Keys to Long-term Success
Lee Kern, Clinical Director, Structure House
At the time of her obesity surgery in May 2000, Helen was 264 pounds, and miserable. Her joints ached and restricted her activity. At age 51, her weight prevented her from the golf she used to play, and embarrassment over her appearance kept her socially isolated. Her main pleasures were going out to restaurants and drinking wine in the evenings while watching TV with her husband. She sought to reclaim her old life, and hoped that the surgery would be a jumpstart.
At first it seemed like it was everything she had hoped for. She lost 105 pounds in eight months. She had not weighed less than 160 pounds since high school. Her self-esteem got a huge boost. She returned to golf and had the courage to put on a bathing suit and walk on the beach. But slowly her success began to dissolve and she realized the surgery was no magic bullet. By March 2006, her re-gain reached over 30 pounds (she weighed 190). Fearing she would gain it all back, she enrolled in a cognitive behavioral treatment program to help her restore control.
Over the course of several sessions, Helen described the patterns that led to regaining weight. A typical day was one big graze, especially on pretzels. Wine had crept back into her evening ritual and she worried she was using it as an escape. Meals often consisted of a large portion of pasta, which she acknowledged she used for comfort. Her overeating was driven by a cluster of emotional factors: 1) She was heavy all her life and as a result had chronic feelings of shame and inadequacy. 2) Her feelings were hurt when her husband made critical comments about her appearance, and some of her high calorie snacks were used to stuff her anger. 3) She felt inferior to others in her upper class neighborhood and used her weight as an excuse to isolate.
There are several themes that were at the core of Helen’s recovery of control and resumption of weight loss:
* CONSCIOUS EATING,
* FOCUS ON FOOD DEPENDENCE,
* VIEW GOALS BROADLY,
* BALANCE BENEFITS AND STRATEGIES
* SEPARATE WEIGHT FROM SELF ESTEEM.
These themes serve as a link to many successful losers and are a reminder that the success of surgery is enhanced if it is viewed as a tool that needs to be paired with other strategies.
CONSCIOUS EATING. Relapse recovery began when Helen committed to making all eating the result of conscious plans and choices. She used a food diary, a powerful tried and true tool for controlling portions and learning calorie values. She began to plan meals ahead, including a plan for parties and restaurants. The ideal day contained three meals and one snack; this became a map that helped her highlight the “off the road” urges to snack and graze. Meals were balanced, fulfilling and at regular predictable times, channeling hunger to meal times rather than scattered throughout the day.
FOCUS ON FOOD DEPENDENCE. By cultivating a reflective view of her old patterns, Helen realized she was using food for non-food reasons. Eating had become her way of “self medicating.” When her feelings were hurt, or she was angry with her husband, or she felt lonely or rejected-these were times she was using food to stuff her feelings. Getting back in control meant having the courage to dig deeper and ask questions: What do I feel? What do I need? What is the trigger to this urge? How can I respond to the feeling or need in a more functional way? She decided that meditating every day and taking more time for herself would help replace the self soothing function of snacks and wine.
VIEW GOALS BROADLY. Studies indicate that weight loss goals are typically unrealistic and rigid and set people up for chronic disappointment. All her life, Helen was driven by the scale. Her goal was to get under 160, a weight she had not been since high school. She was ecstatic when she hit 159, and devastated when the regain led to her goal slipping further away. A new view of goals was needed: 1) Health – appreciate that her hard work led to improved blood pressure and cholesterol levels, and taking less pain medication for aching joints. 2) Functioning – take pride in returning to golf and tennis, being able to go up a flight of stairs, and being active with the grandkids. She learned it was possible to enjoy the results of her efforts without exaggerating the importance of a number on the scale.
BALANCE BENEFITS AND STRATEGIES. Research on successful weight losers suggests that the best long-term results occur when weight loss is viewed as a natural result of living life in incrementally healthier ways. Weight, health and fitness benefits occur when there is an underlying infrastructure of lifestyle change and behavior strategies including exercise, self-monitoring and behavior modification. Helen developed an exercise plan that included cardio (kickboxing class and elliptical) six times a week and weight training three times a week. She kept an exercise and weight log, and viewed these similarly to the important daily routine of brushing her teeth. She shopped smarter and decided to keep tempting snack foods out of the house.
SEPARATE WEIGHT AND SELF ESTEEM. Helen had a revelation: all her life she blamed her feelings of inferiority and self-consciousness on her weight; yet, at her lowest weight she still felt subservient to her husband and perceived her neighbors as looking down at her. Her invalidating childhood led to pervasive negative self-talk, and weight or no weight, she had work to do to rebuild her self esteem. She learned to use assertiveness and effective communication skills with her husband, developed affirmations to improve her self-talk and body image, and practiced the principles of “self diversity” – celebrating strengths and positive attributes that were unrelated to weight or appearance. Slowly she came to believe in a self that had worth, one that deserved the care of continuing to engage in healthy, affirming behaviors.
Life long weight control is a dynamic and integrated process. Helen learned to maximize the results of her surgery by combining it with cognitive and cognitive behavioral strategies, building an effective, comprehensive, long lasting approach.
About the Author Lee Kern is the clinical director of Structure House, a residential weight loss facility in Durham, NC, that offers a unique behavioral approach to weight loss and healthy lifestyle change.