Back cover copy:

After reading the Ten Steps in Part 1 and doing the easy action steps exercises in Part 2, you will be well-prepared for adopting a healthy and satisfying lifestyle.

This book is for you if any of these apply …

• You are a man or woman wanting to adopt a healthier lifestyle
• You are discouraged by dieting (Who isn’t?)
• You are overweight and feel helpless to do much about it
• You want clear, relevant, research-based information about a major global health problem
• You are disappointed in yourself for lack of “willpower” 
• You suspect there may not be an easy, magic answer to your problem with weight (there isn’t!) 
• You are bewildered by the overwhelming mass of conflicting information about diet, exercise, and lifestyle we are all exposed to on a daily basis

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CONTENTS

Preface

Part 1

Introduction

Chapter 1 -- Step 1: State a reason to change your behavior

Chapter 2 -- Step 2: Choose a realistic weight range 

Chapter 3 -- Step 3: Learn about “willpower” and self-change 

Chapter 4 -- Step 4: Learn how to manage stress

Chapter 5 -- Step 5: Guard against “willpower fatigue”

Chapter 6 -- Step 6: Learn the basics about diet and exercise 

Chapter 7 -- Step 7: Learn from others’ experience 

Chapter 8 -- Step 8: Consider your family and social network 

Chapter 9 -- Step 9: Learn about alcohol, drugs, and addictive behavior 

Chapter 10 -- Step 10: Create a plan and “routines”

Part 2

Chapter 11 -- Empower yourself to change your behavior – easy action
steps to get you started 

Chapter 12 -- Research on weight management

Chapter 13 -- Advanced techniques for behavior change

Chapter 14 -- Summary and conclusion

Acknowledgements

Notes

Index

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Preface

Have you ever said, about managing your weight, “I know what I have to do, I just need to do it!”?  I must have heard some version of this statement hundreds of times.  Most people know about eating less and exercising more, and also know it is not easy to do on a consistent basis.  I appreciate this dilemma as well as anyone, which is why I decided to organize what I have learned over the years in the format of a self-help book. 

As a physician for over 35 years, most of that time practicing as a Board Certified psychiatrist, I have witnessed hundreds of people struggling with managing their weight.  My experience as a psychiatrist is relevant, because much of my practice has consisted of helping people become more aware of their options, recognize and eliminate self-defeating patterns, develop skills that will help them maximize their strengths, and learn to make decisions that are in their best long-term interest.  I have never had much affection for the “victim role” that some people prefer, and have worked hard to increase feelings of
empowerment in myself and others.

I have observed the weight loss and exercise self-help literature for decades, and have come to the conclusion that most of it is misleading because it panders to our desire for a quick and easy solution to a difficult problem.  Few books about weight management deal with the subject of self-empowerment
seriously or in much depth or breadth.  My objective in writing this book is to summarize relatively simple ways to begin to overcome the problem of eating too much and exercising too little.

I said the solution was simple, but that does not mean it is easy.  There is a big difference between the two concepts. 

The solution is simple because it only involves engaging one’s mind to make a commitment to eat less and exercise more.  To maintain your weight, calories taken in must be in balance with calories expended through metabolism and activity.  More or less eating, and more or less activity, affect the ratio. All of the variables are under the control of voluntary behavior.  If more calories go in than out, you have weight gain – only 100 extra calories a day can add ten pounds in a year!  Weight loss results from changing the ratio in the other direction: reducing calories in and/or increasing calories out.  Simple.

At the same time, using your mind (or “willpower”) to change the way you eat and move can be very difficult.  Most people do not really know how to fully engage their mental and emotional resources in a way that will get them through both the initial difficulty of changing behavior and the lifelong commitment
it takes to maintain the healthy behavior. 

WHO THIS BOOK IS FOR

This is a self-help book for people who want the basic information and skills necessary for choosing a healthy weight range and maintaining it for life.  It is for people who suspect or know for sure that the power needed to adopt a healthier lifestyle will come from within themselves, even though they may
need help and support to fully tap and focus that energy.  Please use it as a source of encouragement and guidance to assist you in becoming healthier and improving your quality of life. 

Weight Management for Your Life does not feature a diet or weight-loss plan in the usual sense.  It contains no recipes, recommends no products, nor does it offer a “quick start” program.  Instead, it will give you the tools you need to choose a way to eat and exercise for life, and reading it will improve your ability to evaluate diet and exercise programs that are being marketed through books, magazines, ads, and infomercials. 

The advice in this book is not intended for people who have a severe eating disorder, tend to be underweight, or have extreme obesity and are looking for a way to lose 100 pounds.

On the other hand, please do read this if you are mildly or moderately overweight, if your weight is in a healthy range but you are concerned about possible weight gain in the future, or if you don’t really know what a desirable weight range should be.  This book will help you determine whether you are ready to make a commitment to proactive lifelong weight management and, if not, what actions and decisions might bring you to that point.  Also read it if you are concerned about the health of a friend or loved one who may be overweight.

Although this book is based on my many years of experience with weight management as an individual, family member, and health professional, I wrote it from a holistic perspective.  It is my strong belief that weight control, though extremely important, is only one part of a lifelong commitment to health and happiness. 

HOW TO USE THIS BOOK

The book is organized so as to make the difficult tasks involved in behavior change as simple and natural as possible. All you need to do is read the introduction and the next ten chapters.  Each chapter is organized so you can very quickly discover “what you need to know” and then explore the topics in more detail in the rest of the chapter.  The small numbers (superscript) that appear in the text (“footnotes” or “endnotes”) refer you to reference material or additional information arranged by chapter in the final section of the book.

After reading the ten steps in Part 1, use the easy action steps in Chapter Eleven to begin to apply what you have learned.  These action steps are designed to help you translate the content of the reading into behavior, one step at a time.  Additional chapters in Part 2 give you even more detailed information than the previous chapters.  If you do most of the exercises in Chapter Eleven, you will be able to say with confidence, “I know what I want to do, and I am doing it!”

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Introduction
 

“Whether we live to a vigorous old age lies not so much in our stars or our genes as in ourselves.”

WHAT YOU NEED TO KNOW

Whether we live a long and healthy life and feel satisfied in old age is at least in part determined by the way we think and what we do to help ourselves. A reasonably healthy lifestyle, including weight control, exercise, moderation in drinking and no smoking, can make a huge difference in our long term health and
happiness. Adopting a positive “glass half-full” attitude, valuing lifelong learning and interests, and nurturing supportive relationships are the other keys to aging well. The ten steps in the chapters that follow this introduction will give you the knowledge you need to make significant changes in behavior in order to better manage your weight and generally improve your health and happiness.
 

MORE DETAILS

How to be “Happy-Well”

To “see the glass of life as half-full, not half-empty,” and to “understand how to savor joy and how to turn lemons into lemonade,” according to Harvard research psychiatrist George Vaillant, are the thinking patterns of people who age successfully.  In his book Aging Well he describes in detail the long-term
outcomes (at ages 70 – 80) of three groups of people who were studied with thorough evaluations every few years from youth through old age. The research subjects were 724 men and 682 women, 63% of whom lived to old age; all were initially included in the research because they seemed “normal” and were free of any obvious illnesses or disabilities.

Vaillant writes about factors that seem to predict which research subjects turn out to be Sad-Sick (including dead) and which Happy-Well.  One description of the Happy-Well group highlights their “learning to live with neither too much desire and adventure nor too much caution and self-care. … Rather, successful aging means giving to others joyously whenever one is able, receiving from others gratefully whenever one needs it, and being greedy enough to develop one’s own self in between.” 

After reviewing the data on all 1406 subjects Dr. Vaillant was pleasantly surprised to learn that most of the significant predictors of positive outcome were things we have some measure of control over:

The results of these studies and Dr. Vaillant’s thorough analysis give a huge boost to those of us who believe that our conscious health-related decisions are extremely important in determining how well we live and enjoy old age.

What is most relevant to weight management about Vaillant’s work and the other research on lifestyle choice is the message that one can learn new ways of thinking about one’s situation and can practice new behaviors that will result in a happier and healthier life.  I have found this to be the case personally
and in my psychiatric practice.

This book provides a guide to get you started in changing your lifestyle. The approach involves education and behavior change. In my experience, people have only bits and pieces of the knowledge they need to successfully alter their lifestyle. We are bombarded with information and misinformation, opinions and gimmicks, and this can be overwhelming. The following chapters present ten basic steps to prepare you to evaluate the information you come across and, more importantly, help you engage the power of your mind to improve your life.

_______________________________________________________________________________________________ 

Chapter 1

Step 1: State a reason to change your behavior

"We have goals because that’s how our brains evolved: the people without goals became extinct because they simply could not compete.”

... 

_______________________________________________________________________________________

Index

 AA, Alcoholics Anonymous  31, 32

abdominal obesity  12, 13, 21, 95 – 96

Acceptable Macronutrient Distribution Ranges (AMDR)  60

action stage (of self-change)  36, 41, 46, 71

activity, non-exercise  see NEAT

addiction  34, 85 – 88, 103, 106 – 107

Aging Well  7 – 8, 15 – 16, 71

alcohol  8, 60, 85 – 88, 103, 115, 119

alignment (of thoughts, feelings, and behavior; congruence)  35, 98

anger  49, 100

anorexia  12

anti-anxiety medications  65, 68

antidepressant (effect, medication)  65, 68, 88,

antioxidant supplements  56

anti-psychotic medication  88

anxiety  35, 40, 50, 65, 68, 82

appetite (craving, hunger)  24, 28, 32, 57, 74, 87, 90, 107, 109, 114 – 116, 118

arthritis  13, 16, 23

Atkins diet  63, 105

automatic (and emotional) eating  39, 40, 42, 59, 114 – 116

balance (in life)  31

bariatric surgery  56, 110

Baumeister, Roy  28, 46

Beck Diet Solution  24, 74 – 75, 87, 113 – 117

Beck, Aaron  113

Beck, Judith  24 – 25, 74, 87, 113 – 117

behavior change  3, 9, 37, 63, 113 – 120

belly fat  see abdominal obesity

bias (and lack of bias)  13, 17 – 18, 61, 106, 111

binge eating  40 – 42, 98, 108, 118

Binks, Martin  45

biological reductionism  108 – 110

bio-psycho-social factors  106 – 108

BMI, see Body Mass Index

Body Mass Index (BMI)  12 – 13, 21, 95 – 96, 127

boredom, eating from  40, 99

Bowen Center for the Study of the Family  81

Bowen, Murray  81

brain, cerebral cortex  28, 107

breakfast, importance of  62, 74 – 75

bulimia  12

burnout (also see decision fatigue and willpower fatigue)  29, 51

CAGE  88

calorie counting  62 – 64, 119

calories  2, 22, 33 – 35, 40, 55, 57 – 65, 69, 73 – 74, 86 – 87, 90 – 91, 96 – 97, 106, 110, 119

cancer  12, 110

carbohydrates (carbs)  57 – 58, 60  - 61, 87, 105

cardiovascular effects of exercise  65, 67

case examples  15, 22, 33, 41, 71, 81

CBT  see cognitive behavioral therapy

central adiposity  see abdominal obesity

centripetal obesity  see abdominal obesity

change model  see stages of self-change

childhood obesity  17

cholesterol  12, 61, 105, 111

cognitive behavioral therapy  35, 103, 113 – 120

cognitive therapy  see cognitive behavioral therapy

comfort food, comfort eating  40 – 42, 82, 98

comfort range (weight)  22

commitment  2 – 3, 11, 13 – 14, 26, 30 – 31, 36, 48, 51, 71 – 72, 75, 89, 92, 99, 114, 117 – 118

congruence  see alignment

conscious volition  2, 8, 26, 31, 85, 108, 111

Consumer Reports  61

contemplation stage  see stages of self-change

counselor  see health professional

craving  see appetite

Cristakis  79

Davis, Carolyn  34

decision fatigue  46, 50

delay of gratification  28, 40 – 41

demoralization  47

depression  13, 29, 35, 43, 66, 68

deprivation and self-denial  26 – 27, 52, 63, 118 – 119

determinism  32, 108

diabetes (also pre-diabetes, borderline diabetes, type 2 diabetes, insulin resistance, metabolic syndrome)  12 – 16, 23, 72, 110

DiClemente, Carlo  36

diet  2, 26, 27, 29, 61, 62 – 64, 72, 91, 105 – 106, 109 – 110, 113 – 117, 119, 121

diet coach  116

diet drugs  56, 67 – 68, 101, 121

diet fads/gimmicks  15, 31, 41, 55 – 56, 62 – 63

diet gurus  26, 31

diet, lifetime eating pattern (habitual nourishment)  60 – 62, 64, 68 – 69, 74 – 76, 80, 100 – 101, 113 – 117

Dietary Guidelines for Americans  60 – 61, 67, 96

dietary supplements  56

dieters  25, 47, 113 – 114, 116

dieting, yo-yo (roller coaster)  29, 50 – 51, 75, 81, 106, 116,

diets, research on  80, 105 – 106

diets, two types of (eating plans and counting)  63

differentiation  81

discomfort food  41

Dorfman, Lisa  116

drugs  56, 67 – 68, 85, 87 – 88, 101, 103, 108

easy action steps  3, 19, 53, 95 – 103, 119

eating (and overeating)  2, 12, 21 – 22, 29, 30 – 31, 33, 35, 37 – 38, 39 – 43, 46, 50, 53, 55 – 56, 58 – 60, 62 – 64, 68 – 69, 73 – 76, 81 – 83, 85 – 87, 90, 96 – 100, 106 – 111, 114 – 116, 118 – 120

Ellis, Albert  113

emotional eating  39, 40, 42, 59, 114 – 116

empowerment  1, 34, 37, 48, 95

energy density (food)  56 – 57, 106

exercise, aerobic  65 – 66

exercise, antidepressant effects  65

exercise, isometric  64

exercise, Kegel  66

exercise, of core muscles  66

exercise, physical  2, 8, 14, 18, 34, 42 – 43, 55, 59, 64 – 67, 69, 73 – 76, 80, 90 – 92, 99, 101, 110, 115

exercise, spontaneous  55, 64, 87, 91, 101, 115

exercise, strength-building  66 – 67, 91

exercise, warm-up before  67

fad diets  see diet fads/gimmicks

Fairburn, Christopher  118

false hope  29

family  37, 49, 77 – 78, 81 – 83, 88, 98, 102 – 103, 116, 122 – 123

fast-food culture  59

fat in diet  40, 57 – 62, 68, 74, 87, 106

fatigue  see burnout, decision fatigue, willpower fatigue

fatty liver  13

fear of failure  48

fear of success  49

Flier, Jeff  31

food allergies/intolerance  56

food labeling  57 – 58, 100, 119

food preferences  57, 64, 69, 100

food restriction  62, 74, 108

Fowler  79

framing  see reframing

free will  26, 30, 32, 97, 109, 111

free won’t  28

French paradox  59

GABA  107

genes and genetic  1, 8, 18, 22, 26, 36, 65, 106, 108, 109, 125

ghrelin  109

glycemic index  57

goals and goal setting  11, 13 – 15, 21 – 24, 33, 35 – 36, 43, 46 – 49, 51, 53, 64, 72, 75, 78, 86, 89 – 92, 96, 103, 109, 116 – 117, 119

Graham, Sylvester  26

habits, healthy  30, 33 – 34, 47, 64, 69, 77, 81, 108, 118

happiness  3, 7 – 9, 18, 30, 40, 43, 51, 52 – 53, 58, 73

health problems  11 – 13, 23, 109

health professional (therapist/counselor/physician)  1, 13, 18, 26, 32, 35, 41, 48, 53, 68, 72, 75, 77, 78, 80, 82, 87, 88, 99, 101, 103, 111,

healthy behavior/lifestyle  see lifestyle and habits

helplessness and learned helplessness  29, 48

hierarchy of needs (Maslow)  47

holistic  3

hormone(s)  18, 109

hunger  see appetite

impatience  49

impulsive eating  see emotional eating

inspiration  39, 43, 78

insulin  12, 57, 105, 109

intentionality  26, 42, 109

Internet  14, 22, 58, 59, 64, 81, 87, 95, 96, 97, 99, 101, 116, 119

junk food  42, 53, 55, 80

Kolata, Gina  33, 72, 109 – 110

labels  see food labeling

language (importance of)  30, 34, 41

learned helplessness  see helplessness

leptin  109

Levine, James  64 – 65, 107

Levitan, Robert  34

lifestyle  2, 7, 9, 15, 26, 31, 34, 46, 52, 53, 56, 57, 60, 64, 68, 73, 92, 100, 102, 107, 108, 110, 111, 113, 118

liposuction  110

long term perspective  1, 7 – 8, 14, 30 – 31, 34, 40 – 41, 62 – 63, 73 – 74, 76, 92, 117

malnutrition  23

marshmallow experiment  28, 35

Maslow, Abraham  48

meat  58 – 59, 61, 69

meditation  43, 99

mental illness  41

metabolism (metabolic rate)  2, 65

mindfulness  42 – 43, 59, 99, 115

mindless eating  see automatic eating

Minsky, Marvin  11

Mischel, Walter  28

mission statement  see personal mission statement

moderation  7, 57

mood  40, 58, 88

mood stabilizers  88

motivation  26, 116,

multi-tasking  16, 42, 66

National Weight Control Registry (NWCR)  73 – 74, 102

NEAT (non-exercise activity thermogenesis)  64 – 65, 101, 107

network, social  see social network

network medicine  80

neuroimaging (studies)  26, 28, 107,

non-exercise activity  see NEAT

Norcross, John  36

Nutrition Action Health Letter  61

nutritionism  56

obesity  3, 12, 14, 17 – 18, 21, 23, 26, 40, 59 – 60, 64, 68, 75, 79, 96, 107, 109, 110 – 111, 117 – 118

obesity by choice  107

obesity epidemic  59 – 60, 79

obesity hypoventilation syndrome  23

obesity, types of  12, 13, 95 – 96, 107, 109

optimists  29, 51, 97

organic food  26, 69, 101

Ornish diet  105

overeating  see eating

overweight  3, 11 – 12, 15 – 18, 21 – 24, 31, 36, 52, 65, 79, 96, 105, 107, 109

patience  25, 49

perfectionism  18, 51

perseverance  25, 48

personal growth  31, 47

personal mission statement  14, 91, 96

pessimists  29, 51

physical exercise  see exercise, physical

plan, planning (for weight management)  2, 25 – 27, 34, 36 – 38, 41 – 42, 47 – 48, 51 – 53, 63 – 64, 68 – 69, 74 – 76, 77, 80 – 83, 86 – 88, 89 – 92, 98 – 99, 101, 103, 113, 115 – 116, 118 – 119

plateau, weight loss  29, 115, 119

Pollan, Michael  56

portion distortion  59, 101

portion size  55, 59 – 60, 73, 101, 106 – 107, 110, 119

posture  66

preferences, food  see food preferences

prefrontal cortex (of brain)  28, 107

prescription drugs  88

primary goals  15

priorities  48, 91 – 92

Prochaska, James  36

procrastination  31, 50

protein  57 – 58, 60 – 61, 87

psychosocial factors  79, 109

quality of life  2, 43, 56, 66, 74, 91, 103

RAPS4  88

Rational Emotive Behavioral Therapy  113

rational thinking  28, 35, 42, 43, 45, 49, 50, 51, 81

reframing  25, 27, 32 – 35, 86, 90, 98, 114 – 115

relapse  36 – 37, 51, 98, 119

relationships  7, 8, 36, 39, 43, 47, 69, 77, 83, 102, 108

relaxation  39, 42 – 43, 99

research studies  8 – 9, 13, 18, 21 – 24, 26, 27 – 28, 34 – 36, 40 – 41, 46, 56, 57, 58 – 59, 62, 63 – 65, 68 – 69, 72, 79 – 80, 102, 105 – 111, 116, 118

resistance to change  45 – 46, 48 – 49, 53, 99 – 100

respiratory problems  13, 23

responsibility  30 – 31, 50, 97

restrained eating  108

Rethinking Thin  33, 72, 109

risk factor  12 – 13, 23 – 24, 34, 64, 67

roller-coaster pattern  see dieting, yo-yo

routines, importance of  25, 47, 89, 91 – 92, 101, 103

sabotaging thoughts and behavior  47, 51, 53, 75, 80, 87, 99, 114, 116

screening tests for problem drinking  88

sedentary (lifestyle)  64 – 65, 67, 107

self-change  see stages of self-change

self-control  18, 25 – 26, 28, 46, 85

self-defeating habits and patterns  1, 28, 31, 40 – 41, 43, 49, 51 – 52, 73, 118 – 120

self-denial  see deprivation

self-discipline  17 – 18, 73

self-empowerment  see empowerment

self-esteem  26, 48

self-fulfilling prophecy  32

self-help books  1 – 2, 46, 113, 118

self-medication  12, 87, 103

self-sabotage  see sabotaging thoughts

self-talk  114, 118

Seligman, Martin  29

Selling Sickness  108

serving size  58, 62

set point  22

sexuality  43, 99

significant other  8, 80, 99

silence  42 – 43, 99

sleep-apnea  13, 23

slow and steady weight loss  49, 117

smoking (cigarettes)  7, 8, 67

snack(s)/snacking  16, 35, 41, 55, 58, 59, 69, 76, 90 – 91, 118 – 119

social network  18, 77 – 81, 102, 107

social stigma  see stigma

social support  see support

sodium  58, 61

soft drinks  55, 57

South Beach diet  63

special occasions  52, 115, 119

spontaneous exercise  see exercise, spontaneous

stages of self-change  25, 36 – 37, 41, 46, 71, 98

starving (see also appetite)  24

stigma  17 – 18, 23, 52, 96

stimulants  see diet drugs

stinking thinking (see also sabotaging thoughts)  114

stomach-reducing surgery  56, 110

strength training  66 – 67, 91

stress  37, 39 – 43, 46, 78, 98, 102, 106, 115, 117

stress buffering  78, 102

sub-goals  89

success stories  71 – 76

sugar  40, 55, 57 – 58, 60, 69, 86, 87, 91, 106, 120

support/supportive relationships  2, 7, 36, 39, 47, 64, 72, 78, 80, 86, 115 – 116

surgery for obesity (bariatric)  56, 110

Svetkey, Laura  80

therapist  see health professional

thermic effect of food  65

tipping point  23

trans-fats  57, 61

triggers (for overeating)  76, 86, 115 – 116

type 2 diabetes  see diabetes

Vaillant, George  7 – 9, 15 – 16, 71

variety (in food)  56, 61, 68 – 69

vegetables  26, 33, 55, 57, 60 – 62, 101, 120

vicious cycle  40, 81

victim role  1

visceral fat  see abdominal obesity

vitamins  56

Volumetrics Eating Plan  62 – 63

voluntary behavior  see conscious volition

waist circumference  see abdominal obesity

walking  34, 42 – 43, 59, 65 – 66, 73, 90 – 91, 101, 119

walking workstation  65

Wansink, Brian  40, 59

wants, vs. goals  13 – 15

water drinking (and intoxication)  58

weakness  22, 41

weighing  47, 62, 72, 100, 115

Weight Watchers  62 – 64

weight, desired range  2 – 3, 11, 14, 21 – 24, 49, 57, 60, 72, 90, 96, 114, 118

weight, losing  1 – 3, 12 – 16, 21 – 24, 25, 29, 31, 33, 36, 41, 43, 47, 49, 51, 53, 56. 58, 60, 63, 65 – 67, 71 – 76, 79 – 80, 83, 86 – 88, 90 – 91, 102, 105 – 111, 114 – 118

weight, maintaining  2, 8, 11, 14, 21 – 24, 36 – 37, 49, 57, 60, 66, 68, 71 – 75, 80, 108 – 109, 114, 117 – 118

Wells, Orson  45

white carbohydrates  57

whole grain foods  26, 55, 57, 61

willpower  2, 14, 18, 25 – 38, 43 - 44, 45 – 47, 50 – 51, 53, 97, 99 – 100, 107, 108, 109, 111, 114

willpower fatigue  28, 45 – 47, 53, 99

win-win  44, 79

won’t power  27 – 28, 30, 34, 36, 97

Yoga  43, 66, 72, 101

yo-yo  see dieting, yo-yo

Zone diet  63, 105

Zukowska, Zofia  40