Monthly Archives: December 2015

Procrastination: The Grown-Up Way of Saying ‘I Won’t!’

For months, maybe even a year, a weight-loss client has resisted my exhortation to exercise. The excuses ranged from plausible to doubtful, but the result is always the same.

“Maybe next week.”

She had participated in a walking program in the past, a few diets ago (before we met), and because of back pain, had been given exercises to strengthen her core muscles. But this time, despite knowing intellectually that her weight, her diabetes, and her bad back would all benefit, she refused to literally take, the all-important first step. But she also refused to join social groups, volunteer, look for a job, or get out of the house; in short my client refused to do anything that would stop her from sitting home at night and eating. “I will, I will,” she would tell me. But she never did.

When we discussed this, she excused her failure to take on those activities beneficial to her attempts to lose weight by saying she was a procrastinator. Obviously she would get around to following my suggestions, but not just yet.

There have been many studies on the phenomenon of procrastination, and it is a rare person who has not put off doing something he or she has to do. The reasons range from fear of failing a task (such as locating cancelled checks for income tax preparation) to avoiding emotionally painful situations like breaking up with a boy/girl friend.  Dieters or wannabe dieters may procrastinate starting a weight-loss regimen because of past failures, and memories of deprivation and hunger. More than several weight-loss clients have told me that they waited for years for a perfect weight-loss pill to be discovered before attempting to diet, and the effect of this procrastination on their health did not bother them. (Some are still waiting.)

Procrastination may also lead not just to putting off strategies to lose weight; it can easily contribute to weight gain. Eating is an effective way of delaying doing what one does not want to do. The procrastinator tells himself, “I will eat dinner and then maybe a small snack after dinner, and then maybe make myself a cup of tea and a couple of cookies. Oh, then I think I will pop some popcorn and fish out the ice cream from the freezer to take away the salty taste of the popcorn and then…” Eventually time passes and suddenly there is no time to pay the bills, or phone the parent, or clean up the garage.

Procrastination is a huge stumbling block to effective dieting. How many very low-calorie ice cream bars or bowls of air-popped popcorn can the dieter justifiably eat while procrastinating without eventually undoing the diet? And how long can the dieter avoid, as my client is managing to do, engaging in some exercise and non-eating activities, without this influencing the rate of her weight loss?

Any parent who has lived through the toddler and adolescent stages of child rearing knows that it is often impossible to get the two-year-old or the 16-year-old to do something they do not want to do.

“No, I won’t” is a favorite reply, be it a toddler told to pick up toys or a teenager asked to at least take the dirty clothes on the floor and put them in the laundry basket. The teen, considerably more sophisticated than the toddler, may temper the reply with, “I will do it later” and thinks, “I can procrastinate until I move out of the house.”

But what about the grownup who says, “I will do it later” to excuse failing to take on the responsibilities associated with weight loss, i.e., choosing low-calorie healthy foods, drinking sufficient liquids, getting enough sleep and exercise, and dealing with the stresses causing overeating—rather than eating his way through them?  Isn’t, “I will do it later…” a way of saying, “NO, I don’t want to do it at all”?

Weight-loss counseling really does not have any answer for this problem. If it did, fewer people would fail to lose weight and even fewer would fail at maintaining their weight loss. So far, we don’t know how to strengthen motivation and commitment to permanent lifestyle changes so someone can banish being overweight for good.

Maybe one reason why so many wannabe dieters fail to commit to permanent change is that it is overwhelming. There are complicated diets with points, counting calories, and determining good and bad carbs, saturated/unsaturated fats, and whether a food is high or low protein. Exercise is boring,  repetitive and even unpleasant and painful if muscles are worked too hard. It is easier to put it off, to procrastinate.

But I think of advice given often to new runners by those experienced in the activity. The new runner is told to run for a minute or two and walk for the same period of time. Run and walk, run and walk. Eventually as muscles and stamina grow stronger, the runner is able to shorten and then cancel the walking bit. By that time, she is committed to the sport.  Perhaps dieters should be given similar advice: eat sensibly but do not follow a harsh and unforgiving diet. Exercise, but start slowly. Five minutes is better than zero minutes, one pushup up better than none. Try one activity, class, or social interaction on a lonely winter weekend rather than keeping company with the refrigerator and cookie shelf.  No excuses.

Eventually these small changes will increase into large ones resembling a healthy lifestyle that feels natural and comfortable.  Reserve procrastination, saying, “I won’t!” for balancing your checkbook.

Winter & PMS Woes

“I hate winter. It’s not just the ice, the shoveling, too many snow days, and long traffic-congested commutes. What I really hate is that my PMS becomes unbearable. From November to April, I dread those days before my period comes because I turn into Attila the Hun!“ So stated a weight-loss client of mine. She is not alone.

Most women are not transformed into the 21st century version of a marauding barbarian when they have PMS—premenstrual syndrome—but they may feel that their lives are disrupted and moods out of control. PMS is linked to hormonal changes at the end of the menstrual cycle. The symptoms are numerous but most women do not, thankfully, experience more than a few. The most common are feeling depressed, angry, irritable, longing for sweet or salty fatty foods like ice cream, chocolate or chips. Often a foggy mental state that makes speaking coherently, or concentrating a difficult task, occurs. PMS affects women of childbearing age, from teenagers to women about to enter menopause (whose symptoms are very similar but last for months rather than days).

PMS arrives, often without warning, during the fourth week of the menstrual cycle and may last hours or days, retreating only when menstruation begins.  Changes in mood for no apparent reason, disturbed sleep and increased irritability are often the first signs that PMS is present, but also some women experience a dramatic increase in their carbohydrate craving.  A friend of mine who does the family grocery shopping once weekly, told me of coming home with bags of pasta, bread, cookies, crackers, ice cream, doughnuts and boxes of instant mashed potatoes and nothing else. When her husband helped her put away the food, he asked why she did not buy any milk, vegetables, chicken and fruit. “Because I bought what l wanted to eat,” she told him.  “I have PMS.”

Many of the PMS symptoms are similar to those of Seasonal Affective Disorder (SAD) or winter depression. People suffering from mood and appetite changes associated with diminished hours of daylight experience similar irritability, fatigue, depression, and carbohydrate cravings although they tend to sleep, if they can, many more hours. PMS, in contrast, often causes broken and unrestful sleep. Of course men also suffer from Seasonal Affective Disorder, and there is no age limit as to who may experience it.

Winter can worsen PMS; symptoms can last longer and be more severe. One explanation might be that many of the stresses associated with winter add to the stress of PMS:  prolonged commuting time; roofs sinking under the weight of snow; inability to exercise because sidewalks are too icy or weather too cold; and cabin fever that comes from not being able to escape the house over weekends. But there is probably a biological explanation as well as environmental discontent. Our research at MIT and that of a group from UCLA found insufficiently active serotonin underlying PMS symptoms. Decreased serotonin activity has also been linked to SAD. The diminished hours of winter sunlight further decreases serotonin activity, according to the research of Barbara Parry, thus exacerbating the moodiness, depression, anger distractibility and poor sleep of premenstrual syndrome.

Ironically, Parry and others who have discovered this relationship live in southern California, where the fluctuation in hours of daylight is much smaller than in the northern tier of states where differences in sunrise and sunset between July and January are dramatic.

Other than moving south, getting pregnant or becoming menopausal, there are not many options to ease the monthly mood swings. Parry’s research suggests phototherapy, which involves sitting in front of a so-called lightbox that emits the light spectrum of sunlight without the damaging ultraviolet rays. It is still unclear how exposure to sunlight interacts with serotonin to increase its activity, but positive changes in premenstrual mood are evidence that it is having an ameliorative effect.

The carbohydrate cravings experienced by women with PMS is a clue to another therapy. This one involves consuming a specific dose of carbohydrate once or twice a day to increase serotonin synthesis. The carbohydrate craving is real and measurable. Women with PMS eat about 1100 extra calories daily when they have PMS. The foods contributing these extra calories are sweet and starchy carbohydrates such as breads, pasta, cookies, chips, crackers, and candy.  We have studied the changes in mood, concentration, and cravings before and after premenstrual women consume a beverage containing either carbohydrate or a placebo. Statistically significant improvements were found after the carbohydrate drink, but not after beverages containing nutrients like protein that do not increase serotonin synthesis.

The carbohydrate acts like an edible mood elevator. Eating about 25 to 30 grams of any carbohydrate (except fructose) increases serotonin levels and activity, and subsequently takes the edge off many PMS symptoms.  Eating protein prevents this effect, as protein prevents serotonin from being made. It is best to eat a carbohydrate food like popcorn or oatmeal before eating protein, or two or three hours after a protein-containing meal.

If winter woes include a worsening of PMS, it may be necessary to eat a carbohydrate snack two or even three times a day. (Avoiding fat-containing snacks and limit the calories to about 120 per snack).  Relief comes soon after the carbohydrate is digested. This is another reason why eating low or fat-free carbohydrates are best. They are digested faster if they contain no fat.  From our research we know that the symptoms ease for about three hours.

So far the combination of phototherapy and carbohydrate consumption has not been tested against each of these therapies alone. But presumably eating a bowl of oatmeal while sitting in front of a light box should make even a gloomy winter PMS or SAD day brighter.

Will You Gain Less Weight If You Shop on Thanksgiving? (Or any family get together event…

Business reports indicate that the sharp rise in large retailers open on Thanksgiving Day has leveled off. Perhaps, as has been suggested, this is due to consumer dismay at seeing the holiday hijacked by the temptation to buy deeply discounted electronics and toys, rather than eating another piece of pumpkin pie. However, a few national retailers are opening their doors at the time most people are attempting to carve (not hack) their turkey into attractive servings. It is possible that if this trend increases, Thanksgiving dinner will become a brunch so people can shop in the afternoon.

In the past, a traditionally spent Thanksgiving Day started with morning high school football games, road races usually with the title Gobble or Turkey as in Turkey Trot, much cooking, much traveling, and then much eating. Then, by late afternoon, the inevitable nap followed while attempting to watch more football, and finally a second meal of turkey sandwiches and leftover stuffing and pie was served. And no one needs to be told that the combination of eating and sitting in the car, in the bleachers, at the dining room table and on the sofa, adds up to consuming many more calories than the body needs for energy.

Consider then the benefits of ditching the 2- or 3-hour meal and nap for standing in line outside a big box store, perhaps even shivering, running through the store to find the bargains, pushing heavily laden shopping carts to the checkout area, lifting boxes into the trunk of the car, and then carrying the heavy boxes out of the car and into the house. All that standing, shivering, running, pushing, and lifting takes energy and uses up calories. Couple this bout of physical activity with the “no time to eat seconds,” the lack of opportunity to lie on the couch and nibble the nuts, cookies and chocolates on the coffee table, and a missed chance to pick at the pies and sweet potato casseroles before they are wrapped up in aluminum foil and stored in the refrigerator. It is possible (although unlikely) that dedicated shoppers could even lose a few ounces because consuming is directed toward buying, and not eating.

Overeating may also be diminished for another reason: less stress at the dinner table. In contrast to the imagined scenes of happy families sitting around the table oohing and aahing over a perfectly roasted turkey brought into the dining room (why don’t my turkeys look like that?), the family members may be already in verbal combat mode. Ancient quarrels, nasty remarks, boredom, too many invasive questions about someone’s weight, or grilling about a boy or girl friend, or failure to find a job and other unfortunate conversations can cause stress. And that is often the trigger to overeating.

Every year as Thanksgiving approached, many of my weight loss clients would beg me to think up some reason they could use as an absentee excuse, because they couldn’t bear to be with their families for the holiday. Their weight was always the issue. If they had gained, then every morsel of food put into their mouths would be scrutinized and “tsk tsk” would be heard from someone who saw any food my clients ate, as being too much food. On the other hand, if they had lost weight, there was the pesky relative telling them they looked wan, gaunt, and even sick so why didn’t they have some gravy on the turkey or a larger piece of pie? Now, of course, these beleaguered individuals can escape. Who can fault them for skipping dessert entirely or packing a piece of pie in their tote bag as they race out the door to stand in line to buy a tablet or a computer-driven stuffed animal?

However, there are flaws in substituting shopping for a Thanksgiving celebration. Those who must work are not able to celebrate this national holiday, this day of thankfulness. And unless and until retail stores can be staffed by computers, this is not going to change.

And then there are the dishes. Does everyone go to the store or do some stay behind to clean up the mess?

Finally, if the meal is concluded prematurely, no doubt there will be much food left over. At least until the shoppers come home, take off their coats and sit down again to eat.