Healthy Weight, Healthy Mind: Relapse Prevention, Part 2

We are pleased to bring you this regular column by Dr. David Creel, a licensed psychologist, certified clinical exercise physiologist and registered dietitian. He is also credentialed as a certified diabetes educator and the author of A Size That Fits: Lose Weight and Keep it off, One Thought at a Time (NorLightsPress, 2017).

Do you have a weight loss question for Dr. Creel? Email him at [email protected]. He may answer your question in a future column.

Realistic Expectations

Our hospital-sponsored weight loss program includes 20 sessions over seven months. During the first ten sessions patients see a physician and a behavioral specialist every week to work on specific nutrition, exercise, and psychological goals. The appointments spread out to every other week after the first ten weeks. Patients often lose 10 to 15 pounds during the first month and another 5 to 10 pounds during weeks six to ten. If you needed to lose 60 pounds, this would put you one-third of the way to your goal — an exciting accomplishment.

This is when expectations rise. Buoyed by their success, many clients say, “I’ll bet I can lose another forty pounds during the second half of the program. I just need to keep working hard, get a little more consistent with my exercise, and I think I can do it.”

I never like raining on anyone’s parade, but our conversation usually ends with at least a few sprinkles. The goal is possible, but highly unlikely for a variety of reasons, including metabolic changes, neurochemicals affecting appetite, and psychological factors such as restraint fatigue. What will happen to these folks if they only lose five more pounds or no weight at all in the next ten sessions? What if they gain back five pounds?

When our expectations are too high and we miss a goal, it’s easy to lose sight of what we’ve already accomplished. Losing 20 pounds and gaining back five is still progress and will improve your health. Imagine if every time you lost weight and regained just a little of it, you could view this as a success, not a fatal setback to your plans.

Suppose you get through a season of travel softball for your daughter, an injury to your back, the holiday season, or long work hours with only a few pounds gained? In my book, that’s a big accomplishment. Good for you!

Of course you don’t want to ever regain any weight, but it will happen at some time. People regain a little weight with nonsurgical interventions, the use of appetite suppressants, and after bariatric surgery. Expecting it to never happen is unrealistic and leads to anxiety-provoking fear. If you get married, you’ll argue with your spouse. If you have children, they will misbehave. Invest in the stock market and sometimes you’ll lose money. Lose weight, and a portion of it will be regained. If we accept this as normal and treatable, you needn’t fear it — especially if you have a back-up plan.

Contingency Planning

Fire safety is a big deal where I work. Fires in a hospital can be devastating, so our administrators work hard to prevent them. They also consider worst-case scenarios and give us contingency plans in case of a fire, natural disaster, or other danger. We can do the same thing with weight loss. Just as fire alarms and smoke detectors give warnings of fire, we can set up an early detection system for danger in our weight management efforts.

At the beginning of a relapse your weight begins drifting upward, often without your awareness. Perhaps you’re distracted by a change in your life that takes precedence over diet and exercise. Before you know it, your body adds ten pounds. This is when your bathroom scale turns into a smoke alarm: “Danger! Weight gain!”

Frequent weighing can help avoid this scenario. When the patients I work with decide to stop treatment after successful weight loss, we discuss the future: How they’ll recognize trouble and what they’ll do to self-correct. Weighing ourselves is a simple, easy way to sound an alarm that signals us to take action.

The action part of this process is slightly different for each person. Often the first bullet point after In case of fire: is remain calm. The same goes for a slip in your weight management. Stay calm, and problem-solve. Fretting over weight gain, putting yourself down, and overreacting will not help. Ignoring the problem won’t help either. Stay calm and follow the rest of the plan you created. Preventing a slip from becoming a catastrophic fall usually contains such elements as self-monitoring your diet, planning meals and physical activity, and examining the thinking process that led to this point.

Sometimes you may need professional help to get back on track, such as visiting with a registered dietitian, a physician, a therapist who specializes in weight management, or a personal trainer. The use of appetite suppressants may also be part of the plan.

Neil lost 60 pounds in a year of treatment and decided, because of finances and a one-hour drive to our center, that he would try to maintain this weight loss (and hopefully lose another 20 pounds) without his individual appointments. We created a contingency plan for him based on these warning signs:

• Exercising less than three times per week.
• Drinking alcohol more than twice per week, or to excess.
• Snacking between meals when not hungry.
• Weight gain.
• Current weight: 200; Weight below 205 is acceptable.

Neil’s Specific Plan:

• Weigh daily.
• If weight hits 205 for three consecutive days, I will begin recording my food again to determine the problem and/or increase my awareness of eating.
• I will do this until my weight and behavior are stabilized.
• If I’m unable to do this or if my weight hasn’t returned to less than 205 within two weeks, I will email you with a more specific plan.
• My note will include a three-day meal plan and my plan for exercise over the next three days. I will do this for two weeks.
• If this isn’t successful, I’ll make an appointment to come back to the center.
• If at any time my weight hits 210, I’ll make an appointment right away.

As I write this, I’m reminded that I haven’t heard from Neil. I hope that means he’s doing well. I’ll give him a call and report back in a later article.

Do Something Quickly to Get Back on Track

Larry was a great guy; a caring soul who along with his wife had raised three biological children and had numerous foster kids, four of whom they adopted. He loved conversation and had a great interest in other people. My role was to help him get a handle on his diabetes, lose weight, and get physically active. I often redirected our conversation to strategies Larry could use to make his life healthier.

One day after about nine months of treatment Larry said, “You know what I’ve learned since starting in this program?”

“What’s that?” I asked.

“First, I’ve learned that I screw up every day. I make a poor food choice or I have two drinks when I only planned to have one. I miss planned workouts. I deviate from my plan. But I already knew that before I came to see you. What I really learned here is how to handle my screw-ups. I used to get so discouraged I’d go way off track and then make a plan to start over at a later time. I don’t do that anymore.”

“So how do you handle it now?”

“As soon as I realize what I’ve done, I ask myself, “What can I do, right now, to get back on track? And then I do something right away.”

“Can you give me an example?” I asked.

“The other night, I had a second drink when I only planned to have one. So I took the dog for a walk. Last Friday I ate a doughnut at the office. I wasn’t happy about it. Well, I was sort of happy while I ate it, but not pleased with my decision. I took three minutes and wrote down what I was going to eat for lunch and dinner. Right away I started feeling better about myself and my ability to stay on track. Psychologically, this is much easier than getting way off track and then trying to overcompensate. I feel like I’ve become pretty good at making corrections when I mess up.”