But let me tell you, starting all at once (with every change that you might need to make) can be a Herculean task (can you tell I signed up for a word-a-day email? herculean means something that would take the strength of Hercules to overcome).  Not even Lance Armstrong could step out his front door one day and run a marathon.  He would have to start with short runs and gradually build up to longer more extensive training as he got stronger.

What does this have to do with you? It’s extremely hard to change all of your habits in one fell swoop.  What would I like to see in an ideal world? I’d like to see all my patients exercise 5 hours per week, I’d like to see 80+% of your meals be within the box and I’d like to see everyone lose 1-2 pounds a week until they reached their goal. 

But Hekier and I just started a new nutrition program ourselves and making all of the changes above would be well nigh impossible given how hard it is for us just to make some minor adjustments in an already healthy lifestyle.  We’re trying to really focus on cutting out “carbs” (e.g. bread, rice, pasta) and focus on fruits and vegetables instead.  Just one little difference, and boy-howdy….. it’s tough!!  And when you don’t succeed it’s really tempting to just give up.  “Well, I already cheated with some toast, might as well just have rice with dinner.”

So my tips for getting started and staying on track-based on recent personal experience-are:

prepare, prepare, prepare: plan out your menu for the week, shop for everything you need, make as much as you can in one day so you don’t spend every day in the kitchen for hours.  Always bring your lunch/snack/dinner with you to work, never leave it to chance to figure out what you’re going to eat

Do a mental clean-up: get rid of any thoughts of who you “used” to be, of what you used to be able to wear or how long you used to be able to exercise.  Figure out where you are NOW, and then celebrate every success, no matter how small.  Doesn’t matter what was, only what is and what will be.

Get your posse behind you: want to start walking on the track? Great! Bring your children and let them run around on the grass in the middle of the track while you walk.  Or even better, let them roller-skate/bike/skateboard on the streets while you run/walk along with them.  Make your spouse vow to eat healthier with you.  Get some friends to join you in signing up for a 5K walk and train together.  The more people you have supporting you, the better you are likely to do.

“Just Do It”: there are lots of times I just don’t want to exercise but I promise myself I can quit after 5 minutes if I’m still not in the mood.  Know what? In the last 10 years, I’ve only quit once.  Once you’ve started, you’ll keep going 99.9% of the time.  If you can just start, you’ll finish.  But if you never start…… you’ll never finish.

Everything in life has plusses and minuses.  Go to a club on Saturday night and have a great time, but have a hangover Sunday morning.  Buy a beautiful fast car with leather seats, pay more in insurance.  Go shopping often and spend most of your paycheck, then have nothing put aside for a rainy day or retirement.

Food is no different.  Yes, there are a lot of perfectly yummy things you can eat that are healthy and won’t make you overweight.  But there are far more things that taste super-fly fabulous, but have no nutritional value and are guaranteed to make you fat.  Does this mean you should never eat them?  No, but you should follow what somebody once told Dr. Hekier is the 80/20 rule.  Eat 80% of your meals for nutrition, 20% for taste.  You simply can’t have the most yummilicious thing to eat for every meal if your version of yummy is chocolate covered peanut butter or fried anything.  You can have treat-ish stuff 20% of the time, or 1 in every five meals, but the other 4 out of 5 meals need to be nutritional and waaayyyy inside the box.  And even that 20% of the time, you shouldn’t go super-ultra wild.  Is pizza your downfall?  Then let your 20% be a slice or two of pizza, but not half the pie (and preferably not a double decker, stuffed crust, meat lovers delight either). 

Learn how to eat to live, not live to eat.  To quote Remy’s father from the Disney movie “Ratatouille”, “Food is Fuel”.  I’m not saying to eat tasteless bland crap 3-4 times per day, but do look at each meal as an exercise in taking in the nutrition you need – the protein, the calories- and not as a chance to find the most fabulously delicious thing on the menu.  Look at a menu trying to find the lowest fat, lowest calorie source of protein on there, not the double battered chicken fried steak with gravy.  If you change your fundamental approach to food, then dieting and maintaining your weight becomes a habit, not something you have to constantly fret over and work on.

They said they were carrying a jar of peanut butter in their purse (!) and snacking on peanut butter throughout the entire day.  The primary reason “It tastes good.”

Yes it is true, it probably does taste good.  But that doesn’t mean it is good for you.  If I could, I would live on a diet of jalapeno poppers & curly fries, dipped in ranch dressing.  That is all I would eat: morning, noon, and night.  Why?  Because IT TASTES GOOD.

Remember, a treat is a treat, not a meal.  Remember food is fuel for your body, and treat your body right.  (See my brief earlier post: fuel for your body. )

Would I like to live on curly fries?  Would I like for every single thing I put in my mouth to taste as good a hot, freshly fried and breaded jalapeno popper, filled with dripping melted cheese, and dipped in thick creamy ranch dressing?  Yes I would.  But if I did that, it would be the same as putting sand in my car’s gas tank.  Food is my fuel.  Once in a while I cheat, but I remember that the primary goal of my eating is to fuel my body, not my tongue.

Is it any wonder why New Year’s Eve brings a flood of resolutions to lose weight and why gyms experience their highest volume of new clients in January?

While I can’t steer anybody away from making poor choices over the holidays, I can help with a tip for the leftovers.  If you’re anything like me, you hate to throw food away.  It’ll sit in little plastic containers in the fridge getting whittled away a few bites at a time.  While it feels profoundly wasteful, THROW THE LEFTOVERS AWAY.  I know, I know- I hate to do it, too.  But most of the leftovers of this season- candy, pie, broccoli rice casserole – are high fat, high sugar, or high calorie and not what you should be eating more than a little smidgin of anyway.  Eating a few tablespoons of each at Thanksgiving is one thing, eating it for the whole next week is quite another.

One of my patients (who FYI lost weight over the Thanksgiving holiday) told me today that she had baked a chocolate pie for her sister to eat for the holiday.  Sadly her sister is ill and had to be hospitalized earlier that week and stayed in the hospital over the holiday.  Since she couldn’t give it to the intended recipient, she threw it in the trash.  Yes, a freshly baked, never touched, chocolate pie.  She tried to give it away, but since nobody wanted it she said, “..I’ve worked too hard to lose this weight and I like it too much to risk ruining it for a pie!”

To say I’m proud of her goes without saying

I thought about this when a patient came in recently, angry because she wasn’t losing weight.  She had eaten a large fast-food lunch just before she came and brought her extra-large soda with her into the office.  I can’t help but think that she did that to thumb her nose at me and Betty – nobody can honestly say that they’re unaware of the “no soda” rule. 

So here’s my mistake of the week:

do not assume your weight loss or gain either affects anybody else or is anybody else’s responsibility

I am not trying to be harsh, but your success or your failure is your own.  We can help, cajole, educate and fill, but the final choices that are made when you stand in front of the fridge are your own.  We will know whether or not they were good choices when you come to the office and weigh.  I will celebrate your triumphs and console your setbacks, but in the end you get to keep your weight or lose it, nobody else.  Rebelling against the rules or against the doctors or Betty or Amy or Lori doesn’t accomplish anything in the end, except sabotage your goals.

1) Shop the periphery of the store, not the center aisles.  No matter what market you use, they’re all basically set up the same.  The fruit and veggies line one wall of the store, the fresh meat and fish are at the back and healthy dairy stuff (like low-fat cottage cheese, low-fat yoghurt, low-fat string cheese) line another wall.  What’s in the middle?  Junk! Pastas, rice, cookies, chips, lots of pre-packaged low-nutrient food like substances.  So shop along the outside walls of the store where the fresh stuff your great-great-grandmother would recognize as food is kept (clearly Cheetos don’t meet this criteria).  That’s the stuff that kept America slim and trim for two centuries before the current obesity epidemic.

2) Don’t shop hungry-  you’ll buy lots of junk food because it captures your attention and imagination and it’ll seem like a good idea at the time.

3) Go with a pre-written list and stick with it – no improvising.  Buy what you’ve determined you actually need, not what catches your eye as you walk down the aisle. 

4) Make a schedule of healthy meals you want to cook this week as well as healthy lunches you want to bring to work.  Use this schedule to write a shopping list of things you’ll need for those recipes and buy them.  Do not buy them AND the chocolate bars at the check-out counter AND the 12 pack of Coke on sale 2 for $4.00.  Just buy your ingredient list and get out of Dodge.

5) If you have to buy junk food (say for another member of the household like children), try to buy the healthiest version of that snack.  Get the low-fat or low sugar version of the junky item, or see if it comes in a 100 calorie pack, or make your own low-calorie snack pack with small “snack size” Ziploc bags (they’re half the size of sandwich bags).

Sounds super-ultra-dull right? Wrong!! He’s a really lively speaker and he only interviews people who have made interesting discoveries. What does this have to do with weight loss you ask?  One of the people he spoke with conducted what he called the popcorn study.   In the popcorn study, the researchers made only a small change in the way the popcorn was given out to movie-goers.  All of the people who ordered the large popcorn were either given the usual ginormous tub or they were told that the concession stand had run out of the big tubs- would they mind getting their popcorn in 4 medium paper bags instead?

So both groups got the same amount of popcorn; the only difference was the container(s) it came in.  What they found was surprising.  If you got all your popcorn in one big tub, you ate almost all of it.  But if you got in 4 sacks, you usually only ate one sack – only 1/4 of the amount!  They repeated this same scenario with some farm workers.  When the workers were given all of their paycheck in one envelope, they tended to spend it all.  But when they were given two envelopes, one with 90% of their paycheck and one with 10%, they tended to save the 10% instead of spending it.  If the researchers put a picture of the worker’s child and a note that the 10% was to be saved for their child’s education, absolutely nobody spent that extra 10%.

So it would appear that how we package food (known as “choice framing” in behavioral economics) affects how much we eat.  The food industry has come to understand this principle and that’s how we got the “100 calorie” packs.  But why not do this will all your food?  I’ve adopted this technique for two of my own problem foods – pasta and cereal squares. 

Left to my own devices, I’ll fill a serving platter with pasta and still go back for seconds.  But by dividing the package into single serving sizes (according to the nutritional label on the back) as soon as I bring it home, I don’t end up cooking the whole box by default and therefore eating half of it just because it’s there.  I do the same thing with the Kashi Cinnamon Squares to which I’ve become addicted – I divide them up into little snack size Ziploc bags to make my own little “100 calorie” snacks.  Because believe me, if I eat right out of the box, I’ll eat half the box.  That is problematic for several reasons: 1) it’s a lot of pure carb calories and 2) all that fiber can a make a person kind of socially unacceptable for a day or two if you know what I mean.

So start trying this with your groceries – both staples and treat foods.  You can do the same thing with leftovers, so you can take them to work for lunch over the next few days.  Or you can do it with food you cook ahead of time and use for lunch all week long.  Saves a lot of money over buying pre-packaged microwave meals and I guarantee you can make a healthier meal for yourself  with far less sodium.

The lesson to learn is that we can’t always trust ourselves to know when to say “stop”.  Sometimes you need your eyes (and a handy kitchen scale) to help you determine a good portion size.  The movie-goers in the popcorn study didn’t feel hungry and deprived…,neither will you.

Remember our cardinal rule: it’s not how much you can eat, it’s how little you can eat and still not be hungry between meals.

While I don’t mind doing this a lot of the time, I would much rather teach everyone how to fish instead of just giving them a fish (as it were).  My favorite method of diet education is not, “make this smoothie in the morning, eat this salad at lunch, then finish the day with….” but more, “these kinds of food are good for you, these methods of preparation are calorie dense and therefore poor choices….” etc.  I write these blog posts to help guide people’s eating choices by using solid, healthy nuritional tips.  But I can’t account for differences in taste or particular challenges faced with eating some foods like amount of restriction, lack of access to a variety at the grocery store or lack of cooking skills.

Here’s one example: porcini mushrooms (you know those big, umbrella sized mushrooms?) make great substitutions for steak – you can grill’em, you can lightly brown them in a pan – and they have a  lot fewer calories and shouldn’t present as much of a challenge as steak would to a bandster.  But you know what? I hate, HATE mushrooms.  Can’t stand’em, don’t like the look/smell/texture/taste of them.  So a diet where you had to eat lots of mushrooms all the time would be a terrible fit for me.

All of you have specific likes and dis-likes, foods that go down easily and things that cause a PB as soon as you swallow them.  So I want to help you learn to navigate the supermarket, the restaurant menu and your own pantry, not dictate precisely what you can and can’t eat.  My bandsters that navigate by general principles lose weight without trying too hard.  They just make good choices (sometimes without even counting the calories) and by following the general rules, the pounds melt away.

So what are some of the biggest rules?

Don’t drink your calories (they run right through the band, won’t fill you up and will cause an insulin spike leaving you hungry an hour later)

Avoid anything and everything fried

Eat protein at every meal

Avoid empty carbohydrate-dense calories like white breads, chips, crackers, white rice and stuffing.  Substitute nutrient dense carbs like fruits and veggies

Don’t graze! Eat three meals per day and a protein snack if needed in the afternoon.

Don’t skip breakfast!

NO SWEET TEA!!!!!!

Learn to read nutrition labels so you can start to figure out where some diet saboteurs reside in your food choices

Peanut butter is not a good protein source (but is a great treat)

Avoid dessert in the form of cookies/cakes/candies.  Do start making a piece of super-ripe fruit your go-to dessert choice.

And biggest of all for banded patients: don’t drink with your meals or for at least 30 minutes after your meals. You’ll defeat the whole purpose of the band and it won’t help you with staying satisfied with small portions.

Write a comment and tell me some of YOUR basic rules.  I’m always looking to pass on good suggestions

#1   EAT!!!!  You are not going to lose fat by eating only 450 calories a day.  Your body needs fuel so it’s going to get it one way or another… by you feeding it regularly….or by saving every little morsel you give it…..or by stealing it from your muscles.  I had someone come to me and tell me they had hit a plateau.  So we started going through what she had eaten over the last few days….400 calories one day and 450 calories the next.  Get real…..a 2 year old needs more than that!!!  If you continue to do that you not only stay hungry, maybe not physically hungry but nutritionally hungry, but you are defeating yourself before you even get to the race!  Can’t even slog with so few calories! (that one’s for you Dr. K)  You will learn in your journey that its all about NUTRITION NUTRITION NUTRITION!!  If you think that eating this little will help you lose weight faster then we need to review a few things together….remember it’s nutrition not malnutrition!.  Not only do you feel hungry, you may feel like you are failing because you haven’t lost “enough”.  Of course not….your body is not going to let you with that little to sustain it.  Now you may END UP losing weight…right after you lose a lot of hair…energy….skin tone…..even sex drive….got you with that one didn’t I!!!

#2    Be ready to EAT!!!  But not as a hobby.  Eat to maintain your body.  You chose to have weight loss surgery.  Give up food as a hobby and find a new one.  Believe me I know this one was really hard for me.  What I am trying to say is you need to eat at regular intervals to keep your brain from telling you it is hungry but you don’t need to make it a mission to go to the movies for the popcorn or a picnic for the fried chicken.  On the other hand, you need to prepare for those times that you will be in certain situations….for example, if you are going to a movie and think you may need a snack then prepare for it….don’t let the concession stand be your only option…..I’m here to tell you that they do not search your purse or coat pockets for healthy snacks upon entering the theater.

#3   EAT with your family.  Just because you have had weight loss surgery doesn’t mean everyone in your family needs to lose weight.  There are going to be times when they have things you can’t tolerate and it WILL get to a point that it is OK with you.  You can still enjoy the time around the table with your family. You don’t have to be segregated to the table in the corner or wait until everyone else is done.   When he was in high school my son told me….”Mom, we are so lucky we get to eat dinner together every night.  My friends don’t have that.”(Yes, I cried later) Dinner is a bonding time for a lot of families….a time to fulfill more than our nutritional needs. But it can also be a time of realization for your whole family. Sometimes the “starving to death” feeling has nothing to do with food….it is an emotional need that requires fulfillment.  The pleasure we feel when our kids enjoy our cooking is sometimes beyond words.  Let your family see the person (you) who cares enough about them to take care of yourself.   In learning how to satisfy your own needs you can help your family learn how to help you. They aren’t going to know what you can eat until you tell or show them! (Inspired by last support group topic “how to not let your loved ones sabotage your weight loss”) What better example can we set…..OK, so there may be some better but let’s pretend this is the most important one   See you at Wadley,  November 9th @ 7PM for support group —Lori