Warren L. Huberman PhD.

One of the most common questions I am asked is “How long does it take for before a new behavior feels normal?” Much has been written on this topic. I’ve read that it takes 18 days for a new behavior to become a habit and I’ve read 21 days as well. The answer is that we don’t really know. What we do know is that it takes awhile…probably more than a few weeks. The reason so many people ask this question is quite understandable; everyone wants to know, “How much longer am I going to have to put forth so much conscious effort before things get a little easier?” The greatest challenge of losing weight and keeping it off is that so many behaviors need to be changed and most of our eating behaviors seem automated. Like a computer’s hard drive that automatically runs programs without our input, our brains guide us to perform many of our behaviors, seemingly without our effort. So changing behavior patterns is a bit like reprogramming a computer’s hard drive. Here’s a true story. Earlier this year I stopped drinking diet cola. For a long time I wanted to stop consuming this chemical concoction and I finally decided to take action. Every day for over ten years, I’ve been going to the same deli in the morning to pick up a cup of coffee and a diet cola for later in the day. After making the decision to stop drinking diet cola, I noticed that every morning in the deli, after I poured my coffee, I continued to take a few steps towards the cooler containing the diet cola before realizing that I don’t drink diet cola anymore. How long did it take before I stopped taking that step towards the cooler? By six weeks I was no longer taking that step and simply walking out the door with only a cup of coffee. Think about that. My brain’s hard drive was running on autopilot for 45 days even after I made a firm decision. Once I stopped taking those few steps towards the cola cooler, controlling my diet cola intake became much easier….at least in that situation. There were also many other situations where buying or drinking diet cola had commonly occurred and I had to endure and change my behavior in those situations as well. As you know, the first few weeks are always the hardest, and then it gets easier. The “easier” part everyone is familiar with. We have all started a diet and stuck with it long enough that it started to feel like we finally beat the bully. “This time I’m going to finally lose the weight and keep it off!” (I’m envisioning Charlie Brown running towards the football Lucy is holding thinking “this time I’m really going to kick the football!). But as we all know, somehow the hard drive seems all too willing to revert back to its original setting. For some reason, even after we seem to be on easy street for a while and drop 20 or so pounds, and make significant behavior changes…something happens. We slip, we slide and seemingly overnight the 20 pounds has found its way back onto our midsections. What happened? What happened is the answer to our original question. “How long does it take to reprogram my hard drive? Maybe forever. The problem is thinking that behavior change and losing weight is a finite objective…that you can actually stop trying at some point. That you can wipe out the old hard drive and completely replace it with a new one. This is one of the major reason why diets and other weight loss programs fail…we start diets believing that there will come a time that we can stop diets…and then act surprised when the weight we’ve lost comes back! Even with weight loss surgery, it is foolhearty to think "I'm cured!!" In theory, there may come a time where it simply never occurs to me to have a diet cola…but it’s now well over six months and that time is nowhere in sight and I am no longer waiting for it. Rather than waiting and hoping that I will one day simply no longer yearn for a diet cola I have substituted a host of other drinks for diet cola. Water actually tastes great now. I’ve even decided every now and then to go to a new deli where I’ve never purchased diet cola before. I try not to eat in my office as often and actually go outdoors for 10 minutes to enjoy my lunch. I’m breaking old connections and building new ones, but I try not to ask myself when it is going to end because it’s better to think that it never ends and that I always need to be on my toes…even though it does get easier with each day. So don’t diet. Don’t start what you know you can’t finish. Make small behavior changes every day while keeping an eye on unwanted old habits and stop looking over every horizon to see if you’re close to the finish line where you can finally let your guard down. There is no finish line…but I assure you that it can be an enjoyable journey that you can tolerate for the rest of your life…even without getting a new hard drive. Warren L. Huberman, Ph.D. • Clinical Psychologist licensed in New York and New Jersey. • Clinical Faculty in the Dept. of Psychiatry at the Langone NYU School of Medicine. • Affiliate Psychologist at the Langone NYU Medical Center. • Consulting Psychologist to the NYU Langone Weight Management Program • Affiliate Psychologist in the Department of Psychiatry at North Shore/LIJ - Lenox Hill Hospital. • Maintains a private practice in Clinical Psychology in Manhattan. Dr. Huberman can be reached at 212-983-6225.

One of the more common stories I hear from people who want to lose weight is this one: “I’ve successfully lost weight a few times in the past and each time it started with this big boost of motivation. I can’t explain it…I was just super motivated and stuck to the plan, and I lost the weight. It almost seemed easy. Now, I just can’t seem to get started. I wish I could figure out how to get back that boost of motivation.” As a psychologist, I wish I had the secret of how to unlock that boost of motivation that so many of my patients’ desire…but their previous and future success is not due to just an initial boost of motivation. Motivation is only one piece of the puzzle, and quite frankly, not something that most overweight people lack. Think of it. What overweight person isn’t motivated to lose weight? It’s not a lack of knowledge. Most overweight folks can think of 101 good reasons to lose weight and many could write a diet book. It’s certainly not laziness. Overweight folks are some of the most eager and hard working people there are! They try and try and try and try. In my experience, one mistake that many overweight (and other) folks make is waiting to feel motivated in order to get started. Consider the little vignette above. The person in this story (and many stories) is wishing they had that special missing ingredient that got them started in the past. They don’t know what it is or where it came from. All they know is that when they had it, losing weight was much easier. Well, I’m a psychologist and make a living studying and trying to understand human behavior and I can’t always explain it either. But I’m also going to tell you that you don’t have to figure it to be successful. Sometimes the cause of that initial boost of motivation is easier to define. Maybe there was a major incident and you heard yourself saying “that’s it…I’ve had it!” and you were off to the races. Patients have told me countless stories of such events that were their “that’s it, I’ve had it” moment. One gentleman told me he couldn’t tie his shoelaces and had to ask a co-worker to help him and was terribly embarrassed. Another woman told me she sat on a chair and it broke beneath her. Yet another gentleman told me that his doctor (not so kindly) told him he’d be dead within a year if he didn’t lose a significant amount of weight. In fact, I can recall seeing one of my ex-girlfriends after she lost over 30 pounds and I vividly recall hearing myself say “that’s it, I’ve had it!!” and went on to lose over 50 pounds. Many of you probably have your own such stories. But the real question is, “What can you do when you DON’T have that kind of a moment?” How do you create your own motivation? As I said earlier, that “moment” and the boost of motivation that followed does fully explain your past weight loss successes. That “moment” may have helped light the fuse, but it did not provide all of the fuel that kept the flame of all of your hard work and perseverance going. I wasn’t thinking of my ex-girlfriend’s success all the time. The gentleman who couldn’t tie his shoes wasn’t thinking of that awful moment all day, every day. Try to recall back to what you were doing for all of those months when you were successfully losing weight. Was your behavior exactly as it is now? Were you eating the same foods you are now? Were you eating the same amounts of food? Were you as focused as you were then? When you lost the weight, were you living your life exactly as you are now? Probably not. So here is the punch line: Rather than wishing or waiting to feel that big boost of motivation to get started, why not start by doing all of those things that you did when you were successful losing weight in the past. Consider this. If you don’t do those things then you’re not really doing what you need to do to lose weight…you’re just waiting to do something. Don’t hear this as criticism. Just a few moments ago I said you’re not stupid, lazy or any of those things. But you’re not doing what’s in your best interest to meet your goals. Every day I speak to overweight people that admit that they have poor eating habits. They eat on the run. They don’t prepare meals. They don’t sit down at the table to eat. They eat too much fast food. The list goes on and on. And when I ask them what they were doing when they successfully lost weight in the past? They shopped for food. They cooked more often. They read food labels. They avoided fast food. They monitored their portion sizes. They didn’t eat cookies out of the box. They sat down at the table for meals rather than eating carbohydrate snacks out of the box while standing in their kitchen looking at the clock (we’ve all been there!). So, here is what you can do. Sit down with a pen and pad and try to recall each successful weight loss effort you’ve had in the past. Some of you may have one or two; others of you have four or five. If you have none, imagine how you would advise someone in your situation to lose weight. What would you specifically tell them to do? On the pad, make a list of all of the specific behavior changes you made when you were losing weight. When you lost all that weight were you writing down everything you were eating? Put that on the list. Were you exercising? Put that on the list. Were you bringing fruit to work with you for a snack rather than hitting the vending machines? Put that on the list. Were you having yogurt and some granola for breakfast rather than an egg and cheese sandwich on a bagel every morning? Put that on the list. I think you’re getting the picture. Then, start introducing one or two of those behavior changes each day. Within a week or two, you’ll be doing all of the things you need to do to get back on track…even without the big initial boost of motivation to do so. By the time you notice that the motivation to get going wasn’t initially there, it will be there in the form of excitement that you got the ball rolling yourself. Is my suggestion the answer? Perhaps not the entire answer, but it certainly is a big part of the answer. You know that somewhere along the way to losing weight, you will need to DO many or all of those things you once did to lose weight. So rather than waiting for that big motivation boost to come along to carry you through to making all of those behavioral changes, why not make some of those behavioral changes now and maybe the motivation will show up along the way? Do I think this is easy? No…of course not. Wouldn’t it be easier to make all of those changes if the motivation were there from the starting line? Of course it would. But maybe that big boost of motivation isn’t necessary. Maybe the best way to proceed is to put the cart before the horse…the doing part BEFORE the motivation part. I know…it sounds a little strange. But if you don’t…you’re not really trying to lose weight. You’re waiting to try to lose weight.

Inertia – The Real Weight Loss Killer We do what we do because that’s what we do. That may seem like one of the most ridiculous sentences ever committed to paper, but read it again. We do what we do because that’s what we do. This means that we don’t necessarily do what we do because we made conscious choices to do it that way. It means that much of our behavior is on autopilot. Think of this phrase with regards to eating. We spend so much time talking about emotional eating that we’ve forgotten that most of the time that we’re eating unhealthy or eating “comfort foods” it is not because we are depressed or anxious, it’s because we’re just not thinking about what we are doing, and eating has become a seemingly automatic behavior. Our minds are somewhere else. I’m not saying that emotional eating isn’t a problem, but rather that the behavior of eating without thinking is as big if not the bigger problem much of the time. Think about it. How often do you go into the kitchen to have some cookies because you are depressed? Now, think about how many times you go into the kitchen to get some cookies and you have no idea why you went into the kitchen. I bet the latter situation happens much more often. Ever find yourself in the middle of eating some cookies and you don’t even remember going into the kitchen or opening up the box of cookies? See what I mean!!! It may be true that we learned to eat as a means of comforting ourselves from negative emotions such as anxiety and depression. However, the behavior of eating often persists long after the anxiety and depression is gone. Why? Habits are really hard to break and your brain isn’t in the business of breaking them without a whole lot of effort. A great deal of any individual’s behavior occurs outside of his or her awareness and with very little conscious thought. What this means is that many of our bad habits persist because we are not aware enough to do anything about it. We don’t necessarily reach for the cookies because we CHOOSE to have cookies. Our brains just automatically crave cookies when we are in circumstances that we have commonly eaten cookies in the past. We don’t even need to think about it anymore. Because you’ve engaged in the behavior of eating cookies under specific circumstances so many times (let’s say at night, feeling tired, watching television, a bit bored with the show) your brain now cues you to go for cookies without any conscious thought from you. No thinking required! And if you’re not actively thinking about your choices, you’re not making a choice. You’re operating on inertia. What is inertia? You remember that phrase from high school physics… “an object in motion is likely to stay in motion….” What this means in terms of behavior is that a behavior that is repeated over and over (also called a habit) will persist unless something comes along to interfere with that behavior. Inertia is when behavior just keeps going because it’s been going. John Lennon had this wonderful lyric that said “life is what happens to you while you’re busy making other plans.” This means that as long as you are alive, even when you’re not trying to make decisions or to make change, life goes on. Therefore, if you don’t do something to make changes in your behavior, you’ll likely keep performing the same behaviors you’ve always performed under similar circumstances. This is exactly what happens with eating most of the time. Diets are an exception. Consider just how different your eating behavior is from its normal state when you’re on a diet. When you’re on a diet, you are contemplating every decision. You are in the moment and you are making choices. You are reading labels. You are measuring servings. You are counting calories, points, carbohydrates, etc. You are “on.” When you go off the diet, if you’re like most people, ALL of this stops. No more thinking, no more measuring, no more counting, no more making choices…just running on inertia. Eating with very little thought and your brain seems to eagerly resort back to its old ways. That’s inertia. The keys to change are therefore rather obvious. Be in the moment. Contemplate as many food decisions as you can. Plan your meals and snacks ahead of time rather than trusting that your brain will help you make the right decision in the moment. It won’t. Anticipate high-risk eating situations like parties, weddings, and barbeques. Maybe you’ve heard all of this before. You probably have. There are many different terms used for this approach and they are likely speaking to the same concept. A hot term these days is “mindfulness.” It’s not really a new concept…the Buddhists have been talking about it for several thousand years. It’s really very simple in theory…be aware and observe your thoughts and feelings, and be present in the here-and-now. Then make your decision. Why is mindfulness so important? Because habits and the power of inertia are incredibly powerful and the weight you have lost or are trying to lose wants to come back. Your body isn’t the least bit interested in helping you lose weight. So if your mind isn’t very conscious of what it’s trying to achieve, it’s just not going to happen. In fact, your body is fighting tooth-and-nail against you. Inertia is what happens when you’re not fighting back. Remember…we do what we do because that’s what we do. If you want to lose weight and keep it off, your new phrase needs to become “I do what I do because that’s what I’ve decided to do,” or better stated, “I eat what I eat because that is what I choose to eat.”

I’ve always despised the term “willpower” because it’s one of those words that seems to say something, but says nothing. Applied to weight loss or keeping weight off, willpower is always cited as something you must have to be successful. When patients struggle to lose weight, they tell me it’s because they have no willpower. Willpower is spoken of as if it is the secret weapon in the battle of the bulge but nobody seems to be able to define what willpower is or how to acquire it. What truly bothers me is that willpower is often explained as something intrinsic…that you either have it or you don’t. This is nonsense. Anyone who has ever lost weight can recall at least one time when they thought “This is it! This is the time I’m really going to keep it off!” You felt as if you were in a groove. You turned away from cake and potato chips. You said no to second helpings. You were invincible! You even bought the smaller jeans to punctuate your accomplishment! But then there was a wedding, or a cruise or just a little, harmless piece of chocolate that you let yourself enjoy. Suddenly, your “willpower” seemed to be gone and you didn’t know how to get it back. Well that ends today. I have news for you. Successful weight losers do not have more willpower than you do. Unsuccessful dieters do not have less willpower than you do. The popular conception of willpower is nonsense. There is nothing magical about willpower. It is not something that you have one day and lose the next. I’m going to teach you how to make your own willpower. First, let’s expose the myth of willpower. Willpower found! When you lost all that weight way back when, it began with a conscious decision and a few key factors lined up in your favor. While it may seem that you suddenly had the willpower to start the diet and successfully begin to lose weight, what actually occurred was that emotion (motivation) and an awareness of the positive and negative consequences of weight loss were both in focus. Often by chance, the emotional energy to persevere is so strong that we tolerate hunger, frustration, cravings, etc. You might think that you were not feeling hunger, cravings, or frustration when you were losing the weight but in fact you were. They were simply dwarfed by the high level of emotion and motivation you had to tolerate them. Willpower lost! Unfortunately, this initial emotional thrust eventually wears off if there’s nothing else to give it more fuel. When willpower seems to suddenly disappear what has happened is that the equation has shifted. Reasons to eat the chocolate and the desire to eat it are suddenly greater than the initial emotional thrust to tolerate this discomfort. At this point, you begin giving yourself permission to go off track. You find yourself in an environment where temptations seem greater than before. You tell yourself things that enable a setback. Willpower didn’t go anywhere. And as you well know, from that point on, it was only a matter of time until the weight returned. You probably remember that awful feeling of powerlessness that you couldn’t grab hold of the reigns and turn things around. Of course, there are also times where an overwhelming emotional event may occur that throws your motivation out the window. 9/11 was such an unfortunate example for many of my patients. Making your own willpower whether it is losing weight, quitting smoking, or accomplishing any other endeavor, there are a few specific actions that successful people take that make them successful: 1) Create measurable goals and write them down. If you’re not willing to write them down then you’re not really serious about success. Keep reading your goals every day or they won’t stay in the front of your mind. If they’re not in the front of your mind, they’re in the back of your mind. If they’re in the back of your mind, they’re useless. 2) Motivate yourself to accomplish each goal. Ask yourself “What’s in it for me (WIIFM) to accomplish this goal?” Then ask yourself “What is the consequence of failing to accomplish this goal?” Identify short and long-term goals as well as short and long-term consequences. Don’t dance around this issue…be honest. There are real negative short-term consequences of dieting and keeping weight off. Hunger, feelings of deprivation and temporary emotional distress are a few. Fear of being without food as a comfort is another. Having a clear list of benefits that you will gain in the future in exchange for tolerating these negative consequences in the short-term can help you through these tough times. Ask yourself “What do I stand to gain, both now (within a few days) and in the future if I stick to my goal of losing weight.” This is the real definition of willpower: being able to tolerate frustration or discomfort in the present in exchange for a desirable outcome in the future. Perhaps a better phrase for willpower is discomfort tolerance or frustration tolerance. Take your time with this step. Remember, in order to have the ability to tolerate frustration and discomfort when they strike, you need to be acutely aware of “what’s in it for me?” 3) Make clear action steps that you plan to take to accomplish the goal. The goal itself is not as important as understanding the behavioral steps you plan to enact in order to accomplish them. Ask yourself “what am I going to do to accomplish my goal. Also ask, “What do I need to stop doing or do differently if I am to accomplish this goal. For example, don’t ask yourself “How am I going to find the time to exercise?” Ask yourself “How am I going to make the time to exercise.” Then take out your blackberry or schedule book and figure out exactly what you are going to shift around to create the time to exercise. 4) Practice your strategies. Ever notice that the best athletes practice almost EVERY DAY?! Batting practice, free throw practice, the driving range, and on and on. Practice is what makes people successful. It’s not willpower. In case you’re telling yourself that it’s the money, you’re mistaken. There are plenty of highly paid athletes that are bums. Our favorite athletes are generally the ones that practice the most. They try harder and give a little more than the “prima donnas.” We tend to like the players who are shorter, slower, injured, or who are older but simply refuse to give up. Its constant effort, and a refusal to quit, not talent that makes the difference. 5) Think like a winner. When a winner has a setback, they don’t pack it in. They start over. Don’t “catastrophize.” Don’t categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything. There you have it…the mystery of willpower unraveled. The power to make real change and MAINTAIN real change is well within your grasp. You don’t suddenly get it and just as suddenly lose it. Make a commitment to your goals, write them down, document what’s in it for you, read your goals daily, diligently engage in behaviors that support each goal, think like a winner and you will be successful. I know that some of you are reading this and sighing, saying that it’s not so simple. It doesn’t have to be so complicated either. Take a bold step. Start writing some goals down right now and follow the steps I’ve outlined above before you log off. You have the power to change right at this very moment. No willpower required!

I’ve always despised the term “willpower” because it’s one of those words that seems to say something, but says nothing. Applied to weight loss or keeping weight off, willpower is always cited as something you must have to be successful. When patients struggle to lose weight, they tell me it’s because they have no willpower. Willpower is spoken of as if it is the secret weapon in the battle of the bulge but nobody seems to be able to define what willpower is or how to acquire it. What truly bothers me is that willpower is often explained as something intrinsic…that you either have it or you don’t. This is nonsense. Anyone who has ever lost weight can recall at least one time when they thought “This is it! This is the time I’m really going to keep it off!” You felt as if you were in a groove. You turned away from cake and potato chips. You said no to second helpings. You were invincible! You even bought the smaller jeans to punctuate your accomplishment! But then there was a wedding, or a cruise or just a little, harmless piece of chocolate that you let yourself enjoy. Suddenly, your “willpower” seemed to be gone and you didn’t know how to get it back. Well that ends today. I have news for you. Successful weight losers do not have more willpower than you do. Unsuccessful dieters do not have less willpower than you do. The popular conception of willpower is nonsense. There is nothing magical about willpower. It is not something that you have one day and lose the next. I’m going to teach you how to make your own willpower. First, let’s expose the myth of willpower. Willpower found! When you lost all that weight way back when, it began with a conscious decision and a few key factors lined up in your favor. While it may seem that you suddenly had the willpower to start the diet and successfully begin to lose weight, what actually occurred was that emotion (motivation) and an awareness of the positive and negative consequences of weight loss were both in focus. Often by chance, the emotional energy to persevere is so strong that we tolerate hunger, frustration, cravings, etc. You might think that you were not feeling hunger, cravings, or frustration when you were losing the weight but in fact you were. They were simply dwarfed by the high level of emotion and motivation you had to tolerate them. Willpower lost! Unfortunately, this initial emotional thrust eventually wears off if there’s nothing else to give it more fuel. When willpower seems to suddenly disappear what has happened is that the equation has shifted. Reasons to eat the chocolate and the desire to eat it are suddenly greater than the initial emotional thrust to tolerate this discomfort. At this point, you begin giving yourself permission to go off track. You find yourself in an environment where temptations seem greater than before. You tell yourself things that enable a setback. Willpower didn’t go anywhere. And as you well know, from that point on, it was only a matter of time until the weight returned. You probably remember that awful feeling of powerlessness that you couldn’t grab hold of the reigns and turn things around. Of course, there are also times where an overwhelming emotional event may occur that throws your motivation out the window. 9/11 was such an unfortunate example for many of my patients. Making your own willpower whether it is losing weight, quitting smoking, or accomplishing any other endeavor, there are a few specific actions that successful people take that make them successful: 1) Create measurable goals and write them down. If you’re not willing to write them down then you’re not really serious about success. Keep reading your goals every day or they won’t stay in the front of your mind. If they’re not in the front of your mind, they’re in the back of your mind. If they’re in the back of your mind, they’re useless. 2) Motivate yourself to accomplish each goal. Ask yourself “What’s in it for me (WIIFM) to accomplish this goal?” Then ask yourself “What is the consequence of failing to accomplish this goal?” Identify short and long-term goals as well as short and long-term consequences. Don’t dance around this issue…be honest. There are real negative short-term consequences of dieting and keeping weight off. Hunger, feelings of deprivation and temporary emotional distress are a few. Fear of being without food as a comfort is another. Having a clear list of benefits that you will gain in the future in exchange for tolerating these negative consequences in the short-term can help you through these tough times. Ask yourself “What do I stand to gain, both now (within a few days) and in the future if I stick to my goal of losing weight.” This is the real definition of willpower: being able to tolerate frustration or discomfort in the present in exchange for a desirable outcome in the future. Perhaps a better phrase for willpower is discomfort tolerance or frustration tolerance. Take your time with this step. Remember, in order to have the ability to tolerate frustration and discomfort when they strike, you need to be acutely aware of “what’s in it for me?” 3) Make clear action steps that you plan to take to accomplish the goal. The goal itself is not as important as understanding the behavioral steps you plan to enact in order to accomplish them. Ask yourself “what am I going to do to accomplish my goal. Also ask, “What do I need to stop doing or do differently if I am to accomplish this goal. For example, don’t ask yourself “How am I going to find the time to exercise?” Ask yourself “How am I going to make the time to exercise.” Then take out your blackberry or schedule book and figure out exactly what you are going to shift around to create the time to exercise. 4) Practice your strategies. Ever notice that the best athletes practice almost EVERY DAY?! Batting practice, free throw practice, the driving range, and on and on. Practice is what makes people successful. It’s not willpower. In case you’re telling yourself that it’s the money, you’re mistaken. There are plenty of highly paid athletes that are bums. Our favorite athletes are generally the ones that practice the most. They try harder and give a little more than the “prima donnas.” We tend to like the players who are shorter, slower, injured, or who are older but simply refuse to give up. Its constant effort, and a refusal to quit, not talent that makes the difference. 5) Think like a winner. When a winner has a setback, they don’t pack it in. They start over. Don’t “catastrophize.” Don’t categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything. There you have it…the mystery of willpower unraveled. The power to make real change and MAINTAIN real change is well within your grasp. You don’t suddenly get it and just as suddenly lose it. Make a commitment to your goals, write them down, document what’s in it for you, read your goals daily, diligently engage in behaviors that support each goal, think like a winner and you will be successful. I know that some of you are reading this and sighing, saying that it’s not so simple. It doesn’t have to be so complicated either. Take a bold step. Start writing some goals down right now and follow the steps I’ve outlined above before you log off. You have the power to change right at this very moment. No willpower required!

One of the most common questions I am asked is “How long does it take for before a new behavior feels normal?” Much has been written on this topic. I’ve read that it takes 18 days for a new behavior to become a habit and I’ve read 21 days as well. The answer is that we don’t really know. What we do know is that it takes awhile…probably more than a few weeks. The reason so many people ask this question is quite understandable; everyone wants to know, “How much longer am I going to have to put forth so much conscious effort before things get a little easier?” The greatest challenge of losing weight and keeping it off is that so many behaviors need to be changed and most of our eating behaviors seem automated. Like a computer’s hard drive that automatically runs programs without our input, our brains guide us to perform many of our behaviors, seemingly without our effort. So changing behavior patterns is a bit like reprogramming a computer’s hard drive. Here’s a true story. Earlier this year I stopped drinking diet cola. For a long time I wanted to stop consuming this chemical concoction and I finally decided to take action. Every day for over ten years, I’ve been going to the same deli in the morning to pick up a cup of coffee and a diet cola for later in the day. After making the decision to stop drinking diet cola, I noticed that every morning in the deli, after I poured my coffee, I continued to take a few steps towards the cooler containing the diet cola before realizing that I don’t drink diet cola anymore. How long did it take before I stopped taking that step towards the cooler? By six weeks I was no longer taking that step and simply walking out the door with only a cup of coffee. Think about that. My brain’s hard drive was running on autopilot for 45 days even after I made a firm decision. Once I stopped taking those few steps towards the cola cooler, controlling my diet cola intake became much easier….at least in that situation. There were also many other situations where buying or drinking diet cola had commonly occurred and I had to endure and change my behavior in those situations as well. As you know, the first few weeks are always the hardest, and then it gets easier. The “easier” part everyone is familiar with. We have all started a diet and stuck with it long enough that it started to feel like we finally beat the bully. “This time I’m going to finally lose the weight and keep it off!” (I’m envisioning Charlie Brown running towards the football Lucy is holding thinking “this time I’m really going to kick the football!). But as we all know, somehow the hard drive seems all too willing to revert back to its original setting. For some reason, even after we seem to be on easy street for a while and drop 20 or so pounds, and make significant behavior changes…something happens. We slip, we slide and seemingly overnight the 20 pounds has found its way back onto our midsections. What happened? What happened is the answer to our original question. “How long does it take to reprogram my hard drive? Maybe forever. The problem is thinking that behavior change and losing weight is a finite objective…that you can actually stop trying at some point. That you can wipe out the old hard drive and completely replace it with a new one. This is one of the major reason why diets and other weight loss programs fail…we start diets believing that there will come a time that we can stop diets…and then act surprised when the weight we’ve lost comes back! Even with weight loss surgery, it is foolhearty to think "I'm cured!!" In theory, there may come a time where it simply never occurs to me to have a diet cola…but it’s now well over six months and that time is nowhere in sight and I am no longer waiting for it. Rather than waiting and hoping that I will one day simply no longer yearn for a diet cola I have substituted a host of other drinks for diet cola. Water actually tastes great now. I’ve even decided every now and then to go to a new deli where I’ve never purchased diet cola before. I try not to eat in my office as often and actually go outdoors for 10 minutes to enjoy my lunch. I’m breaking old connections and building new ones, but I try not to ask myself when it is going to end because it’s better to think that it never ends and that I always need to be on my toes…even though it does get easier with each day. So don’t diet. Don’t start what you know you can’t finish. Make small behavior changes every day while keeping an eye on unwanted old habits and stop looking over every horizon to see if you’re close to the finish line where you can finally let your guard down. There is no finish line…but I assure you that it can be an enjoyable journey that you can tolerate for the rest of your life…even without getting a new hard drive. Warren L. Huberman, Ph.D. • Clinical Psychologist licensed in New York and New Jersey. • Clinical Faculty in the Dept. of Psychiatry at the Langone NYU School of Medicine. • Affiliate Psychologist at the Langone NYU Medical Center. • Consulting Psychologist to the NYU Langone Weight Management Program • Affiliate Psychologist in the Department of Psychiatry at North Shore/LIJ - Lenox Hill Hospital. • Maintains a private practice in Clinical Psychology in Manhattan. Dr. Huberman can be reached at 212-983-6225.

Most of the folks that I have seen after weight loss surgery describe some anxiety about weight regain. The effects of weight loss surgery are most robust during the first year after surgery. There are a number of reasons for this fact, including increased motivation, anxiety about eating and the need for significant and immediate behavior change. This first year is often referred to as the “honeymoon phase” because, like new love, it’s all good. Then things begin to change…not overnight, but gradually. Through time, you notice that you can eat more, either because the physical changes created by the surgery are changing, or perhaps because you’ve learned what you can eat more easily. Of course it is important that you continue to try to maintain the dietary changes your nutritionist and surgeon have recommended, and if you have a gastric band to ensure that it is properly filled. Interestingly, I’ve noticed that a great number of patients stop there. What else can you do? Wouldn’t it be great if there was some secret formula for keeping weight off, or an easy to follow list of things to do to improve your chances of success? Well, you’re in luck. The National Weight Control Registry (NWCS) has tracked the weight loss of over 5000 people who have kept a significant amount of weight off for over a year. Their membership has lost an average of 66 pounds and kept if off for an average of 5.5 years. If you’re “serious” about losing weight, it would seem that following in the footsteps of these folks would be a wise move. So what are some of the secrets of NWCS members? 1. Exercise Every Day Numerous studies as well as your own experience have likely taught you that exercise alone isn’t going to be enough for you to lose weight and keep it off. However, cutting calories without incorporating exercise is making your goal of keeping the weight off that much harder. It just makes sense that if you’re performing activities that burn a few hundred calories a day, it would make it easier to stay on track. Case in point, 90% of NWCR members exercise every day on average for an hour. The most popular exercise is walking. I find that the two greatest obstacles that patients cite for their inability to follow this recommendation are finding the time to exercise and not enjoying exercise. Consider that NWCS members do not have 25 hours in their day, they have the same 24 as we all do…they just make exercise a priority. Similarly, it would be ridiculous to believe that the 5000+ members of the NWCS enjoy exercise more than the average human being; they simply push themselves to do it. 2. Keep track of what you put in your mouth and what you weigh 75% of NWCR members weigh themselves at least once per week. This highlights the need to keep track of your behavior. The problem with the number on the scale is that your weight reflects the consequence of another behavior…eating. Therefore, simply tracking your weight is inadequate. Several studies have demonstrated that self-monitoring (the fancy name for keeping track of what you eat) alone has contributed to weight loss. How? If you know that you’re going to write down everything you eat, you might think twice before eating a candy bar…especially if you’re going to write down the calories in that candy bar. The power of self-monitoring your food intake in particular is that it makes you mindful and aware of your actions and helps keep you in the present moment, which is the only time that you can choose to behave differently. Not in the past or in the future, but right now! You can’t change behavior unless you are in the present moment and fully aware of the choices you are making. Writing down what you eat requires mindfulness and being in the present moment which will help you make better choices. I find that the two greatest obstacles to self-monitoring are that it is inconvenient or annoying and the belief that “I shouldn’t need to write down what I eat in order to control my behavior.” If you consider obesity to be a chronic condition and writing down what you eat to be a treatment strategy for that condition, you would likely have a difficult time complaining about your treatment to someone who has kidney failure and requires dialysis three times a week for a few hours per visit. Folks who require dialysis don’t have the luxury of complaining that it is time consuming, inconvenient and annoying. Am I being dramatic? Absolutely! Is what I’m saying accurate? Yes. Again, ask yourself if you’re serious about keeping the weight off. If you are, I’m confident that you will agree that keeping track of your food intake in a little booklet or online and getting on a scale once a week is not that big of an inconvenience. As far as the notion that you “shouldn’t need to write it down,” I strongly disagree. Behavior change usually occurs gradually and with great effort. Behavior doesn’t change on its own; it changes when you consistently work to make it change. Therefore, you “should” need to keep track of your behavior in order for it to change. If you’re not actively trying to change your eating behavior, it’s foolish to believe that you will eat any differently than you always have. Write it down!! 3. Be consistent If you look at some of the statistics about the behaviors of members of the NWCR you’ll notice that they are very consistent. Consider some of the statistics that I’ve already mentioned. 90% exercise every day, 75% weigh themselves every week and add to those that 75% report that they eat Breakfast every day. They didn’t exercise “when they had the time.” They didn’t eat breakfast “here and there.” Whatever it is that you’re doing to lose weight and keep it off; you need to be doing it most of the time. And some things you should be doing very rarely…like eating treats. Consider the word “treat” for a moment. Most of us would consider things like cake, candy, chips and chocolate to fall into the category of “treats.” The Merriam-Webster definition of a “treat” is “an especially unexpected source of joy, delight or amusement.” Something that you eat every day or even a few times per week cannot possibly be considered “especially unexpected.” Treats, therefore, would be things that you ate very rarely…and this would be a good policy if you’re serious about losing weight and keeping it off! Please note that no one is saying that making these changes is easy. In fact, it’s quite challenging. However, if you focus on how hard it is to make these changes or how unfair you feel it is that you need to make these changes, it’s taking your energy and focus away from discovering how you can actually make these changes. While there is no guarantee that following these steps will ensure lasting weight loss, there is an old adage that states that “If you want to be successful, do what successful people are doing.” Members of the National Weight Control Registry definitely qualify as successful, and if you’re truly serious about losing weight and keeping it off, it would be wise to follow in their footsteps.

Keep up the good effort!

One of the most common questions I am asked is “How long does it take for before a new behavior feels normal?” Much has been written on this topic. I’ve read that it takes 18 days for a new behavior to become a habit and I’ve read 21 days as well. The answer is that we don’t really know. What we do know is that it takes awhile…probably more than a few weeks. The reason so many people ask this question is quite understandable; everyone wants to know, “How much longer am I going to have to put forth so much conscious effort before things get a little easier?” The greatest challenge of losing weight is that so many behaviors need to be changed and most of our eating behaviors seem automated. Like a computer’s hard drive that automatically runs programs without our input, our brains guide us to perform many of our behaviors, seemingly without our effort. So changing behavior patterns is a bit like reprogramming a computer’s hard drive. Here’s a true story. Earlier this year I stopped drinking diet cola. For a long time I wanted to stop consuming this chemical concoction and I finally decided to take action. Every day for over ten years, I’ve been going to the same deli in the morning to pick up a cup of coffee and a diet cola for later in the day. After making the decision to stop drinking diet cola, I noticed that every morning in the deli, after I poured my coffee, I continued to take a few steps towards the cooler containing the diet cola before realizing that I don’t drink diet cola anymore. How long did it take before I stopped taking that step towards the cooler? By six weeks I was no longer taking that step and simply walking out the door with only a cup of coffee. Think about that. My brain’s hard drive was running on autopilot for 45 days even after I made a firm decision. Once I stopped taking those few steps towards the cola cooler, controlling my diet cola intake became much easier….at least in that situation. There were also many other situations where buying or drinking diet cola had commonly occurred and I had to endure and change my behavior in those situations as well. As you know, the first few weeks are always the hardest, and then it gets easier. The “easier” part everyone is familiar with. We have all started a diet and stuck with it long enough that it started to feel like we finally beat the bully. “This time I’m going to finally lose the weight and keep it off!” (I’m envisioning Charlie Brown running towards the football Lucy is holding thinking “this time I’m really going to kick the football!). But as we all know, somehow the hard drive seems all too willing to revert back to its original setting. For some reason, even after we seem to be on easy street for a while and drop 20 or so pounds, and make significant behavior changes…something happens. We slip, we slide and seemingly overnight the 20 pounds has found its way back onto our midsections. What happened? What happened is the answer to our original question. “How long does it take to reprogram my hard drive? Maybe forever. The problem is thinking that behavior change and losing weight is a finite objective…that you can actually stop trying at some point. That you can wipe out the old hard drive and completely replace it with a new one. This is why diets fail…we start diets believing that there will come a time that we can stop diets…and then act surprised when the weight we’ve lost comes back! In theory, there may come a time where it simply never occurs to me to have a diet cola…but it’s now well over six months and that time is nowhere in sight and I am no longer waiting for it. Rather than waiting and hoping that I will one day simply no longer yearn for a diet cola I have substituted a host of other drinks for diet cola. Water actually tastes great now. I’ve even decided every now and then to go to a new deli where I’ve never purchased diet cola before. I try not to eat in my office as often and actually go outdoors for 10 minutes to enjoy my lunch. I’m breaking old connections and building new ones, but I try not to ask myself when it is going to end because it’s better to think that it never ends and that I always need to be on my toes…even though it does get easier with each day. So don’t diet. Don’t start what you know you can’t finish. Make small behavior changes every day while keeping an eye on unwanted old habits and stop looking over every horizon to see if you’re close to the finish line where you can finally let your guard down. There is no finish line…but I assure you that it can be an enjoyable journey that you can tolerate for the rest of your life…even without getting a new hard drive. :frown:

I’m a runner. I’ve been a runner since I was a teenager. I’ve run five or more miles three times a week for the past four years and rarely take a day off. Many of my runs have been over ten miles. I’m the crazy guy you’ve seen running in the rain and the snow on the side of the road at 7 AM. I’ve learned a lot from running and many of those lessons I have applied to life in general. I’ve shared much of what I’ve learned about running with many of my patients because I believe that there are a number of parallels between long-distance running and the journey through weight loss. Many of my patients agree. I’d like to share some of these parallels with you to provide you with a helpful way to think about all that you’ve gone through and may still experience going forward. I should make an admission to you first. I’ve never actually run a marathon. It’s something I very much want to do someday but have yet to attempt because of some nagging injuries and such. However, I know enough about long-distance running and have spoken to enough marathon runners to understand the psyche of the marathon runner. Therefore, I feel comfortable speaking of it here. Consider the entire journey of weight loss surgery from before surgery to years afterwards as a marathon. For those of you who are unfamiliar, a marathon is a race of 26.2 miles. The modern Marathon commemorates the run of the soldier Pheidippides from a battlefield at the site of the town of Marathon, Greece, 26.2 miles to Athens in 490 B.C. It is seen by many as the ultimate test of endurance (although there are now ultra-marathons that can go for 100 miles or more!). There are many things one must do to prepare for the running of a marathon. A marathoner has to complete several practice runs and work up his stamina and endurance to get into peak physical condition for the race. A marathoner is encouraged to make dietary changes, especially in the few days before the race. A marathoner has to mentally prepare for the grueling 26.2 run and plot out the course and a strategy of how he is going to make it from start to finish. The process of weight loss surgery is quite similar. There are many steps to take before your big day. There is research to do. Perhaps you will talk to doctors or to those who have had surgery to better understand what you will be experiencing. When you decide that surgery is for you, there are pre-surgical assessments, medical tests and other things that must be done to ensure that you are prepared for what lies ahead. You are instructed to make dietary changes in anticipation of your surgery…perhaps a liquid diet for a week or more. And certainly you must mentally prepare for all of the physical, behavioral and emotional changes that lie ahead. For the most part, your surgery date is the starting line. You’re nervous. You’re excited. You’re hopeful. Similarly, the marathoner heart is pounding long before the starting gun is fired. The gun is fired and suddenly…they’re off! The first few days after surgery, you’re just trying to do as told. Listen to what the surgeon, the nurses and other professionals’ tell you and get home from the hospital as soon as you can. The marathoner is just putting one foot in front of the other and trying to find a good pace…a comfortable groove. Nothing fancy, just moving ahead. The first few weeks after surgery are like the marathoners first few miles…nice and easy. Learning to chew, learning what to eat and what not to eat…adjusting to the new pace of eating and making other changes in your life to improve your chances of success. Much of the journey lies ahead and thinking too far ahead can be daunting. Keep your head in the present. At some point, there will be bumps in the road. The runner may have a side-stitch, a cramp, pain, fatigue, a pebble in his shoes; some complications to be addressed. The marathoner understands that some of these discomforts will come and go. Sometimes, if you just let it be and shift your focus to other aspects of the running experience and away from the discomfort…the discomfort goes away. It is important that the marathoner not panic about the situation. The journey through weight loss surgery will also have its discomforts. Like the marathon, many will simply come and go. Some days may be more difficult than others. On some days eating may be more difficult than other days. On some days, cravings will seem stronger than others. In most instances, the discomfort will be temporary. Avoiding “catastrophic” thinking is the key. I am speaking of the mental demons that we all must deal with. Often while running, it seems as if a little devil appears on my shoulder whispering negative comments in my ear. “You’re never going to make it.” “You can’t do it.” “What were you thinking trying to run so far!?” “You’re not into it today…just go home and try again tomorrow.” Weight loss surgery patients also hear the voice of a little devil who attempts to derail you. “How am I going to avoid eating some of those foods that I love?” “What am I going to do at the holiday barbeque…I’m going to go nuts!” “I can buy a pint of ice cream and just have a little…what’s the big deal.” “A few cookies couldn’t hurt.” Part of your preparation for the marathon of weight loss surgery needs to include maintaining a positive attitude that can help you last the equivalent of 26.2 miles and to develop strategies for coping with these mental “cramps” and “side-stitches.” What am I going to tell myself when and if things get a bit complicated? What you tell yourself is immensely important in determining how and whether you will reach the finish line. Believing that you can cope with some of the temporary and unpleasant bumps in the road is essential for your success. Many of my patients initially get quite deflated by setbacks or slips. Most times, they are engaging in what I call “black and white thinking.” In this way of thinking, eating one serving of ice cream immediately becomes “I’m sabotaging my surgery!!” One day of feeling deprived or hungry becomes “My band isn’t working!” or “I’m never going to be able to live this way!” It is dramatic, exaggerated and self-defeating thinking. The marathoner’s mindset needs to be focused on “how I can” not “why I can’t.” There is nothing propelling the marathoner forward other than his or her own desire to persevere. He can stop with one step, but CHOOSES not to. He tolerates the discomfort. You also can stop. You can “cheat.” You can avoid getting your band adjusted. You can eat around the bypass. You can drink your calories. You can eat sweets. But you won’t finish the race and you’ll feel terrible for it. Several miles further down the road, the marathon becomes a strange combination of harder and easier. The marathoner has plenty of discomfort. Discomfort is probably an understatement. His body aches, his feet burn and his mind is often numb…but at the same time, he is beginning to almost taste the finish line. There are fewer miles ahead than behind. There is a mild euphoria as he considers that he might actually make it!! The surgery patient has lost a lot of weight several “miles” into her race. Perhaps most of the weight has already been lost…or maybe it’s already all off and now she’s focused on keeping it that way. But perhaps there are still some discomforts. Maybe some people continue to make annoying comments, or you have some body image concerns, or are experiencing other sources of anxiety and insecurity. It will be ok. Keep the focus on the here and now, avoid catastrophic thinking, and address what needs to be addressed. Try to taste the finish line. It’s not much farther now. This is where the analogy ends. The marathoner raises his arms as he crosses the finishing line and gasps in a combination of exhaustion and euphoria….I did it!! It is an incredible accomplishment. He is finished. But as a person who has had weight loss surgery, you will always be running your race. Through time, your pace will hopefully become more predictable and steady, but the journey of weight loss surgery never truly ends. There are always “side-stitches” and “cramps” and little “pebbles in your shoes.” Rub out the cramps. Take a few breaths to relieve the side-stitches. Step off the track for a moment and shake out the pebbles in your shoe. Focus away from whatever the source of discomfort. There’s no timer anymore so there’s no rush to the finish line. Take each day as it comes, some better than others. Just keep a steady pace, a clear focus, and a positive attitude and you will successfully cross a thousand finish lines. Important lessons to remember: · Stay focused in the present. Avoid thinking of how far you still have to go. Instead, focus on how far you’ve come. You cannot effect change in any moment other than the present one, so thinking about and certainly worrying about the future is in many ways both pointless and counterproductive. It only creates anxiety and ruins the present moment. By focusing in the present, you will get to the future faster than you think. When I run, if I focus on the fact that 90% of the distance lies ahead, I immediately feel tired and overwhelmed. When I simply take it one step at a time and enjoy the run, by the time I next think about my distance I’m that much further along and confident that I’ll get through it. · Keep your “qi” (pronounced “chee”) about you. Qi is the circulating life energy that in Chinese philosophy is thought to be inherent and flowing in all things (it’s like “the force” in Star Wars). I think of qi as being a peacefulness, and being at one with the world around me. When I run, I feel more alive than at any other time. I am at one with the world around me. I am moving through the world and feel the world moving through me. Live in the current moment and allow yourself to experience all that you are experiencing. Be present in the present. Avoid thinking of what is wrong or what could go wrong. Instead focus on what is wonderful right now. · Most of the physical and emotional discomforts that you will experience on your journey will come and go. Maybe not right away or even today. But most discomforts do not last forever. Just as many of the runner’s side-stitches and cramps work themselves through, so will yours. · Avoid focusing on small and meaningless detail. Don’t weigh yourself incessantly and get down on yourself for every calorie. Do not become overly disappointed if you do not achieve these silly and arbitrary goals. The marathoner can choose to obsess about his slightly slow pace and tragically turn a remarkable event into an unbearable trek. · Believe that you can “stand” some discomfort. Telling yourself “I can’t stand it” will lead you to not stand it. The marathoner perseveres through extraordinary physical and psychological challenges to reach the finish line. It is not an easy path. Your path too will be littered with obstacles. Trust in yourself and believe that you “can stand it” as well. · Focus on the journey and the big picture. The transformation. The accomplishment of weight loss surgery is not in losing a certain amount of weight. It is about being able to make positive, meaningful change in your life that is now possible at this lower weight. Success isn’t achieved through a number on a scale; it’s by being able to live the life you’ve always dreamed of. · Enjoy the run, not just crossing the finish line. In every moment of the race and in every moment of your journey…take a look around. Breathe in what is beautiful and enjoy each moment. Don’t live your life only in anticipation of crossing the finish line. When you have reached the finish line, I promise you that you will look back and think very fondly of the race you’ve run. :thumbup:

"Emotional Eating" is one of the most common topics addressed with regards to weight loss surgery. Every weight loss surgery book, blog and website is full of articles explaining the causes of emotional eating and tips on how to defeat this dangerous villian that threatens to derail your success from surgery! Hold onto your seat because I'm going to try and convince you that "Emotional Eating" is an overused and incomplete expression to describe the very problem the problem it is supposed to address. I'm also going to provide you with a new way of thinking about your eating behavior and a methodology to change it so that you can have more success from weight loss surgery. "Emotional Eating" is generally thought of as eating that occurs in response to a particular emotional state. The basic premise is that a particular emotional state somehow triggers undesired eating. Some people eat when they're depressed, some when they're nervous and others when they're angry. Of course, others eat when they're happy or in the mood to Celebrate. In fact, virtually everyone on the planet does the latter. If humans didn't eat in response to positive emotions half of the restaurants around the world would close within the next few weeks. Thanksgiving would be cancelled and Christmas dinner would be no different than Tuesday's leftovers. What about eating in response to negative emotions...is that fairly universal as well? I can confidently tell you that in working with thousands of patients over the past 20 years, many of whom were NOT surgical weight loss patients, that almost everyone has used food on occasion to provide temporary relief from emotional distress. In fact, many researchers believe that our brains are actually pre-wired to use food in this manner. Such researchers will tell you that drugs such as heroin, cocaine and others are actually "hijacking" the receptors and neural pathways that were designed for food! So there you have my first problem with the expression "Emotional Eating"....JUST ABOUT EVERYONE IS AN EMOTIONAL EATER TO SOME DEGREE, so labeling yourself an "Emotional Eater" is to state the obvious. However, it is interesting that there is considerable variability in the behavior of those who describe themselves as emotional eaters. As I mentioned, some people eat in response to one emotion while others eat in response to others. Some people eat in response to mild disappointment while others eat only when they feel really distressed. Why is this so? The reason for this and for a wide variety of eating behaviors is that most eating behavior is "learned." I will spare you an Introduction to Psychology class and try to minimize the psychobabble, but consider that when it comes to human behavior, we do what we do either because of our genetic endowment or what we've learned. Nature (genetic) or nurture (learning). Much of this learning isn't voluntary. In other words, most of your eating behaviors were not learned the way you would learn to play the piano. Much of what we've learned we picked up by watching others or by being instructed by others or through trial and error and the positive or negative consequences that followed. Learning as it relates to food and eating begins on day one. Consider that at birth the behavior of a newborn is 100% genetic and 0% learning. Nothing has happened to the newborn child yet so they haven't learned a thing. Nurture has yet to exert an influence...it's all nature. Whatever a newborn does is pre-wired. But that changes almost immediately. Here comes the first bottle...yum! Sweet sugary milk. Lesson one: Milk tastes good and feels good going down. Later that day the baby cries...mommy rushes in with a bottle. Lesson number two has just occurred: I cry loud enough and mommy feeds me. I feel better and I stop screaming. Food is a reward and soothes my distress...and I am now in complete control of mommy!! "Learning Eating" quickly proceeds in leaps and bounds in childhood. There's a very good chance (for example) that you "learned" to clean your plate because your mother told you that you had to and that you wouldn't be allowed to have dessert if you didn't. Or perhaps you received Cookies as a reward for good report cards or for cleaning your room. Now as an adult, long after mom stopped giving cookies for good report cards, you continued the habit of rewarding yourself for your daily successes. I can think back to all of the times that I was offered chicken Soup by my grandmother when I was disappointed for some reason or another as a kid. There is still no scientific evidence that chicken soup is effective in treating disappointment or depression, but the soothing taste of the soup sure does make you feel a little better. Even better, eating chicken soup today at age 41 provides me with warm memories of my grandmother. Starting to get the picture? From a young age, we quickly "learn" to like certain foods for certain reasons and develop eating habits and preferences almost completely without effort and often without any awareness. By using the term "Learned Eating" you are more elegantly and accurately describing what is really going on here. The concept of "learning" better answers the questions of "Why do I eat this way?" and "How did I develop these problematic eating patterns?" Also, "Learned Eating" accounts for more of your eating behavior than just what is triggered by emotions. All of the behaviors that we commonly call "habits" are more accurately called "learned behaviors." So "Emotional Eating" is just one of the many types of eating behaviors that you've picked up (learned) throughout your life. The real #1 reason that I'm trying to get your vote for "Learned Eating" is that this expression makes you empowered and able to change. Everyone is familiar with the concept of learning because we are all students in our own way. You don't need to be a psychologist to understand "learning." "Learned Eating" is a simple concept: If you have "learned" maladaptive or destructive eating behaviors that have contributed to weight gain, you can also "unlearn" these behaviors and "learn" or "relearn" new ones that help you keep the weight off after surgery. Emotions are a whole other murky, mysterious matter. Many people feel confused by the concept of "Emotional Eating." It doesn't empower you. It doesn't tell you how to change. So many people ask me, "I can't just stop feeling depressed, anxious or even happy. So how can I stop eating in response to these emotions?" The answer is that you need to understand how your emotions have become triggers associated with eating. Only then can you change your behavior. That is the stuff of "learning." Here's an exercise to put the concept of "Learned Eating" to work in helping you to identify and correct some of your unwanted eating behaviors and to learn some new healthier ones. In fact, this exercise is one of the very exercises that I do with "emotional eaters" who come to me for assistance if they're struggling to make changes in their eating behavior either before or after weight loss surgery: Take out a few pieces of paper and make six columns going from the top to the bottom of each page. Write the following headers on top of each column from left to right: Food eaten, Time of day, Location, Reason, Thoughts, Feelings. Over the next two weeks (14 days) write down what you ate, when you ate it, where you ate it, why you ate it and what you were thinking and feeling when you ate it. I know, you hate writing things down. Want to learn? You've got to do your homework. The purpose of this exercise is to learn as many of the associations between your eating and its causes as possible. In case you're wondering, you can think of the feelings column as the "emotional eating" column. Now there are certainly more than 6 causes for your eating behavior, but this will give you tons of useful clues as to the cues that trigger your eating. By filling out these forms you will start to see what is pushing your eating buttons. Sometimes it will be genuine hunger. When this is the case, be sure to write "hungry" in the "why I ate it" column. Sometimes you're going to eat potato chips because you were bored. Write "bored" in the "why I ate it" column. Sometimes it will be an emotion like loneliness that triggers your urge to eat. Write "lonely" in the feelings column. Always fill out every column because you are going to find some surprising associations by completing these logs. You're going to find that where you are and the time of day are often the key triggers and not just that you were bored or lonely. You will find that feeling depressed isn't always the trigger for eating but feeling depressed when you're alone on a Friday night seems to push the potato chip eating button. Very important and useful information. Learning to identify all of the cues, triggers and associations between your internal world (thoughts and feelings) and external world (people, places, times of day, etc) allows you to see what pushes your brain's eating buttons. Having this information allows you to comprehensively assess your eating behavior and to identify where and how to make changes. For example: should you clearly see from your logs that being alone at home at night is almost 100% associated with eating ice cream, you now know that you must address what's going on at home under these circumstances. Perhaps you need to change what you're doing at home at night or consider finding ways of getting out of the house some evenings altogether! Here's another example that you probably already know: The very sight of certain foods is a big trigger for eating. This one is easy to fix and many of you already know this....stop bringing the foods you find irresistible into your home! Either unlearn the habit of bringing cake into your house or relearn by bringing in healthier foods to eat. Hopefully, I've convinced you that emotions are really just one of many triggers for eating and that "Emotional Eating" is no longer the best or most comprehensive concept to use if you want to make significant changes in your eating behavior. The concept of "Learned Eating" better explains how to understand, think about, and change your behavior. Take the time to learn as many of the cues, triggers and associations that relate to your eating behavior so that you can begin making changes in your eating and become more successful in keeping the weight off beginning right now. Do your homework...it's due tomorrow!! :wink2:

Holiday season is upon us and it's time for the 3 "F's"... friends and family, festivities, and food. My message to you is quite simple...keep the last "F" in perspective. This is the season when we give thanks, cherish our friends and loved ones, share experiences, have fun, give gifts and look forward to the promise of the new year. food and eating is intertwined with all of these activities, but should be neither "THE" activity nor "THE" focus. Each of us would probably love nothing more than to stop thinking about eating, food or (most of all) our weight. During this time of year, focus on enjoying your loved ones and the opportunities to Celebrate the season. This is what life is really about so try to enjoy every moment. Sure, continue to watch what you eat and don't let things get too out of hand during the season of fruitcake and chocolate covered everything... but even if you do, just let it go. It's really not that important. If you eat too much one moment, just begin anew the next...don't make the mistake of making yourself miserable over a stupid piece of cake. I promise you that twenty-five years or more from now, when you're older and grayer....you're going to tell yourself that you should have enjoyed your loved ones and all of the opportunities you had to spend with them even more than you did. I guarantee that when you're rocking in your rocking chair you will not be telling yourself that you should have spent more time focusing on your weight and you're certainly not going to lament about the extra scoop of mashed potatoes that you ate on Thanksgiving in 2008! If per chance the holidays are a painful or lonely time, make every effort to begin new traditions with new people. You don't have to allow every holiday season to be a reminder of those you have lost or memorable times gone by. Every town and community has holiday social events that you can plug into. It requires some work, but things can absolutely be different if you make the effort to make it so. So, should an errant chocolate melt-away or piece of pecan pie or turkey drumstick wind up in your belly by mistake, keep things in perspective. Don't condemn yourself for hitting a bump in the road en route to whatever weight loss goal you are pursuing....that just leads to self-hatred and more eating. Let it go, give yourself a break and most importantly....enjoy your loved ones and the holiday season. Happy holidays!:thumbup:

As I was reaching for one of the few remaining pieces of Halloween candy that is still in my kitchen it occurred to me that successful behavior change is all about what you do "in the moment." "The moment" is that brief second between initiating the behavior and executing the behavior. With regards to eating it is the millisecond between reaching for the food and putting it in your mouth. There I was standing in my kitchen, holding the mini-Butterfinger that I just unwrapped in my hand. As I was raising it to my mouth...I stopped. I don't know why I stopped on this occasion as I had eaten several pieces of candy over the past two weeks...but I did. In that instant it occurred to me that this is the exact moment where behavior occurs. This is the tiny window of time when I can alter my behavior or allow it to proceed as per usual. The window was open. I felt very powerful in that moment. I was in charge. I was mindful of the importance of this moment. It occurred to me that this is "thee" moment...the only moment where behavior change occurs. Not before and certainly not afterward. I felt as if I was in total control. Although the moment could have lasted for just a nanosecond, I stayed in it for what seemed like an hour. It seems like a simple reflex of either putting the candy in my mouth or putting it down, but it really isn't. "The moment" involves a series of small but crucial steps that dictate what will happen next... The first and most important step is to STOP! Most of our behavior occurs while we are completely on auto-pilot. We just go about our day doing 95% of what we do without a thought. We walk without thinking, we drive without concentrating, we eat without being aware. Most behavior can proceed without conscious thought. To change, you have to stop and step out of auto-pilot. On this moment, for whatever reason, time stopped for me. I suddenly became mindful of the moment and stopped what I was doing. The next step is to BREATHE. Really this step involves taking a second to step back from the moment, now that you have stopped what you were doing. It is advisable to take a breath to relax and focus on what is happening. You're in charge. You can to alter your behavior. The next step is REFLECT. Reflection is thinking. What do you want to do? What are your choices? Do you want to go about business as usual or do something different? What will the consequences be if I change or if I proceed as usual! I asked myself..."Do you want the chocolate?" "If you eat the chocolate, how will you feel about it afterwards?" "Aren't you trying to control your weight?" "Is eating this chocolate really what you want to do?" Of course these questions occur in an instant, as do most thoughts, but they definitely were flying through my mind as I was holding the candy in hand. The next step is CHOOSE. I had to make my choice...eat it or put it down. Having reflected on the moment, you choose what to do. You execute your decision. I put the candy bar in the garbage. The final step is EVALUATE. This is a post-behavior reflection. How do I feel about my choice of behavior? Would I do it again? If not, what would I like to do differently? How can I make sure this behavior either happens again or how can I prevent it from happening again? So there it is..."the moment"...a nanosecond of time during which we have the ability to change. The time to step out of auto-pilot and be mindful. I was fortunate that this moment arrived with little help from me. I am confident that you have had these kinds of moments as well. Perhaps you never realized just how much was going on in your mind during that instant of time. Going forward, especially when you're eating or are about to eat, try to STOP!..BREATHE... REFLECT...CHOOSE and see if you can more consistently alter your eating behavior so that it is more consistent with your long-term goals of losing and maintaining your weight. Consider writing down this little series of steps and reading it several times per day in an effort to commit it to memory so that you can make mindfulness more automatic. STOP! > BREATHE > REFLECT > CHOOSE > EVALUATE Best of luck!:smile2:

The world doesn’t seem to like overweight people. Discrimination against the obese is widespread and many patients have provided me with examples to illustrate just how common it is in everyday life. The truth is; I knew this already because I’ve been there myself! The demeaning treatment takes its toll. Most of my patients report that their self-esteem and self-image has suffered due to their weight. Many patients also describe how their weight has impacted their intimate and social relationships, as well as their careers. Therefore, overweight people would have to develop some pretty strong coping mechanisms to make it through their days without going off the deep end. There are three common coping strategies that people describe prior to weight loss surgery: 1) trying to be funny, 2) tolerating a lot of mistreatment from others and being “a doormat,” and 3) becoming bitter and angry and keeping others at a distance. Each of these strategies has its problems, but there is a common resolution. I. The funny guy It may seem to be a stereotype, but I can attest to the fact that a lot of overweight people are funny. Whether morbidly obese people are significantly funnier than thin people is uncertain, but I’ve spent a great number of hours laughing on the job. Unfortunately, the humor is often self-deprecating. It’s an adaptive strategy…survival of the funniest. Obese patients (and others) describe two functions that self-deprecating humor can serve: 1) I cut myself down before you have a chance, which seems to protect me while at the same time disarming you, and 2) it may endear me to you…we often like the funny guy. The strategy is simple: My sense of humor is a characteristic you might find attractive should you find my appearance to be unattractive. There are many reasons why heavy people should abandon this strategy – if for no other reason than it generally backfires in the long run. However, there is often a temporary benefit, which is why it persists. It’s probably less likely that you’ll insult me now that I’ve just insulted myself – but in the long term it will probably make you feel more comfortable insulting me, given that I’ve demonstrated that I’m seemingly comfortable with it. Even if you believe you’re comfortable with these barbs, I would argue that you’re not, and in either case it serves to erode your self-esteem. Some might argue that you eventually get used to it, but actually most patients tell me that they hear fat jokes often enough that they start to believe it. At some point, you start to believe it even though you don’t want to. II. The doormat The doormat is basically the funny guy without the sense of humor. The doormat just takes it all in…the jokes, the comments, the sneers, the constant diet suggestions, and on and on. The doormat has very low self-esteem and believes that he may actually deserve poor treatment from others because he is overweight. Like the funny guy, the doormat believes all of the comments and is often quite depressed. The doormat might be more isolated than the funny guy because he lacks the strategy of humor to attempt to win others over. III. The bitter and angry loner The bitter and angry loner doesn’t take a lot of garbage from others; he dishes it out! This person is angry at the world and fends others off, not through humor, but by being a bear. The bitter and angry loner isn’t seeking to be endearing to others, but rather to keep others away from him. The strategy is “I’ll hit you before you hit me!” While it does defend him from other people’s comments and opinions, he’s not having a particularly good time of it, and it isn’t truly keeping his esteem from being diminished. This type of patient will tell me that other people are mean and nasty and that he’s ok being a loner because there is nobody in the world that is worth his time anyway. The problem is that he doesn’t really believe this. He desperately wants to be proven wrong and to have meaningful relationships with others. As you might expect, it’s not easy for him to make new friends. He doesn’t want to get hurt so he is defensive and very hard to get close to. What happens to people who use these coping strategies following weight loss surgery? I am known for telling my patients that weight loss surgery will take care of “fat body” long before it does anything for “fat brain.” Put simply, you will lose weight much faster than you will lose the perception that you are overweight, and faster than you will repair the emotional damage that being overweight has caused. For many patients, being overweight was a major ingredient in the formation of their personality…and personality doesn’t change so quickly. Sometimes, these coping styles decline gradually with reductions in weight, but more often it takes work for them to change and it is imperative that you try to accelerate the process. In theory, the task is rather simple – act as if you were thinner and your “fat brain” will catch up with your “thinner body.” Think about how people who are not concerned about their weight act in social situations and “act as if” you were one of them. We know that it is not as easy as it sounds, but it doesn’t have to be terribly complicated either. IV. Assertiveness The term that describes the behavior we are looking for is “assertive.” There are a number of definitions of assertive and volumes have been written on this subject. Put simply, assertive means that you are communicating in such a way as to defend your rights and pursue your goals, while respecting the rights and goals of others. Assertiveness, like all forms of communication is both verbal and non-verbal. You are communicating by both what you say and what you do. By being assertive, you are demonstrating to others that you think well of yourself and expect others to treat you with the same amount of respect as they would want from you. Being assertive means speaking directly and honestly. Being assertive does not mean that you are cocky or arrogant. In fact, you can be assertive and quite friendly. You’re simply displaying self-respect through your words and actions. Contrast assertive with the two other types of behavior: passive and aggressive. Passive means that you are sacrificing your rights and goals for the benefit of others, while aggressive is when you are sacrificing others’ rights in the pursuit of your own wishes and goals. Put another way, passive is when you allow yourself to get trampled by others while aggression is when you are trampling over others in pursuit of your own objectives. Assertiveness is the win-win scenario. That’s not to say that everyone is happy, but the intention is that nobody gets hurt. Let’s now briefly go back to our three coping strategies. When an obese person is being self-deprecating through humor or allowing others to do the same, she is really being passive. The jokes may appear adaptive and harmless, but the consequence is generally that you feel badly about yourself. This is not to say that you need to abandon your sense of humor, but the focus of the joke needs to change. When a person is being a doormat and simply absorbing the comments and mistreatment of others, she is again being passive. When a person is being bitter and angry, he is being aggressive. I should note that I’ve met my share of heavy people who were comfortable being assertive long before they had surgery and lost weight. They are the ones who refuse to hide in shame or make excuses to the rest of the world. These folks often acknowledge their size but will not allow it to be an excuse for mistreatment from others. They simply refuse to allow an entire social interaction to go in a certain direction solely because of their weight. They respect themselves too much to allow that to happen. They view their weight as one aspect of themselves, and not one that justifies shame and abuse from others. After weight loss surgery, these folks generally adjust rather quickly and often report feeling whole again. Such patients often tell me that their image in the eyes of others is apparently now commensurate with their appearance. They act like they deserve respect and they now look the part. If you see a bit of yourself in the funny guy, doormat, or angry and bitter loner you can work towards achieving the same assertive endpoint. V. Getting to work The funny guy and the doormat are trying to speak up. These two have been avoiding confrontation by either laughing things off or simply ignoring them. They need to learn to address others more directly and stop letting things slide. The bitter and angry loner has been avoiding people or yelling and screaming at others to get them to back off. He needs to try and tone things down a bit and learn to play nicer with others. Clothes shopping is a perfect opportunity to practice becoming more assertive. When shopping for clothes, many overweight folks can recall being greeted by a rude or disinterested salesperson. Before a single word has been exchanged, there is an opinion forming. Even if it turns out that a particular store doesn’t have something in your size, there is an appropriate way for a salesperson to express this fact. The manner in which an obese person can be told by a salesperson that they don’t have a particular size need not be any different than a tall person is told the same fact, but generally it isn’t. Don’t allow it! If the salesperson seems reluctant to give her full effort, indicate that you expect to be treated the same as any other customer, and if after repeated efforts to find something, you are unable you will gladly concede. Don’t be funny and make jokes about it, and certainly don’t be a doormat and simply head for the exit. If you see yourself as the bitter, angry type; resist the urge to jump down the salesperson’s throat. Causing a scene will not make her want to help you and you will not be gaining self-respect or her respect either. Insist that she help you in the same way she would help someone who was a size 4. Notice, we’re not taking no for an answer (passive) and were not verbally assaulting the salesperson (aggressive), we’re simply asking for the same treatment that anyone else would receive (assertive). Whether you are buying a sweater, negotiating the terms of a mortgage, or ordering a decaf latte it doesn’t matter. Any time that you are dealing with other people in this context, you are within your rights to insist that you are treated with respect. In conversation with friends and family, make efforts to get the focus off of your weight. People who are unconcerned about their weight don’t talk about their weight. Neither should you. Imagine talking about how you were heavy for the next 20 years! It gets old after awhile. Recall that one of the reasons you had surgery was to make your weight a non-issue. Hopefully you will be hearing some compliments and words of encouragement. Take it all in, but then try to talk about all of the other things going on in life…what you are doing and what things you aspire to do…just like everyone else! Certainly do not tolerate negative comments about your progress. Everybody thinks they’re an expert. Many people will tell you that you should have lost more weight by now or they will comment negatively if they see you eating a piece of chocolate. In the past, the funny guy would have made a joke about the comment and the doormat would have said nothing or might have agreed. The bitter and angry loner would have shot an insult back, perhaps throwing in some colorful language in for good measure…but not today! Politely let them know that you and your surgeon (the two true experts) agree that things are going as they should and that you appreciate their concern. If you wish, you can then let them know how they could be more supportive. Let’s assume that people make these silly comments because they are trying to help. Your job is to educate them as to what they can say or do to be helpful. Unfortunately, there may be an individual who doesn’t seem to be championing your cause. Perhaps this person is threatened by your weight loss. Maybe they don’t like the fact that you’re now in the limelight and they want to knock you down a peg. Let them know (assertively) that you won’t stand for it. Take them aside, if possible, and let them know that their comments are upsetting and unwarranted and that you would like them to stop. Maybe they didn’t even realize they were saying things that you found upsetting. If this diplomatic approach does not work, do not become aggressive. Be increasingly assertive. Make a statement that is more forceful, or when they say things in the company of others, immediately comment that you find their comments to be inappropriate and would like them to stop. They will actually be embarrassing themselves in front of others, and that should do the trick. If not, you need to question whether or not you want to continue the relationship. Unfortunately, after weight loss surgery many folks learn that the people they thought were friends were not such good friends after all. VI. Going forward At this point, you want to seek out opportunities to experiment and flex your assertiveness muscles. Make it a point to practice these skills as often as possible. The world does a fine job of putting us in situations where we need to express ourselves and make our wishes known. Don’t shy away from these situations. Also make it a point to practice some of the more subtle non-verbal forms of assertive communication. Work on making more eye contact and maintaining a more assertive posture…no slouching! Face people when you speak to them, rather than angling off to the side. The use of hand gestures is often a sign of assertiveness; practice these as well. With continued effort you will no longer feel as if you are acting as if you were a different and more assertive person…you will be that person; healthier both in body and mind!

Perhaps no topic in the area of weight loss and weight loss surgery receives as much attention as “emotional eating.” Hundreds of articles and books are written on this topic every year appearing in magazines, newspapers, websites and other media sources. But what exactly is emotional eating and why does it receive so much attention? Emotional Eating Defined The term “emotional eating” is in many respects a “garbage-pail term” that is often used to refer to any form of eating that is not purely hunger-based. Most discussions on emotional eating also explain it as a behavior that one should make every effort to minimize, if not terminate completely. However, the irony is that everyone is an emotional eater to some degree and life would be quite joyless if all forms of emotional eating were to be eliminated. Fortunately, this is not necessary. Most folks seem to make a distinction between two types of emotional eating: eating in response to positive emotions and eating in response to negative emotions. Positive emotions are desirable or pleasant such as happiness. This form of emotional eating often relates to celebrations or accomplishments. In this way, holiday meals are a form of positive emotional eating as is going out to dinner to Celebrate a promotion at work. Negative emotions are unpleasant and are generally seen as undesirable. Eating in response to negative emotions is often a way of attempting to provide oneself with comfort. Eating when you are depressed or lonely or nervous are examples of eating in response to negative emotions. In general, eating in response to negative emotions is the type of emotional eating most folks view as being more problematic as the former seems to be almost an inherent part of every culture on the face of the earth. As an example, one of my former patients, a rabbi, jokingly describes the three characteristics of a Jewish holiday as: “they tried to wipe us out, God saved us, let’s eat!” I’m not suggesting that there is no benefit in addressing eating in response to positive emotions; however this is not the focus of the current discussion. So let’s focus on eating in response to negative emotions and to simplify our discussion, simply refer to this as “emotional eating.” One interesting aspect about folks who describe themselves as “emotional eaters” is that in my experience the behavior is often described as being non-conscious or out of their awareness. I refer this state as being on “autopilot,” similar to a plane that is flying itself without a pilot making active decisions as to where the plane should be going. Here’s why. Very rarely do patients describe incidents when they would feel an unpleasant emotion and then consciously decide to immediately march to the refrigerator or corner Quick-mart for a snack. Emotional eating is far more subtle than that. Much more common is that the person recalls a situation when they were surveying the contents of their cabinets or refrigerator and doesn’t even know why they’re there. Some folks go so far as to recall times when they were halfway through eating a bag of corn chips and they don’t even recall eating the first half. They were on autopilot. How does this happen and what can you do to stop it? The Evolution of Eating on Autopilot Consider that eating is almost an automated behavior in that you can do it without paying attention. Walking is much the same way. Initially, when you first learn to eat or walk as an infant, you need to pay attention to learn the skill. Watch any infant taking her first few steps and you will see the focus and determination she has to stay upright and not to fall. She’s really concentrating on what she’s doing. Similarly, when feeding babies with solid food for the first time, we cut up the food very small and feed the baby very small bites because we recognize that eating solid food is a skill that babies do not yet have. We make the decisions on food types and sizes at this stage because we don’t want them to choke. However, in very little time, both eating and walking become activities humans can do with almost no effort. Think about this for a moment. Now, as an adult, when you walk, do you actually think about which leg to move next or do you just seem to go? You can walk a mile without once thinking about your legs or feet for even one second. There’s no thought at all…you’re on autopilot. When you eat it’s the same story. Most adults don’t think about chewing. They can hold a conversation with five people and wipe out an entire plate of food without ever paying attention to their chewing at all. If you’ve had weight loss surgery, you know just how powerful this “eating autopilot” can be because you’ve had to relearn a lifetime of eating behavior that no longer works. After surgery, you had to learn to pay attention and chew more, eat slower, avoid drinking while you eat, etc. These behavior changes probably took awhile to master. In fact, many of my patients who’ve had gastric banding, for example, commented that relearning how to eat was the most difficult part following their surgery. Now let’s turn back to emotional eating. Many of you can recall experiences from childhood where food was given to you as a reward for good behavior or withheld from you for unwanted behavior. Similarly, you may have been offered food to make you feel better when you were disappointed, sad or experiencing some other unpleasant emotion. Almost immediately food and eating was linked to emotions. My grandmother was convinced that chicken Soup could cure anything! And you know what…she was right! It doesn’t take a rocket scientist to recognize that you do feel a bit better while you eat chocolate or nacho chips or whatever your favorite food is. Even folks that didn’t have food thrust upon them to help them cope with negative emotions as children can often recall picking it up themselves later as adults. It seems very easy for humans to learn to eat as a means of coping with emotional upset. Let’s face it…for most of us, eating feels good. Whether it’s the taste or the emotional associations we make with certain foods (comfort foods) or certain people (grandma) or purely a neurochemical affect (serotonin, etc) eating feels good. Unfortunately, what you also probably know is that if you are eating ice cream at night because you are feeling lonely and sad, while you might feel a little sense of pleasure from the ice cream, it does nothing to address the loneliness and sadness and it does wreak havoc on your waistline. Even though it doesn’t really help us cope with emotional upset in the long run, we keep on doing it because it feels good immediately and the consequences of emotional eating are generally delayed, if only by a few minutes. What happened is that over a period of many years, you “learned,” that food has, or is believed to have, the ability to minimize or eliminate your emotional distress. Now, when those feelings arise, you feel compelled to eat as if you’re automatically programmed to do so without even being aware. You’re now running on autopilot. When asked to describe the feelings they have just before eating, many of my patients describe feeling bored or calling it “blaaaaah” referring to some vague, negative emotional state. So if you’re an emotional eater as I’ve described, and you’ve put on a lot of weight as a result, you are not stupid, you are not lazy, you are not pathetic…you are human. Most important for you to understand, you are most certainly not helpless. You need to fix your hard drive and get you out of autopilot by unlearning some ingrained, overlearned maladaptive behaviors in favor of some new more adaptive ones. Shifting out of Autopilot “Recognizing that you have a problem is half the battle!” No it isn’t. That sounds good when people say it but if it were true then being aware that you were 100 pounds overweight would immediately result in a 50 pound weight loss! Not so simple. What this expression means is that if you don’t become aware that you have a problem you can’t possibly do anything to remedy the problem. You must first be aware that this pattern exists in order for you to change it. There is a simple process that you can follow to help make changes in your behavior: Stop→Breathe→Reflect→Choose→Evaluate Let’s go through this one step at a time: 1. Stop! When you’re about to put food in your mouth, stop what you’re doing. It may sound easy but this is clearly the most difficult step. It’s hard to stop engaging in a behavior that you can do without a single thought. Eating is a mindless behavior. As I said earlier, you don’t have to think in order to eat any more than you have to think in order to walk. Hence the autopilot problem. The trick is to develop an improved awareness of your behavior. How can you learn to be more aware? One of my favorite techniques is to put written reminders all over the place. Putting them where you eat is a good idea but other places are great as well. You’re trying to bake this awareness into your brain and knock your brain out of autopilot. Stick those colorful sticky square notes on your bathroom mirror to remind you first thing in the morning to change how you eat. They can say “Be aware of your eating” or even just “STOP!” You’ll remember what it means. Put another note on your rearview mirror in your car. Put another one on your computer screen. Put another one on your refrigerator. Sounds a bit nutty, but if you are truly committed to change you need to remind yourself to do it, otherwise autopilot will rule the day! Just like a computer that has default, automatic settings, so does your brain. Unfortunately, for many of us eating has become the default setting, so without the reminder NOT to eat, eating occurs almost automatically. Another recommendation is that you write down what you eat by keeping a food diary. I know, you’re sighing because you’ve heard this before and you hate this. However, the truth is that when you get into the habit of writing down what you eat, it definitely affects what you choose to put in your mouth. This is why you probably hate writing it down…because it works! After a few weeks of monitoring what you eat your eating habits will change. You will become more “mindful” of the entire practice of eating and will therefore be in a much greater position to change your behavior and CHOOSE to eat differently. Another idea is to put a message of some kind reminding you to eat differently in your schedule book or on your screen saver or on your PDA devise or anywhere that you look numerous times per day. On many occasions, I have written a phrase such as “focus on food” in my schedule book because I look at this book at least 25 times per day. With all of these tactics, and I encourage you to think of your own, the effort is to force your brain to focus on what is going on at this very moment rather than reverting back to old habits we are calling autopilot. 2. Breathe. The idea here is to create a natural pause and to gather yourself and your thoughts. Take a minute and stop what you’re doing and be mindful that you are about to make a change. Breathing helps us relax and makes it easier to focus on your thoughts and block out the world around you. When you find yourself holding open the doors of your cabinet searching for a snack…STOP! and then take a few breaths to gather your thoughts so that you can better decide what you really want to do. The breathing and the few second pause give you a space to slow the wheels down and make small but meaningful changes in your behavior. 3. Reflect. Reflect is a nice way of saying “think.” Now that you’ve stopped and taken a few breaths, think about what you’re about to do. You’re about to eat. Ask yourself a few questions and write them down because they’re going to be the same questions every time and it would be helpful for you to become familiar with the answers: · Am I really hungry? · Do I really want to eat this? · Why am I choosing to eat at this particular moment…what’s going on? · What is the purpose of my eating? · Will eating help my problem beyond making me feel good for 37 seconds? · If I do eat, how am I going to feel after those first 37 seconds? · What is the real issue that I’m using food to try and medicate away? · What is (are) the particular emotion that I’m feeling? · What else can I do other than eat that actually may address the real problem? This step is very important because it can help you understand the reason(s) that you are eating. As we said, eating is your autopilot or your default behavior. If you can learn to stop and think about what’s going on, there will be times that you recognize that your decision to eat was not random. At other times it will be simply because you were truly in the mood for a chocolate bar…and that’s ok from time to time. 4. Choose. The last bullet point above asks “What else can I do other than eat that actually may address the real problem.” This is the key to the whole process. This involves choosing alternative behaviors rather than eating that actually addresses the emotional distress that is leading you to eat. This is where actual change occurs. By choosing an alternative behavior you are actively shifting out of autopilot and proving to yourself that you are capable of making change and that you are not a drone who must obey the urge to eat. I strongly recommend that one of your alternative behaviors be contemplation and journaling. It’s great to develop alternatives to eating, but even better to gain a more thorough understanding of WHY you feel the need to do anything at all. One could make the argument that simply choosing an alternative to eating without becoming aware of why you need to do anything at all is just running away from your discomfort. For example, exercising instead of eating might be good for your health, but it doesn’t go any further in terms of helping you understand what’s causing your emotional upset and how to address it. I’m not suggesting that you need to make yourself miserable, but it is important that you learn what is creating your discomfort. It is also essential to learn that you can tolerate emotional discomfort which I discussed in my previous article on willpower. Seeking professional help or group support is definitely worth consideration if you are struggling on your own. Whatever new strategies you employ, you must practice your strategies every day. Your emotional eating autopilot evolved over a series of years and is quite ingrained. New strategies are going to take a while to take hold and become second nature. Keep the log of your eating long after you think it’s necessary. Keep the sticky square notes around for awhile. It’s important to know that you are going to have setbacks when you resort to emotional eating. Every battle will not be a victory. When these setbacks occur, don’t “catastrophize.” As I said in a previous article, it’s important that you not categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything. 5. Evaluate. Did your choice of strategy help? Were you able to close the cabinet and go back to the couch without a snack? Were you able to diminish your emotional upset some other way with some effectiveness? These are the questions you need to ask to implement the new changes. It is very unlikely that you’ll find one strategy that works all the time. Calling a friend might help some times, while taking a walk might help at others. Keep track of which strategies are helpful and under which circumstances so you can develop a whole toolbox of ways to combat emotional eating and better take care of yourself. Going Forward Most of the people that I have known who seem to have won the battle with emotional eating will admit that they’re still fighting the fight even years later. Although their new habits are strong and the old pattern of emotional eating seems to be gone, they still show up from time to time. I think about all of the people who told me how well they were doing on their diets and on their eating behavior change plans prior to 9/11/01 who recalled the whole thing seeming to unwind overnight in the face of such an incredibly stressful event. So many people tell me their goal is to be cured from the pull of emotional eating. They want the urges to eat in response to these negative feelings to stop occurring in the first place. While this is an understandable goal, it is not necessary one. If you really do your homework and learn new behaviors, learn to tolerate some discomfort and hopefully get at some of the other issues affecting your eating, through time, your new habits will become stronger and stronger and it will become far easier to resist the urge to eat. Even if the day when you no longer even consider eating never comes, it won't need to. You'll be able to handle it. Best Wishes!

Unraveling the myth of willpower I’ve always despised the term "willpower" because it’s one of those words that seems to say something, but says nothing. Applied to weight loss or keeping weight off, willpower is always cited as something you must have to be successful. When patients struggle to lose weight, they tell me it’s because they have no willpower. Willpower is spoken of as if it is the secret weapon in the battle of the bulge but nobody seems to be able to define what willpower is or how to acquire it. What truly bothers me is that willpower is often explained as something intrinsic…that you either have it or you don’t. This is utter nonsense. Anyone who has ever lost weight can recall at least one time when they thought "This is it! This is the time I’m really going to keep it off!" You felt as if you were in a groove. You turned away from cake and potato chips. You said no to second helpings. You were invincible! You even bought the smaller jeans to punctuate your accomplishment! But then there was a wedding, or a cruise or just a little, harmless piece of chocolate that you let yourself enjoy. Suddenly, your "willpower" seemed to be gone and you didn’t know how to get it back. Well that ends today. I have news for you. Successful weight losers do not have more willpower than you do. Unsuccessful dieters do not have less willpower than you do. The popular conception of willpower is nonsense. There is nothing magical about willpower. It is not something that you have one day and lose the next. I’m going to teach you how to make your own willpower. First, let’s expose the myth of willpower. Willpower found! When you lost all that weight way back when, it began with a conscious decision and a few key factors lined up in your favor. While it may seem that you suddenly had the willpower to start the diet and successfully begin to lose weight, what actually occurred was that emotion (motivation) and an awareness of the positive and negative consequences of weight loss were both in focus. Often by chance, the emotional energy to persevere is so strong that we tolerate hunger, frustration, cravings, etc. You might think that you were not feeling hunger, cravings, or frustration when you were losing the weight but in fact you were. They were simply dwarfed by the high level of emotion and motivation you had to tolerate them. Willpower lost! Unfortunately, this initial emotional thrust eventually wears off if there’s nothing else to give it more fuel. When willpower seems to suddenly disappear what has happened is that the equation has shifted. Reasons to eat the chocolate and the desire to eat it are suddenly greater than the initial emotional thrust to tolerate this discomfort. At this point, you begin giving yourself permission to go off track. You find yourself in an environment where temptations seem greater than before. You tell yourself things that enable a setback. Willpower didn’t go anywhere. And as you well know, from that point on, it was only a matter of time until the weight returned. You probably remember that awful feeling of powerlessness that you couldn’t grab hold of the reigns and turn things around. Of course, there are also times where an overwhelming emotional event may occur that throws your motivation out the window. 9/11 was such an unfortunate example for many of my patients. Making your own willpower Whether it is losing weight, quitting smoking, or accomplishing any other endeavor, there are a few specific actions that successful people take that make them successful: 1) Create measurable goals and write them down. If you’re not willing to write them down then you’re not really serious about success. Keep reading your goals every day or they won’t stay in the front of your mind. If they’re not in the front of your mind, they’re in the back of your mind. If they’re in the back of your mind, they’re useless. 2) Motivate yourself to accomplish each goal. Ask yourself "What’s in it for me (WIIFM) to accomplish this goal?" Then ask yourself "What is the consequence of failing to accomplish this goal?" Identify short and long-term goals as well as short and long-term consequences. Don’t dance around this issue…be honest. There are real negative short-term consequences of dieting and keeping weight off. Hunger, feelings of deprivation and temporary emotional distress are a few. Fear of being without food as a comfort is another. Having a clear list of benefits that you will gain in the future in exchange for tolerating these negative consequences in the short-term can help you through these tough times. Ask yourself "What do I stand to gain, both now (within a few days) and in the future if I stick to my goal of losing weight." This is the real definition of willpower: being able to tolerate frustration or discomfort in the present in exchange for a desirable outcome in the future. Perhaps a better phrase for willpower is discomfort tolerance or frustration tolerance. Take your time with this step. Remember, in order to have the ability to tolerate frustration and discomfort when they strike, you need to be acutely aware of "what’s in it for me?" 3) Make clear action steps that you plan to take to accomplish the goal. The goal itself is not as important as understanding the behavioral steps you plan to enact in order to accomplish them. Ask yourself "what am I going to do to accomplish my goal. Also ask, "What do I need to stop doing or do differently if I am to accomplish this goal. For example, don’t ask yourself "How am I going to find the time to exercise?" Ask yourself "How am I going to make the time to exercise." Then take out your blackberry or schedule book and figure out exactly what you are going to shift around to create the time to exercise. 4) Practice your strategies. Ever notice that the best athletes practice almost EVERY DAY?! Batting practice, free throw practice, the driving range, and on and on. Practice is what makes people successful. It’s not willpower. In case you’re telling yourself that it’s the money, you’re mistaken. There are plenty of highly paid athletes that are bums. Our favorite athletes are generally the ones that practice the most. They try harder and give a little more than the "prima donnas." We tend to like the players who are shorter, slower, injured, or who are older but simply refuse to give up. Its constant effort, and a refusal to quit, not talent that makes the difference. 5) Think like a winner. When a winner has a setback, they don’t pack it in. They start over. Don’t "catastrophize." Don’t categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything. There you have it…the mystery of willpower unraveled. The power to make real change and MAINTAIN real change is well within your grasp. You don’t suddenly get it and just as suddenly lose it. Make a commitment to your goals, write them down, document what’s in it for you, read your goals daily, diligently engage in behaviors that support each goal, think like a winner and you will be successful. I know that some of you are reading this and sighing, saying that it’s not so simple. It doesn’t have to be so complicated either. Take a bold step. Start writing some goals down right now and follow the steps I’ve outlined above before you log off. You have the power to change right at this very moment. No willpower required!