself

We can rephrase the information about operant conditioning in another way: We are much more likely to give something up if we get something "good" back in return.

We are much more likely to exercise, for example, if we know that at the end we will get a reward. That's one of the reasons people compete in athletic events like "5K Walks" or marathons: they know that at the end they will be greeted by a friendly crowd and that, silly as it may sound, they will receive a T-shirt or some token of their hard work.

In other words, we are better motivated to do something we don't like right NOW if we know that we later get something we DO want. This is useful.

Furthermore, the reward need not come from someone else. The "bargain" need not be struck with a race organizer or a friend or boss. We can strike a bargain with ourselves. And it can be simple.

How to Bargain

Let's look at how to use self-bargaining to lose weight:

1.     Self bargaining works best to change behaviors in the "now". In other words, rewarding yourself for exercising or eating right THIS meal can help reinforce good eating habits, but rewarding yourself for what you did last week won't.

2.     The carrot is better than the stick. You'll get better results rewarding yourself for "good" behavior than punishing yourself for "bad" behavior. This may be part of the reason why the electric-shock smoking clinics didn't work so well.

3.     Consistency is crucial: the unconscious mind "learns" by repetition. The more consistent you are in rewarding your good eating and exercise habits, the more likely and quickly will form the unconscious association between the act and the reward

 

 

Controlling the "Beast"

Impulse Control, Free Will & Gratification

 

In the last chapter we showed how, despite having the capacity to think very rationally some of the time, much of our brain, especially the brain areas that control survival urges like hunger, "thinks" and causes us to act in ways that are irrational and even destructive. Underneath the thin veneer of intelligence lies the "beast" within us all.

 

This is the beast that ignores weeks of hard work and stands us at the refrigerator door scooping hunks of cheesecake into our mouths or somehow "magically" steers our car into fast-food drive-up window. It is the beast that makes us lash out in anger sometimes, that keeps the alcoholic drunk, the addict always looking for the next high. It is the beast that knows no reason, that cannot be reasoned with, that simply "needs" and always acts. It is like some Loch Ness Monster that hides underneath calm waters and occasionally roars to surface with great sound and fury and then, having spent its energy, falls back down to the depths leaving only ripples on the calm water.

Have you ever had the feeling or the certainty that you are about to do something that you know you will regret later? Maybe it is driving to a casino or walking into an ice cream parlor. Maybe it's coming home in a bad mood and knowing with absolute certainty that you are going to pick a fight with your spouse or your child. Have you ever felt like that?

If you have, then you know the "beast".  When we are out of control we are now being driven by the Loch Ness Monster. Our animal brain that knows no logic has risen up and taken control of our mind. It can't shut the mind down, it just tosses the mind out of the driver's seat for a while. That's why, when we are acting on strong impulse we often have that strange feeling of "watching it all from a distance". In a way, "we" are watching from a distance. "WE" are over in the passenger seat and some maniac monster is driving the car---usually straight into a wall. THAT is the beast.

If you know the "beast" of which I speak, if you have ever felt out of control, if you have ever done something stupid or crazy, then you must know too that the impulse never lasts long. The monster can struggle to the surface but it can't stay there long. The minor event that made us so angry or crazy a few minutes ago, the sudden rage, the overwhelming urge to eat a bag of potato chips, the absolute uncontrollable impulse to buy that $400 item that we can't afford, all of those things pass quickly. We lose control of ourselves and our behavior from time to time and for no apparent reason but minutes later we find ourselves calm, reconstituted and wondering what all the fuss was about. Why did we HAVE to have that greasy cheeseburger that is now making us ill? Why did we yell at our kids or just behave like a fool?  Where did the beast come from and where did it go? And above all, how do we control it? How do we stop acting on impulse?

The answer is that we can't control the beast. We can't "control" ourselves when we are out of control because of an urge or an impulse. If we are looking in the refrigerator door at a banana cream pie and the beast rises to the surface just then, we are going to eat the pie. When the Loch Ness Monster has risen, it is too big and strong to suppress. We cannot stop it.

But we CAN plan for it and THAT is what will save us the next time.

If we change the way we think about weight loss and admit that our willpower will eventually fail, that we WILL be visited from time to time by a Loch Ness Monster who wants to eat everything and cares not, what can we do? Is it hopeless?

No. The monster may be strong, but it has no staying power and it is not smart. It surfaces, it takes over, it makes us do stupid and crazy things and then it lets go and vanishes. The animal brain within us can generate powerful uncontrollable impulses, but not for long. It WILL let go. Time is what will save us.

The trick then is to use our rational minds to structure our lives so that the next time we lose control, we can't immediately act. To keep the beast away from temptation.

For an alcoholic in recovery this means not keeping a bottle of booze in the house. For a gambler it means depositing and not cashing the paycheck. For you it means NOT KEEPING BAD FOOD IN THE HOUSE. It's really just that simple.

You and I and every other healthy person will always be overcome by the urge to eat salty, greasy, sugary terrible food, but if getting our hands on it means a ten minute drive to the store, chances are we won't even get as far as the car before the urge passes. THAT is how we save ourselves from impulse. We can't kill the beast, but we can keep it away from trouble.

To put all of this another way: it's easier to control our environment than our urges.

Keeping it Out of the House

 

Tricking the "Eye"

Numerous studies show that the appearance of food affects how much we eat and that "appetite" and "satiety" aren't ALL about brain chemistry or how full we are. Here are some examples:

1.     A study of 168 moviegoers, who ate either fresh or stale popcorn from different size containers:

a.     People ate 45 percent more fresh popcorn from extra-large containers than large ones and the people who were eating stale popcorn ate 34 percent more from the extra-large buckets than people eating fresh popcorn, according to the study.

2.     People pour about 37 percent more liquid in short, wide glasses than in tall, skinny ones of the same volume.

3.     Children of different weights who were given a 16 ounce bowl were more likely to serve themselves twice as much cereal than children given an 8 ounce bowl.

4.     60 people were given a free lunch. Half the people received 22 ounce bowls of soup, while the other half unknowingly got 22 ounce bowls that were pressure-fed under the table and slowly refilled. The people with "bottomless" bowls ate 73 percent more than those with normal bowls, yet when asked, they didn’t realize they had eaten more.

5.     People were given a pasta buffet with only one kind of sauce. In one group, the people were offered many different shapes of pasta-bowtie, farfalle, macaroni, linguine etc. In the other group people only had one shape of pasta. The result? People who had more shapes to choose from ate more even though the pasta was all made from exactly the same ingredients.

These are surprising results and this is VERY useful information. It means that we can eat less by fooling our eyes.

Here are some strategies that really work:

1.     Use a smaller plate or bowl: use a salad plate and not a dinner plate

2.     Use a tall skinny glass

3.     Use low-calorie density foods like colorful vegetables to "fill-up" your plate

4.     Make food look less appetizing: This may sound strange, but it works

a.     Add green food coloring to a food (try eating green mashed potato).

b.    Chop or cut a piece of meat before you put it on the plate.

c.     Mix everything on your plate together before you start eating

5.     Keep "bad" foods out of sight: put them up or down, high or low in a cupboard so they aren't "staring back at you" when you open the door.

6.     Remove the labels form foods after you buy them. Remember that food companies spend millions of dollars designing labels that make you want to eat their product. If you toss the label it becomes less appealing.

7.     Avoid magazines that have lots of pictures of food.

8.     Don't watch television advertisements--get up or, better still, turn-off or block commercials

9.     Don't watch cooking shows

Tricking the Nose & Tongue:

Changing the smell and taste of food will help you eat less. Here is an example:

A patient of mine many years ago lost a great deal of weight. When I asked her how, she told me that

1.     she hated onions

2.     Since seeing me, she sprinkled onion powder on EVERYTHING she ate.

It worked for her and, if you try it, it will work for you. Here are some suggestions:

1.     Add a powerful flavor that you dislike. If it's onion, use onion, if it's lemon juice, use that.

2.     Add potassium: Potassium chloride is sold in the spice sections of supermarkets as "Salt substitute". It isn't really very appetizing though. Some people find that it helps them eat less. DO be careful though: never use more than about a teaspoon per day or you can become overloaded.

3.     Reduce sodium: Not only is this healthy, food is less appealing

4.     Make it VERY spicy: As we will see later,  capsaicin, the "hot" in chili helps you burn more calories after eating. It also makes you eat less from, frankly, the pain. On the other hand, a small amount of spice makes you eat more.

 

 

 

1.     Modify unrealistic rate and consistency goals

2.     Write a tentative weight-loss plan

 

Giving Up the Bad

Years ago I had a patient, a very nice lady in her mid-sixties who, after several months on my weight-loss program, had failed to lose weight and was frustrated about it. I asked her to describe to me her typical diet starting with breakfast and she told me that every morning, without fail, she ate two buttered croissants slathered with raspberry jelly. I replied to her that perhaps that choice of breakfasts was not the best. She stammered, clearly not happy to hear this and finally replied to me with an air of exasperation: "I am NOT giving up my croissants!" And that was that.

The point of this story is not that this woman was stupid or even generally unreasonable, but that somewhere in her unconscious she had formed the notion that two daily buttered, sugary croissants were an absolute necessity; that she couldn't live without them. The point, rather, is that in many ways, often hidden from our own awareness, most of us have made similar decisions about food. Underneath our conscious awareness, most of us have a few bad dietary habits that we are unwilling or unable to face. These hidden bad habits are the subject of this chapter.

Bad food choices hurt more than good ones help

Patients often tell me about the many great choices they make with food, the broccoli and salads and lean protein they are eating. And these are indeed great choices. But what I seldom hear about and is sometimes the issue, are the candy bars, sodas and fast food that some of them regularly indulge in. It's natural that we all want to hide these vices, but if we actually want to lose weight, they have to change and before they can change, we have to look at them in the cold, harsh light of day. I have found that one of the simplest techniques for helping people un-hide their sometimes lousy food choices is to ask them what they can think of in their diet over the last month that is the WORST (not the best) food choice. Often the conversation will run something like this:

Doctor: "What do you think is the worst food choice you have made in the last month; the most sugary, junky thing you have eaten?"

Patient: (Laughing nervously) "Oh I don't know, probably ice cream."

Doctor: "What kind of ice-cream?"

Patient: "Ben and Jerry's chocolate chip cookie dough."

Doctor: (Laughing) "I have to admit that I like that too. So when you eat this ice cream, how much do you eat?"

Patient: "Oh, not that much."

Doctor: "A single spoonful, a quarter cup, the whole carton?"

Patient: (Long silence) "Alright 'Doc' you caught me. I eat the whole carton. Doesn't everybody?"

Doctor: "I'll plead the fifth amendment on that question, but tell me this, how often do you eat this?"

Patient: "I'm trying to cut-back."

Doctor: "How often do you grocery shop?"

Patient: "Usually twice a week"

Doctor:  "Do you buy Ben and Jerry's every time you shop?"

Patient: "Umm, duh. Would I be here if I didn't? Yes, I do."

Doctor: "So you eat two cartons of Ben and Jerry's a week?"

Patient: "Sometimes my boyfriend brings it home too."

Doctor: "Does he eat it too?"

Patient: (Laughing) "No. He just knows I like it."

Doctor: "So what you're telling me is that you eat a carton every night, right?"

Patient: "Not EVERY night…. Alright, just about every night."

Doctor: "And you're wondering why you're not losing weight?"

Patient: "Yeah 'doc', come on. Don't you have some magic pill to give me?"

Doctor: "No, sorry, I am not licensed in sorcery."

And so it goes. "Denial is not a river in Egypt" as they say…

We all fool ourselves and none of us wants to take a hard look at our own bad habits. But THAT is what weight loss is all about.

So, to say it again: Bad food choices trump good ones. You can eat broccoli until you turn green, but if later you eat a carton of ice cream every night, it won't help (not much anyway).

Long-term weight loss requires long-term change and the most important dietary changes, the changes that make it REALLY happen, usually involve giving up something you dearly love, giving up the one (or five) things that you can't bring yourself to look at. If you do THAT, then you lose weight.

Life goes on without chocolate:

Many foods, particularly sweet foods, are chemically addicting. Addiction is a derangement of the unconscious mind or, to be more scientific, of the neurochemical reward pathways in the brain. Specifically, addiction hijacks the very primitive "survival center" that controls basic survival urges like breathing, thirst and hunger. Addiction tricks that survival center into responding to a chemical substance like heroin, nicotine or sugar in the same way as air, food and water. In other words, addiction makes us FEEL like we will die without the substance the way we really will die without air, food or water.

But that feeling is lie. People don't die without heroin. They don't die without cigarettes and they don't die by giving up chocolate or sugar.

The feeling has another name: withdrawal. And withdrawal never lasts long.

At any rate, the point is this: we all know our own bad habits and changing bad eating habits may require a little short-term suffering, but we live. We really do. Life goes on without chocolate.

Conclusions:

1.     If you want to lose weight, you must change your diet.

2.     The important changes involve giving up foods you "love" and that you can't imagine giving up.

3.     It might feel like you will die without your favorite food, but you won't. And soon, you won't even miss it.


GO TO CHAPTER 10

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