Alternate Expectations: A Guide to Navigating Holiday Eating

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The holiday season is here and it’s time for us all to quickly gain ten pounds. What? Why would I say that? I say that because it’s written all over the place. Over the next few weeks, you are going to see and hear references to our tendency to gain weight during this time of year in every newspaper, magazine, website, blog and television news program. And while the opportunities to eat may increase this time of year and the kinds of foods pushed on us are often not the healthiest, you don’t have to gain weight. However, if you EXPECT to…you will.

What do expectations have to do with weight gain? Think of expectations as a combination of predictions and learned patterns of behavior. Outcomes that have occurred in the past, we generally expect to happen again. Take Thanksgiving for example, or what I like to call “National Binge Eating Day.” Thanksgiving is one of those few days of the year where the holiday seems to be about overeating. Of course, Thanksgiving is supposed to be about taking the opportunity to give thanks for how fortunate we are to live in this great country and to count our blessings for what we have. However, if you ask most Americans what comes to mind when they think of Thanksgiving I’ll bet turkey, stuffing, pie and football come long before giving thanks. More importantly, it’s not only food and eating that we think of but overeating and overindulging. This is so common that it’s often parodied in television commercials. Companies that manufacture antacids run ads showing people with exploding pant buttons or slumped back in the big armchair following the big meal. Thanksgiving, holiday parties and overeating seem to be synonymous.

Many of us expect to overeat on Thanksgiving and at holiday parties so we inadvertently mentally gear up for this to happen. With this expectation of overeating in mind, our behavior becomes less controllable…you’re psychologically setting the stage for a binge to occur by expecting a huge meal to be served and by recalling previous Thanksgivings when you overate. Similarly, this is the season of holiday parties. Holiday parties tend to include foods that are rich, highly caloric and plentiful. And let’s not forget the alcohol. When you attend holiday parties, many of us EXPECT these foods and drinks to be available and we are more likely to overindulge if that has been our pattern in the past. You’re certainly not a drone who is unable to make change, but it is infinitely less likely unless you take active steps to make that change. What can you do to prevent overeating at this time of year and gaining those extra pounds?

1. Change your expectations by planning what you will do ahead of time. On the morning of Thanksgiving, think about what the likely layout will be where you are having the meal. Have you been there before? Do you know what to expect to be on the table? If so, plan ahead. Make some decisions about what you will eat and how much. Promise yourself that you will not overeat. After all, it’s just one meal and ironically many people who overeat say they’re not particularly fond of Thanksgiving food. They just get caught up in the collective binge mentality and the rest is history. If you plan ahead and carefully consider what to do instead of binging, you have a much better chance of controlling yourself and feeling good about your eating behavior afterwards.

2. Consider that while eating may be a significant and enjoyable part of holiday parties and gatherings, OVEREATING does not need to be. Try not to give yourself permission to overindulge. Let’s face it…eating is fun and enjoyable and is a large part of holiday merriment. However, there is no fun in feeling nauseas or uncomfortable just after the meal and guilty and self-deprecating hours later.

3. Don’t starve yourself on Thanksgiving morning or on the day of a holiday party. This is one of the most common, yet foolish strategies people employ. The calories you give up by skipping breakfast and lunch usually pale in comparison to the calorie content of the evening binge at Thanksgiving or the holiday party. Instead, eat normally during the day which may actually help keep you from binging later. You are far more likely to control yourself if you are mostly full during the day rather than starving when you walk in the door of the party.

4. Consider making some eating compromises. Who said you have to have turkey only on Thanksgiving? Is pecan pie banned at other times of year? Consider having the foods that truly are once a year items rather than loading up on everything. And even then, you don’t need five pounds of the special foods. If you only get to eat your grandmother’s special stuffing once a year, you certainly shouldn’t pass that up. However, I promise you that eating a ton of it will not make you happier than having two nice size tablespoons of the stuff. Again, plan ahead and make decisions earlier in the day.

5. Watch the booze. Alcohol causes our judgment to get a little fuzzy. You are going to be more successful controlling your behavior if your brain is firing on all cylinders. If you drink too much too early in the day, you’re going to have a tougher time sticking to whatever plan you created. Also, too much alcohol causes us to make other foolish decisions. There are enough unfortunate tragedies that happen this time of year. Make sure you’re not a part of one.

I’m not suggesting in any way that you be a killjoy and I certainly don’t believe that it’s necessary to avoid holiday parties or gatherings where food is available. By planning ahead, changing your expectations, and making a few specific eating compromises, you can truly have your cake and eat it too.

Happy Holidays!

Dr. Huberman is a Clinical Psychologist with a practice in New York City. He is a Clinical Assistant Professor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New Book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.” For more information, visit warrenhuberman.com.

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Inertia – The Real Weight Loss Killer

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We do what we do because that’s what we do. That may seem like one of the most ridiculous sentences ever committed to paper, but read it again. We do what we do because that’s what we do.

This means that we don’t necessarily do what we do because we made conscious choices to do it that way. It means that much of our behavior is on autopilot. Think of this phrase with regards to eating. We spend so much time talking about emotional eating that we’ve forgotten that most of the time that we’re eating unhealthy or eating “comfort foods” it is not because we are depressed or anxious, it’s because we’re just not thinking about what we are doing, and eating has become a seemingly automatic behavior. Our minds are somewhere else. I’m not saying that emotional eating isn’t a problem, but rather that the behavior of eating without thinking is as big if not the bigger problem much of the time. Think about it. How often do you go into the kitchen to have some cookies because you are depressed? Now, think about how many times you go into the kitchen to get some cookies and you have no idea why you went into the kitchen. I bet the latter situation happens much more often. Ever find yourself in the middle of eating some cookies and you don’t even remember going into the kitchen or opening up the box of cookies? See what I mean!!!

It may be true that we learned to eat as a means of comforting ourselves from negative emotions such as anxiety and depression. However, the behavior of eating often persists long after the anxiety and depression is gone. Why? Habits are really hard to break and your brain isn’t in the business of breaking them without a whole lot of effort. A great deal of any individual’s behavior occurs outside of his or her awareness and with very little conscious thought. What this means is that many of our bad habits persist because we are not aware enough to do anything about it. We don’t necessarily reach for the cookies because we CHOOSE to have cookies. Our brains just automatically crave cookies when we are in circumstances that we have commonly eaten cookies in the past. We don’t even need to think about it anymore. Because you’ve engaged in the behavior of eating cookies under specific circumstances so many times (let’s say at night, feeling tired, watching television, a bit bored with the show) your brain now cues you to go for cookies without any conscious thought from you. No thinking required! And if you’re not actively thinking about your choices, you’re not making a choice. You’re operating on inertia.

What is inertia? You remember that phrase from high school physics… “an object in motion is likely to stay in motion….” What this means in terms of behavior is that a behavior that is repeated over and over (also called a habit) will persist unless something comes along to interfere with that behavior. Inertia is when behavior just keeps going because it’s been going. John Lennon had this wonderful lyric that said “life is what happens to you while you’re busy making other plans.” This means that as long as you are alive, even when you’re not trying to make decisions or to make change, life goes on. Therefore, if you don’t do something to make changes in your behavior, you’ll likely keep performing the same behaviors you’ve always performed under similar circumstances. This is exactly what happens with eating most of the time. Diets are an exception. Consider just how different your eating behavior is from its normal state when you’re on a diet.

When you’re on a diet, you are contemplating every decision. You are in the moment and you are making choices. You are reading labels. You are measuring servings. You are counting calories, points, carbohydrates, etc. You are “on.” When you go off the diet, if you’re like most people, ALL of this stops. No more thinking, no more measuring, no more counting, no more making choices…just running on inertia. Eating with very little thought and your brain seems to eagerly resort back to its old ways. That’s inertia.

The keys to change are therefore rather obvious. Be in the moment. Contemplate as many food decisions as you can. Plan your meals and snacks ahead of time rather than trusting that your brain will help you make the right decision in the moment. It won’t. Anticipate high-risk eating situations like parties, weddings, and barbeques. Maybe you’ve heard all of this before. You probably have. There are many different terms used for this approach and they are likely speaking to the same concept. A hot term these days is “mindfulness.” It’s not really a new concept…the Buddhists have been talking about it for several thousand years. It’s really very simple in theory…be aware and observe your thoughts and feelings, and be present in the here-and-now. Then make your decision.

Why is mindfulness so important? Because habits and the power of inertia are incredibly powerful and the weight you have lost or are trying to lose wants to come back. Your body isn’t the least bit interested in helping you lose weight. So if your mind isn’t very conscious of what it’s trying to achieve, it’s just not going to happen. In fact, your body is fighting tooth-and-nail against you. Inertia is what happens when you’re not fighting back. Remember…we do what we do because that’s what we do. If you want to lose weight and keep it off, your new phrase needs to become “I do what I do because that’s what I’ve decided to do,” or better stated, “I eat what I eat because that is what I choose to eat.”

Dr. Huberman is a Clinical Psychologist with a practice in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New Book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.” For more information, visit warrenhuberman.com.

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Why Does Everyone Want To Be A “Food Addict?”

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In my work, I find that one of the most common explanations people give for their struggle with diets and with obesity is “I’m a food addict.” When asked what this means, most people explain that their inability to maintain the weight lost from diets and the fact that most or all of the weight eventually returns is proof of their “food addiction.” Additional evidence they cite is that their eating is “all or nothing,” that they can completely avoid so-called “forbidden foods” or binge on them with regularity, but nothing in between.

This kind of reasoning is called reasoning from the converse. This is where you have a conclusion or an end state and you then go backwards to explain the cause and use the existence of the end state as proof of the cause. This invariably leads to circular logic that goes nowhere. Here’s how it works: “I am a food addict which explains why I cannot moderate my intake of certain foods, and my inability to moderate my intake of certain foods proves that I am addicted to them and am therefore an addict.” But does it? There is actually another, more accurate explanation.

There are three facts that must be considered:

1) 95% of people will regain most or all of the weight they have lost on a diet within five years. 2) Many, if not most diets teach avoidance of “forbidden foods,” not moderate consumption of them. 3) Very few diets or weight loss regimens are successfully maintained indefinitely.

These facts are very important to our discussion because they are true for almost EVERYONE who has tried to lose a significant amount of weight. Therefore, either everyone who has failed to keep their weight off following a diet or eventually resorts to eating “forbidden foods” is a “food addict” or there are other explanations for this phenomenon.

But why is it that so many of the people I meet are eager to call themselves “food addicts?” Most people are uncomfortable acknowledging that they are addicted to alcohol or illicit substances such as cocaine or heroin, so why is being a so-called “food addict” easier to acknowledge? I believe it is because the label “food addict” removes the feelings of guilt and shame that so many people experience when they regain weight after all of the work they expended in losing it. It is absolutely heartbreaking to lose the weight, have people notice that you’re thinner and then a year later you’ve regained the weight and everyone knows it. It would be very tempting to blame this on a disease called “addiction.” “It’s not my fault that I regained the weight and am obese again…I’m a food addict.” I can certainly understand the desire to be free from responsibility from your obesity or weight regain; however, it’s not necessary to fall back on the explanation that you are a “food addict.” Perhaps if we looked at the facts about weight loss, there would be no need for all of the guilt and shame and the resulting need to explain it away by calling it an addiction.

Review the facts that I mentioned earlier. The overwhelming majority of people regain the weight they have lost from a diet, very few diets teach moderate eating of “forbidden foods” (so you’re left with only knowing how to eat them or not eat them), and most people find it very difficult if not impossible to stay on a regimen of controlled eating for extended periods of time. These are the problems faced by almost all human beings who try to lose weight, not just those who are “food addicts!” So what is the explanation when someone actually succeeds in losing weight and keeping it off? Great question…and the answer is not that these rare souls are not “food addicts” or that they are “recovered food addicts.”

The National Weight Control Registry (NWCR) is an organization that keeps tracks of “successful weight losers” who have lost 30 pounds or more and have kept it off for at least one year. What should immediately catch your eye is that “success” is defined as losing 30 pounds and keeping it off for one year. So if losing 30 pounds and keeping it off for one year is considered “successful,” if you’re morbidly obese and manage to lose 100 pounds and keep that off for several years that would be incredibly successful! Extensive research has been done on these folks over the years and the most recent study has discovered 7 common habits which most of the 6,000 people studied have in common. 6,000 participants in a study is a strong number of people and one where the conclusions drawn are likely very robust.

Interestingly, the researchers noted that 90% of the folks in this study who finally lost the weight and kept if off had a previous history of losing weight and putting it back on. Therefore, the overwhelming majority of people were not successful on their first try. The seven habits of successful “losers” were: 1. Engaging in 200+ minutes of exercise of moderate intensity per week, 2. Limiting TV watching to less than 10 hours per week, 3. Eating a low-calorie, low-fat diet with less than 30% of calories from fat, 4. Consistency – relatively little food variety and the same daily pattern of eating, 5. Eating breakfast, 6. Avoiding emotional eating and binging and limiting consumption of fast food to less than once weekly and, 7. Monitoring yourself such as documenting calories and/or fat. Notice that every one of the seven habits is just that…a pattern of behavior. There is no mention of the characteristics of the 6000 people. It’s not about who they are, but rather what they did and continue to do.

So what do we make of this “food addiction?” Neuroscience is recognizing the difficulty human beings have in resisting certain foods that we can call “engineered foods” that are high in sugar, salt and other additives. These foods are designed by fast-food companies and food manufacturers to be irresistible because they cause certain reactions in the brain that make it hard for us to say no. But these are challenges for us all. In fact, mass consumption of these “engineered foods” is likely one of the great contributors to the obesity epidemic. They explain why we, as a society, are getting fatter. Perhaps we will discover that some individuals (for neurological or other reasons) have a more difficult time resisting these “engineered foods” enriched with sugar, salt and other additives, and that these individuals are the true “food addicts.” But what would knowing that you are one of these individuals change? What would a “food addict” do differently to lose weight and keep it off?

The addiction model says that the addict should completely abstain from using the substance or drug. Should “food addicts” avoid all food (impossible) or just the ones they are “addicted” to? And how would we know which ones those would be? The most commonly cited addictive “substance” in food is sugar, but we’re not at all certain. There is also another problem. Much of the research on binge eating indicates that designating certain foods as completely “forbidden” and avoiding them results in feelings of deprivation and their becoming even more desirable which often results in binging on them when you finally give into temptation.

Perhaps someday there will be treatments for true “food addicts” if “food addiction” actually exists. What is more likely however; is that these folks will simply have to work even harder than most of us to stick to the seven habits that are detailed above. In the meantime, consider giving up the label of “food addict” and instead, recognize that losing weight and keeping it off is a tremendous challenge, but an achievable one. If you’re thinking of beginning to address your own personal “battle of the bulge” either for the first time or the twentieth time, or if you’re feeling hopeless and thinking there is no point in even trying, fear not…most successful losers apparently made several unsuccessful attempts before they finally got it right. And if you are thinking of starting yet again…the seven habits detailed above are a great blueprint to follow.

Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman has been a consulting psychologist to the NYU/Langone Weight Management Program since 2000. Dr. Huberman is the author of the New Book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.” For more information, visit warrenhuberman.com.

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What can I find to substitute for eating? How about nothing!

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Many authors, self-help gurus and other diet and eating experts suggest that we find substitutions for eating, however, the best thing to do might be to simply do nothing. Sounds strange? Why do we have to find substitutes for eating? What about just not eating?

Consider that often times the act of eating serves little or no purpose. Many patients tell me “I’m not hungry” or “I’m not craving anything in particular yet I still keep finding myself in the kitchen going through the cabinets looking for something.” In this situation, why replace one senseless, purposeless behavior for another?

It would almost seem to make sense to substitute another behavior for eating if there was a specific purpose the eating was serving. This form of eating is often referred to as “self-medicating.” For example, if someone finds they are eating at night because they are depressed, lonely or anxious (“self-medicating” the depression, loneliness or anxiety with food), finding better ways of managing depression, loneliness or anxiety to replace eating seems to be an appropriate suggestion. Similarly, many people tell me that they eat at night because they are bored. Eating doesn’t really do much to address boredom, but clearly there are a million and one things someone can learn to do to address boredom that would be better than eating. Going out for a walk, performing some household chores, and calling a friend might be some examples. But what about those people who eat and aren’t even sure why?

Before you try to come up with a quick substitute for eating, consider that the act of eating is a habit. In other words, one of the primary reasons that you are eating is because you have a long history of eating. Over the course of many years, you have unintentionally trained your brain to request food under specific circumstances in specific situations and now, many years later, whenever you are in those specific situations, your brain makes you think of eating and compels you to eat. So the urge to eat is just like a thought. (Yes, there are biological and other factors as play but just stick with me for the moment!) Your brain decided to pop the idea of eating into the front of your mind. This is a perfect example of the famous Pavolvian conditioning (or Classical Conditioning) that you learned in high school. In these situations your desire to eat something is nothing more than an automated response generated by your brain. You paired specific situations together with eating thousands of times and now…voila!!! The situation triggers a desire to eat. Maybe you refer to this is “a habit.” But you don’t have to obey your thoughts and you can break old habits!!

Here’s what you can do. Try to identify as many of your eating triggers as possible. Over the course of a week, write down (yes…write down!!!) every situation you were in when you put something in your mouth. Notice any patterns? Is it often when you’re bored? Is it often at night? Is it often simply when there happened to be food around? Then, over the course of the next week, try to be mindful during those same situations. In others words, when you become aware that you have the urge to eat in a particular situation even though you’re not particularly hungry or craving anything in particular, just sit there in the moment and be still. Notice that you want to eat and don’t do it. Just let the thought be…let it float around your mind a little and prove to yourself that you don’t have to do anything about it.

Not only don’t you have to respond to the thought of eating by going into the kitchen to eat, you don’t even have to pay attention to the thought itself! After a few minutes it will likely go away on its own. Something else will come up in the next few minutes that distracts you from it entirely. Walk away from the kitchen, the refrigerator or the plate of cookies and just move on to the next activity. You may find that after 5-10 minutes that you forgot about your urge to eat.

With practice your ability to say “no” will improve and the urges to eat under these circumstances will diminish because you will be changing the consequence attached to that thought. Every time you eat in response to the thought of eating, the link between the thought and the behavior get stronger. Every time you have a thought about eating and DON’T eat, the association between thinking of food and eating gets weaker. Through time one of two things will happen: either your ability to simply let the thought harmlessly float around your mind will improve or the thoughts will stop happening altogether.

Now, what about those situations where you are self-medicating…when you are using food to cope with anxiety, loneliness, depression or other emotions? Even in these situations, you don’t have to find a substitute for eating. We have this ridiculous notion that we always should try to be comfortable and to avoid emotional pain. In fact, I will make the argument that avoiding emotional pain and finding a substitute activity for eating is exactly what you shouldn’t do. Here’s why…

If you are a person who “self-medicates” with food, somewhere during your life you learned that food can temporarily diminish your unpleasant feelings. For a brief while you get relief from your unpleasant feelings and actually feel better (until the guilt kicks in!). But what that also means is that you are not dealing with your unpleasant emotions and addressing what maintains them…and that is why they continue to bother you. You are simply covering those feelings over with cookies, potato chips or peanut butter. To really fix this problem once and for all, you have to become aware of those unpleasant feelings and actually feel them and work through them. Not eat through them or find some substitute behavior for them.

Here’s what you can do. Once again, try to identify as many of your emotional eating triggers as possible. Over the course of a week, write down (yes…write down!!!) every unpleasant emotional state you were in when you put something in your mouth. Notice any patterns? Is it often when you’re lonely? Depressed? Worried? Then, over the course of the next week, try to be mindful when you are feeling those same emotions and having the urge to eat. Instead of eating, have a pad and pen ready and write down what you are thinking and what you are feeling. Then, try to write down what kinds of strategies might address these problems. For example, if you are lonely, think of as many ways as you can to try to meet some new people or reconnect with old friends. If you are depressed or anxious, think of as many ways as you can to get help with your depression or anxiety (exercise, therapy, support groups, online support, talk to friends, medications, exercise, etc). In this way, you can truly begin to address the sources of your emotional upset and put out the fire, rather than just finding a temporary substitute for eating.

Dr. Huberman is a Clinical Psychologist with a practice in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New Book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.” For more information, visit warrenhuberman.com.

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The “Marathon” Journey of Weight Loss Surgery

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I’m a runner. I’ve been a runner since I was a teenager. I’ve run five or more miles three times a week for the past four years and rarely take a day off. Many of my runs have been over ten miles. I’m the crazy guy you’ve seen running in the rain and the snow on the side of the road at 7 AM. I’ve learned a lot from running and many of those lessons I have applied to life in general. I’ve shared much of what I’ve learned about running with many of my patients because I believe that there are a number of parallels between long-distance running and the journey through weight loss. Many of my patients agree. I’d like to share some of these parallels with you to provide you with a helpful way to think about all that you’ve gone through and may still experience going forward.

I should make an admission to you first. I’ve never actually run a marathon. It’s something I very much want to do someday but have yet to attempt because of some nagging injuries and such. However, I know enough about long-distance running and have spoken to enough marathon runners to understand the psyche of the marathon runner. Therefore, I feel comfortable speaking of it here.

Consider the entire journey of weight loss surgery from before surgery to years afterwards as a marathon. For those of you who are unfamiliar, a marathon is a race of 26.2 miles. The modern Marathon commemorates the run of the soldier Pheidippides from a battlefield at the site of the town of Marathon, Greece, 26.2 miles to Athens in 490 B.C. It is seen by many as the ultimate test of endurance (although there are now ultra-marathons that can go for 100 miles or more!).

There are many things one must do to prepare for the running of a marathon. A marathoner has to complete several practice runs and work up his stamina and endurance to get into peak physical condition for the race. A marathoner is encouraged to make dietary changes, especially in the few days before the race. A marathoner has to mentally prepare for the grueling 26.2 run and plot out the course and a strategy of how he is going to make it from start to finish. The process of weight loss surgery is quite similar. There are many steps to take before your big day. There is research to do. Perhaps you will talk to doctors or to those who have had surgery to better understand what you will be experiencing. When you decide that surgery is for you, there are pre-surgical assessments, medical tests and other things that must be done to ensure that you are prepared for what lies ahead. You are instructed to make dietary changes in anticipation of your surgery…perhaps a liquid diet for a week or more. And certainly you must mentally prepare for all of the physical, behavioral and emotional changes that lie ahead.

For the most part, your surgery date is the starting line. You’re nervous. You’re excited. You’re hopeful. Similarly, the marathoner heart is pounding long before the starting gun is fired. The gun is fired and suddenly…they’re off! The first few days after surgery, you’re just trying to do as told. Listen to what the surgeon, the nurses and other professionals’ tell you and get home from the hospital as soon as you can. The marathoner is just putting one foot in front of the other and trying to find a good pace…a comfortable groove. Nothing fancy, just moving ahead. The first few weeks after surgery are like the marathoners first few miles…nice and easy. Learning to chew, learning what to eat and what not to eat…adjusting to the new pace of eating and making other changes in your life to improve your chances of success. Much of the journey lies ahead and thinking too far ahead can be daunting. Keep your head in the present.

At some point, there will be bumps in the road. The runner may have a side-stitch, a cramp, pain, fatigue, a pebble in his shoes; some complications to be addressed. The marathoner understands that some of these discomforts will come and go. Sometimes, if you just let it be and shift your focus to other aspects of the running experience and away from the discomfort…the discomfort goes away. It is important that the marathoner not panic about the situation. The journey through weight loss surgery will also have its discomforts. Like the marathon, many will simply come and go. Some days may be more difficult than others. On some days eating may be more difficult than other days. On some days, cravings will seem stronger than others. In most instances, the discomfort will be temporary. Avoiding “catastrophic” thinking is the key.

I am speaking of the mental demons that we all must deal with. Often while running, it seems as if a little devil appears on my shoulder whispering negative comments in my ear. “You’re never going to make it.” “You can’t do it.” “What were you thinking trying to run so far!?” “You’re not into it today…just go home and try again tomorrow.” Weight loss surgery patients also hear the voice of a little devil who attempts to derail you. “How am I going to avoid eating some of those foods that I love?” “What am I going to do at the holiday barbeque…I’m going to go nuts!” “I can buy a pint of ice cream and just have a little…what’s the big deal.” “A few cookies couldn’t hurt.” Part of your preparation for the marathon of weight loss surgery needs to include maintaining a positive attitude that can help you last the equivalent of 26.2 miles and to develop strategies for coping with these mental “cramps” and “side-stitches.” What am I going to tell myself when and if things get a bit complicated? What you tell yourself is immensely important in determining how and whether you will reach the finish line. Believing that you can cope with some of the temporary and unpleasant bumps in the road is essential for your success.

Many of my patients initially get quite deflated by setbacks or slips. Most times, they are engaging in what I call “black and white thinking.” In this way of thinking, eating one serving of ice cream immediately becomes “I’m sabotaging my surgery!!” One day of feeling deprived or hungry becomes “My band isn’t working!” or “I’m never going to be able to live this way!” It is dramatic, exaggerated and self-defeating thinking. The marathoner’s mindset needs to be focused on “how I can” not “why I can’t.” There is nothing propelling the marathoner forward other than his or her own desire to persevere. He can stop with one step, but CHOOSES not to. He tolerates the discomfort. You also can stop. You can “cheat.” You can avoid getting your band adjusted. You can eat around the bypass. You can drink your calories. You can eat sweets. But you won’t finish the race and you’ll feel terrible for it.

Several miles further down the road, the marathon becomes a strange combination of harder and easier. The marathoner has plenty of discomfort. Discomfort is probably an understatement. His body aches, his feet burn and his mind is often numb…but at the same time, he is beginning to almost taste the finish line. There are fewer miles ahead than behind. There is a mild euphoria as he considers that he might actually make it!! The surgery patient has lost a lot of weight several “miles” into her race. Perhaps most of the weight has already been lost…or maybe it’s already all off and now she’s focused on keeping it that way. But perhaps there are still some discomforts. Maybe some people continue to make annoying comments, or you have some body image concerns, or are experiencing other sources of anxiety and insecurity. It will be ok. Keep the focus on the here and now, avoid catastrophic thinking, and address what needs to be addressed. Try to taste the finish line. It’s not much farther now.

This is where the analogy ends. The marathoner raises his arms as he crosses the finishing line and gasps in a combination of exhaustion and euphoria….I did it!! It is an incredible accomplishment. He is finished. But as a person who has had weight loss surgery, you will always be running your race. Through time, your pace will hopefully become more predictable and steady, but the journey of weight loss surgery never truly ends. There are always “side-stitches” and “cramps” and little “pebbles in your shoes.” Rub out the cramps. Take a few breaths to relieve the side-stitches. Step off the track for a moment and shake out the pebbles in your shoe. Focus away from whatever the source of discomfort. There’s no timer anymore so there’s no rush to the finish line. Take each day as it comes, some better than others. Just keep a steady pace, a clear focus, and a positive attitude and you will successfully cross a thousand finish lines.

Lessons to remember:

• Stay focused in the present. Avoid thinking of how far you still have to go. Instead, focus on how far you’ve come. You cannot effect change in any moment other than the present one, so thinking about and certainly worrying about the future is in many ways both pointless and counterproductive. It only creates anxiety and ruins the present moment. By focusing in the present, you will get to the future faster than you think. When I run, if I focus on the fact that 90% of the distance lies ahead, I immediately feel tired and overwhelmed. When I simply take it one step at a time and enjoy the run, by the time I next think about my distance I’m that much further along and confident that I’ll get through it.

• Keep your “qi” (pronounced “chee”) about you. Qi is the circulating life energy that in Chinese philosophy is thought to be inherent and flowing in all things (it’s like “the force” in Star Wars). I think of qi as being a peacefulness, and being at one with the world around me. When I run, I feel more alive than at any other time. I am at one with the world around me. I am moving through the world and feel the world moving through me. Live in the current moment and allow yourself to experience all that you are experiencing. Be present in the present. Avoid thinking of what is wrong or what could go wrong. Instead focus on what is wonderful right now.

• Most of the physical and emotional discomforts that you will experience on your journey will come and go. Maybe not right away or even today. But most discomforts do not last forever. Just as many of the runner’s side-stitches and cramps work themselves through, so will yours.

• Avoid focusing on small and meaningless detail. Don’t weigh yourself incessantly and get down on yourself for every calorie. Do not become overly disappointed if you do not achieve these silly and arbitrary goals. The marathoner can choose to obsess about his slightly slow pace and tragically turn a remarkable event into an unbearable trek.

• Believe that you can “stand” some discomfort. Telling yourself “I can’t stand it” will lead you to not stand it. The marathoner perseveres through extraordinary physical and psychological challenges to reach the finish line. It is not an easy path. Your path too will be littered with obstacles. Trust in yourself and believe that you “can stand it” as well.

• Focus on the journey and the big picture. The transformation. The accomplishment of weight loss surgery is not in losing a certain amount of weight. It is about being able to make positive, meaningful change in your life that is now possible at this lower weight. Success isn’t achieved through a number on a scale; it’s by being able to live the life you’ve always dreamed of.

• Enjoy the run, not just crossing the finish line. In every moment of the race and in every moment of your journey…take a look around. Breathe in what is beautiful and enjoy each moment. Don’t live your life only in anticipation of crossing the finish line. When you have reached the finish line, I promise you that you will look back and think very fondly of the race you’ve run.

Dr. Huberman is a Clinical Psychologist with a practice in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New Book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information, visit warrenhuberman.com.

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Forget “Emotional Eating”…Think “Learned Eating”

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“Emotional Eating” is one of the most common topics addressed with regards to weight loss surgery. Every weight loss surgery book, blog and website is full of articles explaining the causes of emotional eating and tips on how to defeat this dangerous villian that threatens to derail your success from surgery!

Hold onto your seat because I’m going to try and convince you that “Emotional Eating” is an overused and incomplete expression to describe the very problem it is supposed to address. I’m also going to provide you with a new way of thinking about your eating behavior and a methodology to change it so that you can have more success from weight loss surgery.

“Emotional Eating” is generally thought of as eating that occurs in response to a particular emotional state. The basic premise is that a particular emotional state somehow triggers undesired eating. Some people eat when they’re depressed, some when they’re nervous and others when they’re angry. Of course, others eat when they’re happy or in the mood to celebrate. In fact, virtually everyone on the planet does the latter. If humans didn’t eat in response to positive emotions half of the restaurants around the world would close within the next few weeks. Thanksgiving would be cancelled and Christmas dinner would be no different than Tuesday’s leftovers.

What about eating in response to negative emotions…is that fairly universal as well? I can confidently tell you that in working with thousands of people over the past 20 years, many of whom were NOT surgical weight loss patients, that almost everyone has used food on occasion to provide temporary relief from emotional distress. I’m confident that this is true among the general population as well. In fact, many researchers believe that our brains are actually pre-wired to use food in this manner. Such researchers will tell you that drugs such as heroin, cocaine and others are actually “hijacking” the receptors and neural pathways that were designed for food! So there you have my first problem with the expression “Emotional Eating”….JUST ABOUT EVERYONE IS AN EMOTIONAL EATER TO SOME DEGREE, so labeling yourself an “Emotional Eater” is to state the obvious.

However, it is interesting that there is considerable variability in the behavior of those who describe themselves as emotional eaters. As I mentioned, some people eat in response to one emotion while others eat in response to other emotions. Some people eat in response to mild disappointment while others eat only when they feel really distressed. Why is this so? The reason for this and for a wide variety of eating behaviors is that most eating behavior is “learned.”

I will spare you an Introduction to Psychology class and try to minimize the psychobabble, but consider that when it comes to human behavior, we do what we do either because of our genetic endowment or what we’ve learned. Nature (genetic) or nurture (learning). Much of this learning isn’t voluntary. In other words, most of your eating behaviors were not learned the way you would learn to play the piano. Much of what we’ve learned we picked up by watching others or by being instructed by others or through trial and error and the positive or negative consequences that followed.

Learning as it relates to food and eating begins on day one. Consider that at birth the behavior of a newborn is 100% genetic and 0% learning. Nothing has happened to the newborn child yet so they haven’t learned a thing. Nurture has yet to exert an influence…it’s all nature. Whatever a newborn does is pre-wired. But that changes almost immediately. Here comes the first bottle…yum! Sweet sugary milk. Lesson one: Milk tastes good and feels good going down. Later that day the baby cries…mommy rushes in with a bottle. Lesson number two has just occurred: I cry loud enough and mommy feeds me. I feel better and I stop screaming. Food is a reward and soothes my distress…and I am now in complete control of mommy!!

“Learned Eating” quickly proceeds in leaps and bounds in childhood. There’s a very good chance (for example) that you “learned” to clean your plate because your mother told you that you had to and that you wouldn’t be allowed to have dessert if you didn’t. Or perhaps you received cookies as a reward for good report cards or for cleaning your room. Now as an adult, long after mom stopped giving cookies for good report cards, you continued the habit of rewarding yourself for your daily successes. I can think back to all of the times that I was offered chicken soup by my grandmother when I was disappointed for some reason or another as a kid. There is still no scientific evidence that chicken soup is effective in treating disappointment or depression, but the soothing taste of the soup sure does make you feel a little better. Even better, eating chicken soup today at age 41 provides me with warm memories of my grandmother. Starting to get the picture? From a young age, we quickly “learn” to like certain foods for certain reasons and develop eating habits and preferences almost completely without effort and often without any awareness.

By using the term “Learned Eating” you are more elegantly and accurately describing what is really going on here. The concept of “learning” better answers the questions of “Why do I eat this way?” and “How did I develop these problematic eating patterns?” Also, “Learned Eating” accounts for more of your eating behavior than just what is triggered by emotions. All of the behaviors that we commonly call “habits” are more accurately called “learned behaviors.” So “Emotional Eating” is just one of the many types of eating behaviors that you’ve picked up (learned) throughout your life.

The real #1 reason that I’m trying to get your vote for “Learned Eating” is that this expression makes you empowered and able to change. Everyone is familiar with the concept of learning because we are all students in our own way. You don’t need to be a psychologist to understand “learning.” “Learned Eating” is a simple concept: If you have “learned” maladaptive or destructive eating behaviors that have contributed to weight gain, you can also “unlearn” these behaviors and “learn” or “relearn” new ones that help you keep the weight off after surgery. Emotions are a whole other murky, mysterious matter. Many people feel confused by the concept of “Emotional Eating.” It doesn’t empower you. It doesn’t tell you how to change. So many people ask me, “I can’t just stop feeling depressed, anxious or even happy. So how can I stop eating in response to these emotions?” The answer is that you need to understand how your emotions have become triggers associated with eating. Only then can you change your behavior. That is the stuff of “learning.”

Here’s an exercise to put the concept of “Learned Eating” to work in helping you to identify and correct some of your unwanted eating behaviors and to learn some new healthier behaviors. In fact, this exercise is one of the very exercises that I do with “emotional eaters” who come to me for assistance if they’re struggling to make changes in their eating behavior either before or after weight loss surgery:

Take out a piece of paper and turn it horizontally. Across the top make eight columns going from top to bottom. Write the following headers on top of each column from left to right: Food eaten, Time of day, Location, Reason for Eating, Thoughts Before, Feelings Before, Thoughts After, and Feelings After. Make 14 copies of the page. Over the next two weeks (14 days), every time you eat, write down what you ate, when you ate it, where you ate it, why you ate it (as best you can tell) and what you were thinking and feeling both before AND after you ate. Many of you are sighing right now thinking “I hate writing this stuff down!” In my experience, most people hate writing down what they eat because they don’t like what they see. However, it’s only by seeing what you are doing, understanding why you are doing it and being accountable to yourself that you can begin to change. Want to learn? You’ve got to do your homework.

The purpose of this exercise is to learn as many of the associations between your eating and its causes as possible. In case you’re wondering, you can think of the feelings column as the “emotional eating” column. Now there are certainly more than 6 causes for your eating behavior, but this will give you tons of useful clues as to the cues that trigger your eating. By filling out these forms you will start to see what is pushing your eating buttons. Sometimes it will be genuine hunger. When this is the case, be sure to write “hungry” in the “why I ate it” column. Sometimes you’re going to eat potato chips because you were bored. Write “bored” in the “why I ate it” column. Sometimes it will be an emotion like loneliness that triggers your urge to eat. Write “lonely” in the feelings column. Always fill out every column because you are going to find some surprising associations by completing these logs. You’re going to find that where you are and the time of day are often the key triggers and not just that you were bored or lonely. You will find that feeling depressed isn’t always the trigger for eating but feeling depressed when you’re alone on a Friday night seems to push the potato chip eating button. Very important and useful information.

Learning to identify all of the cues, triggers and associations between your internal world (thoughts and feelings) and external world (people, places, times of day, etc) allows you to see what pushes your brain’s eating buttons. Having this information allows you to comprehensively assess your eating behavior and to identify where and how to make changes. For example: should you clearly see from your logs that being alone at home at night is almost 100% associated with eating ice cream, you now know that you must address what’s going on at home under these circumstances. Perhaps you need to change what you’re doing at home at night or consider finding ways of getting out of the house some evenings altogether! Here’s another example that you probably already know: The very sight of certain foods is a big trigger for eating. This one is easy to fix and many of you already know this….stop bringing the foods you find irresistible into your home! Either unlearn the habit of bringing cake into your house or relearn by bringing in healthier foods to eat.

Hopefully, I’ve convinced you that emotions are really just one of many triggers for eating and that “Emotional Eating” is no longer the best or most comprehensive concept to use if you want to make significant changes in your eating behavior. The concept of “Learned Eating” better explains how to understand, think about, and change your behavior. Take the time to learn as many of the cues, triggers and associations that relate to your eating behavior so that you can begin making changes in your eating and become more successful in keeping the weight off beginning right now. Do your homework…it’s due tomorrow!!

Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information, visit warrenhuberman.com.

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How Long Does It Take to Reprogram My Hard Drive?

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One of the most common questions I am asked is “How long does it take for before a new behavior feels normal?” Much has been written on this topic. I’ve read that it takes 18 days for a new behavior to become a habit and I’ve read 21 days as well. The answer is that we don’t really know. What we do know is that it takes awhile…probably more than a few weeks. The reason so many people ask this question is quite understandable; everyone wants to know, “How much longer am I going to have to put forth so much conscious effort before things get a little easier?”

The greatest challenge of losing weight is that so many behaviors need to be changed and most of our eating behaviors seem automated. Like a computer’s hard drive that automatically runs programs without our input, our brains guide us to perform many of our behaviors, seemingly without our effort. So changing behavior patterns is a bit like reprogramming a computer’s hard drive. Here’s a true story.

Earlier this year I stopped drinking diet cola. For a long time I wanted to stop consuming this chemical concoction and I finally decided to take action. Every day for over ten years, I’ve been going to the same deli in the morning to pick up a cup of coffee and a diet cola for later in the day. After making the decision to stop drinking diet cola, I noticed that every morning in the deli, after I poured my coffee, I continued to take a few steps towards the cooler containing the diet cola before realizing that I don’t drink diet cola anymore. How long did it take before I stopped taking that step towards the cooler? By six weeks I was no longer taking that step and simply walking out the door with only a cup of coffee. Think about that. My brain’s hard drive was running on autopilot for 45 days even after I made a firm decision.

Once I stopped taking those few steps towards the cola cooler, controlling my diet cola intake became much easier….at least in that situation. There were also many other situations where buying or drinking diet cola had commonly occurred and I had to endure and change my behavior in those situations as well. As you know, the first few weeks are always the hardest, and then it gets easier. The “easier” part everyone is familiar with. We have all started a diet and stuck with it long enough that it started to feel like we finally beat the bully. “This time I’m going to finally lose the weight and keep it off!” (I’m envisioning Charlie Brown running towards the football Lucy is holding thinking “this time I’m really going to kick the football!).

But as we all know, somehow the hard drive seems all too willing to revert back to its original setting. For some reason, even after we seem to be on easy street for a while and drop 20 or so pounds, and make significant behavior changes…something happens. We slip, we slide and seemingly overnight the 20 pounds has found its way back onto our midsections. What happened? What happened is the answer to our original question. “How long does it take to reprogram my hard drive? Maybe forever.

The problem is thinking that behavior change and losing weight is a finite objective…that you can actually stop trying at some point. That you can wipe out the old hard drive and completely replace it with a new one. This is why diets fail…we start diets believing that there will come a time that we can stop diets…and then act surprised when the weight we’ve lost comes back! In theory, there may come a time where it simply never occurs to me to have a diet cola…but it’s now well over six months and that time is nowhere in sight and I am no longer waiting for it. Rather than waiting and hoping that I will one day simply no longer yearn for a diet cola I have substituted a host of other drinks for diet cola. Water actually tastes great now. I’ve even decided every now and then to go to a new deli where I’ve never purchased diet cola before. I try not to eat in my office as often and actually go outdoors for 10 minutes to enjoy my lunch. I’m breaking old connections and building new ones, but I try not to ask myself when it is going to end because it’s better to think that it never ends and that I always need to be on my toes…even though it does get easier with each day.

So don’t diet. Don’t start what you know you can’t finish. Make small behavior changes every day while keeping an eye on unwanted old habits and stop looking over every horizon to see if you’re close to the finish line where you can finally let your guard down. There is no finish line…but I assure you that it can be an enjoyable journey that you can tolerate for the rest of your life…even without getting a new hard drive. _Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information, visit warrenhuberman.com.

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Waiting For Motivation

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One of the more common stories I hear from people who want to lose weight is this one:

“I’ve successfully lost weight a few times in the past and each time it started with this big boost of motivation. I can’t explain it…I was just super motivated and stuck to the plan, and I lost the weight. It almost seemed easy. Now, I just can’t seem to get started. I wish I could figure out how to get back that boost of motivation.”

As a psychologist, I wish I had the secret of how to unlock that boost of motivation that so many of my patients’ desire…but their previous and future success is not due to just an initial boost of motivation. Motivation is only one piece of the puzzle, and quite frankly, not something that most overweight people lack. Think of it. What overweight person isn’t motivated to lose weight? It’s not a lack of knowledge. Most overweight folks can think of 101 good reasons to lose weight and many could write a diet book. It’s certainly not laziness. Overweight folks are some of the most eager and hard working people there are! They try and try and try and try. In my experience, one mistake that many overweight (and other) folks make is waiting to feel motivated in order to get started.

Consider the little vignette above. The person in this story (and many stories) is wishing they had that special missing ingredient that got them started in the past. They don’t know what it is or where it came from. All they know is that when they had it, losing weight was much easier. Well, I’m a psychologist and make a living studying and trying to understand human behavior and I can’t always explain it either. But I’m also going to tell you that you don’t have to figure it to be successful.

Sometimes the cause of that initial boost of motivation is easier to define. Maybe there was a major incident and you heard yourself saying “that’s it…I’ve had it!” and you were off to the races. Patients have told me countless stories of such events that were their “that’s it, I’ve had it” moment. One gentleman told me he couldn’t tie his shoelaces and had to ask a co-worker to help him and was terribly embarrassed. Another woman told me she sat on a chair and it broke beneath her. Yet another gentleman told me that his doctor (not so kindly) told him he’d be dead within a year if he didn’t lose a significant amount of weight. In fact, I can recall seeing one of my ex-girlfriends after she lost over 30 pounds and I vividly recall hearing myself say “that’s it, I’ve had it!!” and went on to lose over 50 pounds. Many of you probably have your own such stories. But the real question is, “What can you do when you DON’T have that kind of a moment?” How do you create your own motivation?

As I said earlier, that “moment” and the boost of motivation that followed does fully explain your past weight loss successes. That “moment” may have helped light the fuse, but it did not provide all of the fuel that kept the flame of all of your hard work and perseverance going. I wasn’t thinking of my ex-girlfriend’s success all the time. The gentleman who couldn’t tie his shoes wasn’t thinking of that awful moment all day, every day. Try to recall back to what you were doing for all of those months when you were successfully losing weight. Was your behavior exactly as it is now? Were you eating the same foods you are now? Were you eating the same amounts of food? Were you as focused as you were then? When you lost the weight, were you living your life exactly as you are now? Probably not.

So here is the punch line:

Rather than wishing or waiting to feel that big boost of motivation to get started, why not start by doing all of those things that you did when you were successful losing weight in the past.

Consider this. If you don’t do those things then you’re not really doing what you need to do to lose weight…you’re just waiting to do something. Don’t hear this as criticism. Just a few moments ago I said you’re not stupid, lazy or any of those things. But you’re not doing what’s in your best interest to meet your goals.

Every day I speak to overweight people that admit that they have poor eating habits. They eat on the run. They don’t prepare meals. They don’t sit down at the table to eat. They eat too much fast food. The list goes on and on. And when I ask them what they were doing when they successfully lost weight in the past? They shopped for food. They cooked more often. They read food labels. They avoided fast food. They monitored their portion sizes. They didn’t eat cookies out of the box. They sat down at the table for meals rather than eating carbohydrate snacks out of the box while standing in their kitchen looking at the clock (we’ve all been there!). So, here is what you can do. Sit down with a pen and pad and try to recall each successful weight loss effort you’ve had in the past. Some of you may have one or two; others of you have four or five. If you have none, imagine how you would advise someone in your situation to lose weight. What would you specifically tell them to do?

On the pad, make a list of all of the specific behavior changes you made when you were losing weight. When you lost all that weight were you writing down everything you were eating? Put that on the list. Were you exercising? Put that on the list. Were you bringing fruit to work with you for a snack rather than hitting the vending machines? Put that on the list. Were you having yogurt and some granola for breakfast rather than an egg and cheese sandwich on a bagel every morning? Put that on the list. I think you’re getting the picture. Then, start introducing one or two of those behavior changes each day. Within a week or two, you’ll be doing all of the things you need to do to get back on track…even without the big initial boost of motivation to do so. By the time you notice that the motivation to get going wasn’t initially there, it will be there in the form of excitement that you got the ball rolling yourself.

Is my suggestion the answer? Perhaps not the entire answer, but it certainly is a big part of the answer. You know that somewhere along the way to losing weight, you will need to DO many or all of those things you once did to lose weight. So rather than waiting for that big motivation boost to come along to carry you through to making all of those behavioral changes, why not make some of those behavioral changes now and maybe the motivation will show up along the way?

Do I think this is easy? No…of course not. Wouldn’t it be easier to make all of those changes if the motivation were there from the starting line? Of course it would. But maybe that big boost of motivation isn’t necessary. Maybe the best way to proceed is to put the cart before the horse…the doing part BEFORE the motivation part. I know…it sounds a little strange. But if you don’t…you’re not really trying to lose weight. You’re waiting to try to lose weight.

Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information please visit www.warrenhuberman.com.

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Developing Discomfort Tolerance

(Something to try when you get hungry)

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One of the most common questions I am asked by patients prior to surgery is “What do I do if I want to eat something after surgery when I know I’m not hungry?” This question stems from anxiety regarding emotional eating and the possibility of weight regain. Many patients recall that these thoughts and feelings triggered relapse from previous efforts to lose weight. There is also the growing concern about what is being called “addiction transfer.” Patients are nervous that if their ability to eat is inhibited by the surgery or by efforts to avoid eating that this urge will somehow morph into some other maladaptive coping mechanism like consuming alcohol. Interestingly, despite much anectodotal discussion about “addiction transfer” there is not much clinical support for such a phenomenon. But the question remains…”What do I do if I want to eat after surgery and I know that I’m not hungry?”

Many patients tell me that they have tried at least one of hundreds of suggestions to cope with hunger…drink some water, go for a walk, eat something healthy, do a crossword puzzle, call a friend…and the list goes on and on. One suggestion that is seldom discussed is to do nothing at all, but rather to try and understand and tolerate the discomfort. Perhaps this sounds shocking to you. Our culture places such a premium on being comfortable that we seem to have lost the ability and the skills to tolerate discomfort. We have 26-way adjustable seats, televisions in every waiting room, drive-through pharmacies, and remote controls for every electronic device. Heaven forbid that we experience any inconvenience or discomfort! Where did we get the idea that we must be comfortable all the time? Why do we believe that we must deperately try to distract ourselves away from all sources of discomfort such as hunger or emotional distress by talking with friends, taking walks or doing crossword puzzles?

These activities of distraction, although not harmful, are a means of escape. By engaging in one of these activities we are essentially telling ourselves that “I can’t stand the discomfort of being hungry…I must find something to distract myself away from this absolutely intolerable feeling…danger, danger, danger!” It’s simply not true.

The next time you experience the urge to eat something when you’re not truly hungry, instead of engaging in an activity to escape from the discomfort, sit with it for a few minutes. Examine the feeling and ask yourself just how intolerable it is. Consider rating it on a 1-10 scale and ask yourself if you truly “can’t stand it!” Is it a mild discomfort or genuinely painful and intolerable? Try sitting in a chair and taking a few deep breaths over the course of two to three minutes and see if you can manage to reduce the anxiety and discomfort. Sounds crazy but at times it will most certainly work. By practicing this exercise and gaining some mastery and control over your response to the discomfort of hunger, you learn that you can actually tolerate the discomfort. Therefore, it is less likely that you will feel anxiety the next time the hunger occurs as you will know that you can “stand it” and that you don’t have to run away. This is how we develop discomfort tolerance and the ability to take care of ourselves despite the presence of discomfort. We try very hard to teach it to our children as we do not indulge all of their crying episodes and tantrums. We teach them to try and cope until the discomfort subsides. It is a great skill to learn to tolerate discomfort and ride it out until it subsides. Try it out!

Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information, visit warrenhuberman.com.

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Keeping Things in Perspective During the Holidays

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Holiday season is upon us and it’s time for the 3 “F’s”… friends and family, festivities, and food. My message to you is quite simple…keep the last “F” in perspective.

This is the season when we give thanks, cherish our friends and loved ones, share experiences, have fun, give gifts and look forward to the promise of the new year. Food and eating is intertwined with all of these activities, but should be neither “THE” activity nor “THE” focus.

Each of us would probably love nothing more than to stop thinking about eating, food or (most of all) our weight. During this time of year, focus on enjoying your loved ones and the opportunities to celebrate the season. This is what life is really about so try to enjoy every moment. Sure, continue to watch what you eat and don’t let things get too out of hand during the season of fruitcake and chocolate covered everything… but even if you do, just let it go. It’s really not that important. If you eat too much one moment, just begin anew the next…don’t make the mistake of making yourself miserable over a stupid piece of cake.

I promise you that twenty-five years or more from now, when you’re older and grayer….you’re going to tell yourself that you should have enjoyed your loved ones and all of the opportunities you had to spend with them even more than you did. I guarantee that when you’re rocking in your rocking chair you will not be telling yourself that you should have spent more time focusing on your weight and you’re certainly not going to lament about the extra scoop of mashed potatoes that you ate on Thanksgiving in 2008!

If per chance the holidays are a painful or lonely time, make every effort to begin new traditions with new people. You don’t have to allow every holiday season to be a reminder of those you have lost or memorable times gone by. Every town and community has holiday social events that you can plug into. It requires some work, but things can absolutely be different if you make the effort to make it so.

So, should an errant chocolate melt-away or piece of pecan pie or turkey drumstick wind up in your belly by mistake, keep things in perspective. Don’t condemn yourself for hitting a bump in the road en route to whatever weight loss goal you are pursuing….that just leads to self-hatred and more eating. Let it go, give yourself a break and most importantly….enjoy your loved ones and the holiday season. Happy holidays!

Dr. Huberman is a Clinical Psychologist with a practice in cognitive-behavior therapy in New York City. He is a Clinical Instructor in the Department of Psychiatry at the NYU School of Medicine. He is an Affiliate Psychologist at the NYU Langone Medical Center and NSLIJ-Lenox Hill Hospital. Dr. Huberman is a consulting psychologist to the NYU/Langone Weight Management Program. He is the author of the New book “Through Thick & Thin: The Emotional Journey of Weight Loss Surgery.”

For more information, visit warrenhuberman.com.

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