Diet Revolution

To be precise, I should say that over the year my diet way of eating (the dieter’s PC phrase) has gradually evolved. While I remain committed focusing on behaviors around health (eating, physical activity, paying attention to my body, etc.), over the last 3 months what I eat has shifted. Time to revise my behavioral goals around food to reflect what I have learned as I went through a prolonged plateau, a battle with severe side effect from a statin medication that left me inactive for weeks, and a reconsideration of the role of cholesterol as a risk factor for me individually.

Going back to January 8, 2010 here were my behavioral goals:

  • restricting my calories to 1500kcal/day on average in a week
  • aiming for a balance between protein, fat and carbs
  • spreading out my food intake throughout the day, which means eating breakfast
  • no food after 7pm
  • no red meat
  • no ice cream (the ultimate trigger food for my binging)
  • minimal refined grains and grain products
  • adding at least 3 fresh fruits/vegetables per day
  • shopping only for fresh produce
  • limiting what is in the cupboard/frig to what is acceptable to eat
  • no artificial sweeteners or drinks with artificial sweeteners – sweet stimulates me to eat more sweets
  • monitoring everything calorie that goes into my mouth (I use the Livestrong.com site)
  • charting my weight twice a week
  • being physically active 30 minutes a day, beyond job and household activities

I believe that insulin is the big drive behind fat – getting fat and staying fat. There is much scientific evidence for support, and as a physician who believes in evidence-based medicine* I am not one to follow fads. My personal experience over the years has shown how sensitive my hunger, eating, and ultimately my weight are to foods (starch, sugar) that increase insulin. I cannot change my genetics, but I can change my food intake so fat is able to get out of my body easier and stay out forever. Also, I want to choose foods that decrease inflammation (because of family history of heart disease and because fat tissue produces inflammatory molecules); and I probably need nutritional supplements with vitamins given that I will still count calories.

Why count calories and not just low carb it? Theoretically one could just eat fat and eat little to no carbs, but eventually their body would stop drawing from fat reserves and use just what is provided in their diet. So calories do count when trying to lose weight  – it is the quality of calories that count for mobilizing fat and maintaining fat loss.

Given all of the above and more information circling in my brain, here are my revised behaviors in an attempt to change the regulation of my fat tissue:

  • No wheat, sugar (except that in natural foods), starch, or grains
  • Emphasize quality protein
  • Aim for ratio of 50:30:20 protein:fat:carbs in 1200 calories
  • Limit fruits to 2 servings a day – mostly berries
  • Veggies are unlimited (potatoes are not a veggie)
  • Monitor all intake daily using software to account for above and review macronutrient intake every week
  • Eat breakfast, ALWAYS
  • Ice cream will always be off-limits, and the only off-limit food
  • Eat if I am hungry – and figure out why I let myself get hungry
  • Have acceptable snack foods available
  • Weigh no more than once a week
  • Engage in fun, physical activity at least 30 minutes/day
  • Supplement with vitamins as needed to reduce inflammation
  • Review the above list every week after weighing

Sound restricted? Yes, it is now because I have another 50 or so pounds to lose. Will I occasionally eat cake (or potatoes) – you bet, but just a taste and only in celebration. Should I exercise more? This is all I can manage now because of the myopathy from taking statins. My goal is to be able to do whatever I want without restrictions because of my weight and to keep my health optimal.

*Evidence Based Medicine is the integration of the best scientific evidence available with clinical expertise and patient values to reach optimal decisions for individual patients.

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Update on (Drowning) Gym Rat

Eleven months and 85 pounds into my weight loss journey, I feel pretty comfortable that I have mastered techniques and behaviors around eating that will keep me going to my final goal weight and even into maintenance. Now that I am embarking on a similar path to changing physical activity, I am hitting a wall. I have an exercise plan developed with a personal trainer (that I might need to modify given the amount of knee swelling after the first workout); got my workout music on the iTouch; picked aquatic classes for my level of fitness; after experimenting with the so-called non-weight bearing elliptical (ha!) decided that the treadmill and recumbent bike will be my cardio machines of choice; even have a schedule – OK, a kinda schedule. But, I am not following through. What the heck is going on? Why can’t I apply the same internal motivation to change around eating to exercise?

I looked at a post from January to help answer my question (partially). I used a model of behavior change called the Stages of Change (proven to show how people change successfully on their own or with help) and applied techniques that matched the Stage (action) that I was in to changing how I ate.

Now I’m going to do the same thing with physical activity and see if I can’t generate some more internal motivation and confidence to stick with my exercise plan. First, the behaviors that I want to accomplish have to be very specific. So here they are (don’t laugh, I’m starting out slowly because of my damn knee and to make these initial goals achievable):

  • Exercise in some form 6 days a week
  • Aquatics class M,W,F – if the aquatics class I chose doesn’t work out, there are 3 others to select from
  • Gym workout T,Th,Sat or 60 minutes of outdoor walking or 60 minutes on home recumbent bike or 60 minutes of walking/bike
  • Check off activities on trainer’s worksheet in the gym

OK, there it is in writing. I can do that. I can. I think.

I am in the action stage for exercising. I need to remind myself of why I am doing this. These new behaviors are very important to me. I want to reclaim my self (body) as an active person, believe life long physical activity is crucial to successful weight loss maintenance and health, and know once I get started that I will feel so much better about my body and reap emotional benefit. I am, however, not so confident that I can carry out this routine even though I just said that I could. Building my self-confidence (not the same as an ego boost) is important now and for the long-term. I worry about my knee flaring up; I reflect back on past failed efforts to exercise; I wonder what to do when family and vacations get in the way (walk maybe?); I know that the very recent death of my mother and my raw grief reaction are probably impacting my ability to act. I need more confidence. So here are things that should help:

  • I have set realistic goals and know that I can modify the goals as needed based on how my body reacts (not on how my brain does)
  • Seek positive support for efforts – spouse, family, close friends, fellow bloggers. All negativity will be booted out the door. My spouse has not been as supportive with the gym. “Why do you need to spend the money? Why can’t you just walk?” Negotiations in progress.
  • Reward myself for small changes – something I didn’t do with my dietary changes. So I’m going to have to think about this. What can I give myself for staying 100% on track for one week?
  • Continue reading/watching the successful exercise experiences of others like myself. “Hey, if she can do it, so can I!”

Those of you who have been successful in becoming a regular exerciser, feel free to let me know how you did it. I’m open to any suggestions on the how to do – not necessarily the what to do. Really, I’m drowning here.

Sarah Harford's "To Save a Drowning Rat"

Six-month Check In

Time flies when you aren’t gaining weight. Daily self monitoring sometime becomes a “losing the forest for the trees” kind of thing, thus, time to reflect and see how I have been doing with behavior changes and remind myself and the vast (cough) number of readers what is working, what I’ve thrown out, and what my latest doctor visit revealed.

As a summary, my plans for weight loss were kick started by a laparoscopic cholecystectomy September 16, 2009. Resulting complications left me unable to eat much for over a month. My surgeon, Dr. Katie Artz, performed a superb procedure using only one incision, and she was amazingly tolerant of me. During my pathetic attempt to play patient through unexpected pain, numerous tests and ridiculous GI side effects, I resolved to make permanent lifestyle (ah, that word) changes and worked hard to outline clear behavior goals and get my partner on board to support me.

Defining goals in terms of behavior change, not just how much weight one wants to lose, is a crucial component of being successful. Ask me, I’m a behavior change expert – no really, want to see my research publications? I consider weight “goals” to be long-term outcomes of behavior. I do know it is  important to establish those long-term and intermediate weight outcomes (as I have posted on the sidebar), but without knowing how you are going to get there, it’s impossible to just go out and lose 140 pounds. Holy shit that’s a lot of weight to lose! Another reason for breaking down the goals into behavior change components is that individual behaviors are much more doable than just dropping an entire person off your body.

Knowing what has worked for people who have successfully lost weight and maintained that loss, knowing from scientific data what people do to change health habits (on their own or with help), knowing my own stumbling blocks from prior losses and regains, here is how I started: I chose a ultimate weight outcome, intermediate weight outcomes, a physical activity outcome and then listed what behaviors I needed to do to get there. January 8th I posted these. Now time to revisit.

I have done stellar at self-monitoring my weight and food intake. I’m still eating a higher percentage of carbs than I would like, but they are complex carbs, so I will live with the current balance between carbs/protein/fat. I still do not eat any protein from animals with eye lashes (go figure – it’s some aversion that occurred postop). No sweeteners – check.  All food within my reach is something on my plan because I still have such low impulse control. The only refined products are Lean Cuisine© and Eating Right© frozen dinners plus the occasional protein shake + skim milk to supplement protein and calcium intake. Fruits and veggies easy now with huge salads, fresh fruit with lunch or breakfast, and low sodium V8 as a treat. And, I have not even looked at ice cream. Breakfast, ummm, sometimes after my morning coffee it’s already time for lunch, so that needs improvement. Although I do not indulge in late night eating any more, I do eat dinner after 7 pm frequently. I need to rethink my time limit or buckle down and cut off eating by 7 pm.

I have continued to keep my family and partner in the loop of what I am doing. Sue and I have effectively blocked her mother subverting my eating plan this winter (perhaps another post about family sabotage later). I stay connected to online support groups because that is the only place where I have been comfortable getting and receiving support in this effort. When I feel a bit edgy, usually in the evenings, I appease my other senses by lighting candles, having an abundance of herbal teas, luxuriating in my therapeutic tub with exotic mineral salts, playing non-violent video games (a change in my gaming pattern), holding the pets, listening to music more, and trying to write more.

My physical activity long-term outcome of walking a 5k is on hold because of a knee injury. An appointment with orthopedic surgeon scheduled since walking around the block is almost impossible at this point.

Having lost 61 pounds and eating so healthy, I proudly presented myself to my PCP for a routine visit, a recheck of cholesterol, and follow-up on liver enzymes that were out of whack for months after surgery. I had gone off my cholesterol lowering med because of its effect on the liver and the fact that I was eating so damn healthy. Good news, my blood glucose is low, low, low; liver enzymes are back to normal. Bad news, my total cholesterol is higher than it has ever been; HDL cholesterol (the good kind) is high; but LDL (the bad kind) is very high. So back on medication. Rats! Also, my blood pressure was elevated even though I am on a beta-blocker for another condition. WHAT THE HECK?

So now… Nothing to change on the diet front. I satisfied that my salt and fat intake are not contributing to my cholesterol and BP problems. In fact, I’m giving myself a huge pat on the back for keeping my behavior changes going although I have so much more to accomplish and a lifetime ahead of me. There are other ways that I can be physically active that do not involve my knee – looking for a pool (we must be the only people in our Tucson neighborhood without one) where I don’t feel too self-conscious showing so much flab. Checking blood pressure 3 times a week for now. Starting on new cholesterol med.

I do allow for special occasion eating. Life goes on, and it’s OK to have a romantic 5-course dinner that includes a few bites of desert – as long as I plan for it.

Oh yes, I am enjoying buying new clothes but still disgusted with my body. Fodder for another post.

Peace.

Changes I Have Made (this time)

I have lost hundreds of pounds since I become overweight around age 26, which means I have regained hundreds of pounds also. Now at the age of 55 and through menopause, the ease of weight loss just isn’t so easy any more. Perhaps that’s “a good thing” as Martha Stewart would comment.

One of the most ironic aspects of my life is that my years in health research focused on health behavior, so I know exactly what one should do for successful health behavior change and maintenance. Ah, but the knowing and the doing and the feeling somehow just aren’t the same are they? Or, no one would smoke; we would all wear seat belts; there would be no fire arm accidents, etc.

Back on track… I finally reached the stage of commitment to weight loss and maintenance (after years of dejection from repeated regaining) and, spurned on by a surgery unrelated to weight problems, found the self-confidence that I could act on life-style changes. [Those interested in the Stages of Change Model for voluntary behavior change can read here a brief and very elementary intro about how people successfully modify their behaviors.]

First, I had to identify which behaviors I wanted to change. Weight loss is a goal – not a behavior. There are no less one than gazillion behaviors tied into losing weight.  That’s right, exactly one gazillion. One must identify which behaviors are specific for you before springing into action.  For me, the starting behavior changes are:

  • restricting my calories to 1500kcal/day on average in a week
  • aiming for a balance between protein, fat and carbs
  • spreading out my food intake throughout the day, which means eating breakfast
  • no food after 7pm
  • no red meat
  • no ice cream (the ultimate trigger food for my binging)
  • minimal refined grains and grain products
  • adding at least 3 fresh fruits/vegetables per day
  • shopping only for fresh produce
  • limiting what is in the cupboard/frig to what is acceptable to eat
  • no artificial sweeteners or drinks with artificial sweeteners – sweet stimulates me to eat more sweets
  • monitoring everything calorie that goes into my mouth (I use the Livestrong.com site)
  • charting my weight twice a week
  • being physically active 30 minutes a day, beyond job and household activities

To help me do these things, I enlisted the support of my partner (too many negotiations to go into here) and got her to agree to help in ways that are acceptable to both.  I announced to family and close friends my plans and asked for their support – mainly by not offering me food.  I joined a support group. We rearranged the kitchen and threw out or gave away everything we would not eat. I found substitute behaviors for my late night eating, e.g. drinking hot tea (bought new mugs, fancy water kettle, special teas), made the bath more spa-like for reading in the tub rather than eating in front of the TV. I chose rewards for certain goals reached. Started this silly blog. I also gave myself permission to go off plan for special occasions – to prevent me from  binging because I had “blown it” by eating chocolate or dessert or had a 5 course dinner including red meat for Christmas eve. LIFE GOES ON!

I will continue to revisit my behavior change list, expecting to change caloric intake and activity levels. If something doesn’t work, I will throw it out. I will continue to seek wisdom from those who have succeeded in maintaining weight loss and from those who are on the same journey.

What are your behavior changes and mechanisms for keeping them going?

Peace.