Guide to Behavior Change for Losing and Maintaining a Healthy Weight 07-07-2003 Source: National Institutes of Health, National Heart, Lung, and Blood Institute Over the past few years, it has become clear that weight is an important health issue. Being overweight is a risk factor for health problems such as diabetes, high blood pressure, high cholesterol and triglycerides, arthritis, gall bladder disease, gynecologic problems, some cancers, and even lung problems. Some people who need to lose weight for their health don't recognize it, while others who don't need to lose weight, want to get thinner for cosmetic reasons. We understand that in some ways your weight is different from, for example, your cholesterol level or your blood pressure, because you can't see what these are by looking at someone. Many patients have had health-care providers who approached their weight in a less-than-sensitive or helpful manner. Some patients may have had health-care encounters in which they felt blamed, but not helped. Please be assured that when we bring up your weight, it's because we know that this is an important aspect of your overall health care. We understand, though, that successful weight management is a long-term challenge. By the same token, we may discuss weight goals that are different from those you select. Weight can affect a person's self-esteem. Excess weight is highly visible and evokes some powerful reactions, however unfairly, from other people and from the people who possess the excess weight. The amount of weight needed to improve your health may be much less than you wish to lose when you consider how you evaluate your weight. If we suggest an initial weight goal that seems too heavy for you, please understand that our major emphasis is on your health and that your health can be greatly improved by a loss of 5-10 percent of your starting weight. That doesn't mean you have to stop there, but it does mean that an initial goal of losing 5-10 percent of your starting weight is both realistic and valuable. Behaviors That Will Help You Lose Weight and Maintain It Set The Right Goals Setting the right goals is an important first step. Most people trying to lose weight focus on just that one goal: weight loss. However, the most productive areas to focus on are the dietary and exercise changes that will lead to that long-term weight change. Successful weight managers are those who select two or three goals at a time that they are willing to take on, that meet the following criteria of useful goals: Effective goals are 1) specific; 2) attainable; and 3) forgiving (less than perfect). "Exercise more" is a commendable ideal, but it's not specific. "Walk five miles everyday" is specific and measurable, but is it attainable if you 're just starting out? "Walk 30 minutes every day" is more attainable, but what happens if you're held up at work one day and there's a thunderstorm during your walking time another day? "Walk 30 minutes, five days each week" is specific, attainable, and forgiving. In short, a great goal! Nothing Succeeds Like Success Shaping is a behavioral technique in which you select a series of short-term goals that get closer and closer to the ultimate goal (e. g., an initial reduction of fat intake from 40% of calories to 35% of calories, and later to 30%). It is based on the concept that "nothing succeeds like success." Shaping uses two important behavioral principles: 1) consecutive goals that move you ahead in small steps are the best way to reach a distant point; and 2) consecutive rewards keep the overall effort invigorated. Success (But Not With Food) Rewards that you control can be used to encourage attainment of behavioral goals, especially those that have been difficult to reach. An effective reward is something that is desirable, timely, and contingent on meeting your goal. The rewards you administer may be tangible (e. g., a movie or music CD or a payment toward buying a more costly item) or intangible (e. g., an afternoon off from work or just an hour of quiet time away from family). Numerous small rewards, delivered for meeting smaller goals, are more effective than bigger rewards, requiring a long, difficult effort. Balance Your (Food) Checkbook Self-monitoring refers to observing and recording some aspect of your behavior, such as calorie intake, servings of fruits and vegetables, exercise sessions, medication usage, etc., or an outcome of these behaviors, such as weight. Self-monitoring of a behavior can be used at times when you're not sure how you're doing, and at times when you want the behavior to improve. Self-monitoring of a behavior usually changes the behavior in the desired direction and can produce " real-time" records for review by you and your health care provider. For example, keeping a record of your exercise can let you and your provider know quickly how you're doing, and when the record shows that your exercise is increasing, you'll be encouraged to keep it up. Some patients find that specific self-monitoring forms make it easier, while others prefer to use their own recording system. While you may or may not wish to weigh yourself frequently while losing weight, regular monitoring of your weight will be essential to help you maintain your lower weight. When keeping a record of your weight, a graph may be more informative than a list of your weights. When weighing yourself and keeping a weight graph or table, however, remember that one day's diet and exercise patterns won't have a measurable effect on your fat weight the next day. Today's weight is not a true measure of how well you followed your program yesterday, because your body's water weight will change much more from day to day than will your fat weight, and water changes are often the result of things that have nothing to do with your weight-management efforts. Avoid A Chain Reaction Stimulus (cue) control involves learning what social or environmental cues seem to encourage undesired eating, and then changing those cues. For example, you may learn from reflection or from self-monitoring records that you're more likely to overeat while watching television, or whenever treats are on display by the office coffee pot, or when around a certain friend. You might then try to sever the association of eating with the cue (don't eat while watching television), avoid or eliminate the cue (leave coffee room immediately after pouring coffee), or change the circumstances surrounding the cue (plan to meet with friend in non-food settings). In general, visible and accessible food items are often cues for unplanned eating. Get The (Fullness) Message Changing the way you go about eating can make it easier to eat less without feeling deprived. It takes 15 or more minutes for your brain to get the message you've been fed. Slowing the rate of eating can allow satiety (fullness) signals to begin to develop by the end of the meal. Eating lots of vegetables can also make you feel fuller. Another trick is to use smaller plates so that moderate portions do not appear meager. Changing your eating schedule, or setting one, can be helpful, especially if you tend to skip, or delay, meals and overeat later.