Monthly Archives: July 2016

Bringing Home Pounds as Well as Souvenirs from Your Vacation

Vacations should make it easy to keep from gaining weight, and indeed to even losing some. Designed to remove daily stresses, give time for adequate sleep, eliminate the endless chores, escape preparing meals, and all the other responsibilities that erode whatever free time we have; vacations provide a respite from the triggers that cause us to eat too much. Vacations also are opportunities for the kinds of physical activity unavailable (for most people) at home: hiking, long bike rides, scuba diving, water skiing, and more.

But then again vacations are times to indulge in alcoholic drinks with umbrellas, and seasonal treats like fried clams, lobster dipped in melted butter, and homemade ice cream bursting with butterfat. Vacations are times to lounge on a beach with a cooler filled with beer and bags of chips… or relax on a terrace in the moonlight enjoying a five-course dinner.  Vacations are also times to park yourself on a tour bus, car, or plane for hours, restrict walking because it is too hot to be outside, and sit even more at sporting events, outdoor concerts, and movies.

Unless the vacation is spent in a spa known for its 6 am hikes up nearby mountains and semi-starvation meal regimen, few people expect to lose weight while they are away from home. After all, why try to diet when the point of a vacation is to enjoy one’s self and not obsess over the calories in the hot buttery croissant served at breakfast or whether the crab salad has too much mayonnaise? But (and there is always a but) should the vacationer who may be somewhat or even more than a little overweight at the start of a much-needed break be oblivious to the possibility of gaining weight? Should the combination of a relaxing, sedentary week or two and deliciously fattening foods be noticed for its weight gain potential?  Should vacationers bury their heads in the proverbial sand about their weight?

I suspect the answer is, ‘Who cares?!?’

And one reason for this answer is that obesity is so common, it seems normal to be many pounds overweight. Recently I had to travel to Miami Beach for some work, and as the weather was very hot people were not wearing much. It was not unusual to see tourists on the streets in bikinis or shorts and skimpy T-shirts. Many were obese, perhaps not more than on the streets of any other American city, but more obviously so because of the lack of clothing. It was too hot to go for long walks or bike rides, and beach walks usually crowded in the winter months were almost empty by late morning because of the heat. Poolsides were packed, but the pools were empty, except for the kids. And crowds were heading toward the beach, pulling carts and coolers that were probably NOT filled with carrot sticks.

And so on the one hand, the answer, ‘Who cares?!?’ is appropriate. It is your vacation and time to be self-indulgent. You are already in a bathing suit so obviously it is too late to lose weight before you put it on, and hey, life is short so why not enjoy yourself!

On the other hand, when the vacation is over, and extra pounds are brought home along with your carved coconuts or mermaids in a snow globe, they may stick around longer than the souvenirs. You resume the life that caused you to gain weight, and now there are more pounds to get rid of. The weather will become cooler and the skirts or pants somewhat tight in early June may not fit over a stomach or hips enlarged by many Mojitos, taco chips with guacamole and chocolate lava cakes. And in not too many turns of the pages of the calendar, the days become noticeably shorter, windier, rainier, cloudier and eventually cold. Inevitably, a weight- gaining lethargy settles in.

So why not take a vacation from weight gain? If buffet breakfasts and multi-course dinners are part of the eating plan, then skip lunch or restrict it to a salad or fruit. Early mornings and evenings are usually cool enough for walks or bike rides (many cities provide bikes to rent at minimum cost) and air-conditioned museums and visitor centers allow for more walking during the day. Pack the cooler with containers of blueberries, raw vegetables, water, and low- calorie munchies like rice crackers, rather than fat-laden chips and sugar-filled sodas.

Yes, it is hard to resist impulsive purchases of ‘tourist’ food like fudge, fried dough and arepas (corn patties filled with melted mozzarella) while sightseeing. These small food items pack impressive caloric content, and their consumption is often overlooked when thinking about what may have been eaten during the day. Carrying your own snacks may prevent you from succumbing to the allure of these streets goodies. Sometimes thinking of possible food poisoning from snack foods baking in a warm sun and soaking up air pollutants is sufficient to make them unappealing. (Of course, food poisoning is one way of preventing weight gain… however, it is not recommended).

Coming back from a vacation weighing less than you were when you began it may not be possible. But if your luggage is the only thing that weighs more at the end, consider the holiday a success.

The Loneliness of the Solitary Dieter

Our table in the hotel dining room gave me the view of a quite large woman sitting quietly, watching her female friend eat through several servings from the breakfast buffet.  What made this woman’s behavior somewhat strange was that the seemingly endless offerings of the breakfast buffet caused most people to eat several courses, ranging from mundane cereal, fruit or yogurt to elaborate quiches, salads, smoked fishes, custom-made omelets and pastries. The gorging companion was demolishing several plates of food (she was not exactly thin) while the non-eater nodded, but remained with her mouth forcefully closed as though if once she opened it, maybe she would start eating.

I wondered, “Had she just had bariatric surgery so she could eat only tiny portions?”  My reason for thinking this resulted from a conversation with my nephew, who had bariatric surgery a year-and-a-half earlier. He told me how difficult it was to dine with others because his marshmallow-size stomach severely limited the amount of food he could eat.  He had to pretend to eat and drink normally when he took clients to dinner, but sometimes he felt socially isolated because of the restriction on his food intake.

Losing weight is an obstacle course with the dieter confronting endless situations that may cause the more healthful eating plan to be discarded, or only partially followed. Dieters need willpower, mindfulness, willingness to take on new and almost ritualistic behaviors. Now eating small portions, exercising daily, and not eating when they are not hungry? It’s a new adjustment which can be very hard when dining with others who pay little attention to how much they eat, or whether they are eating out of hunger or simply because food is presented to them…the way the post-op bariatric patient must function.

Recently I was on a daylong tour that included a visit to a multi-cultural community center. As our group entered the building after a long bus ride, we were offered a variety of ethnic foods along with coffee, pastries and fruit.  “Don’t worry about the small amount of food,” our guide told us, “this is only a snack. Lunch will be served later.” The group lined up to sample the foods. “Is anyone hungry?” he asked. I doubted it, but the group ate eagerly (well almost everyone ate while I took pictures because I wasn’t hungry…).  As the day progressed, an enormous buffet lunch was served and gorged upon, and late in the afternoon different ethnic pastries and cold juices were served.

If someone in our group were dieting, or simply refraining from gaining weight, it would have been hard to resist the many opportunities to eat. And not eating when everyone else did may have been a lonely, alienating experience.

Residential weight-loss programs such as Canyon Ranch work in part because the dieters are part of a community.  A participant eats the same low-calorie food, often at a communal table, participates in group exercise, and hears lectures about mindful eating, relaxation, and avoiding food based ‘temptations.’ But when the residential stay ends, the idyllic bubble of group weight loss is broken. Suddenly dieters no longer have the companionship of others who share in their caloric restriction, but must attempt to hold onto these constrained behaviors in the midst of others eating whatever they wish.

The difficulty of doing this may be under-appreciated, except by the dieters themselves. Not only must they be continually sensitive to their food intake as well as the need to exercise frequently; they are often assaulted by the urging of others to ‘break their diet, just this once, because, “It’s a special occasion!”’ Sometimes, perhaps too often, they are berated for making others look bad because their self-discipline contrasts strongly with the heedless eating of those around them. This is perhaps why I noticed the solitary non-eater in the dining room. Her lack of eating contrasted dramatically with the seemingly endless food intake of her companion.

Obesity experts talk about accepting and following a new, healthy life style if the dieter wants to lose weight and maintain that loss. Another way of putting it is that the dieter must ‘convert’ to a new way of eating. Changing drastically one’s eating behavior, i.e. converting to a different eating ideology, is something quite common these days. People become vegetarian, or vegan, gluten-free, Paleolithic, raw food enthusiasts, juicers, or members of a religious group with stringent eating rules.  Once committed (or converted) to the new eating ideology, the convert follows the rules: vegetarians do not go to steak restaurants, and Muslims do not eat during daylight hours for the month of Ramadan. In fact, surveys now show that dating relationships flourish or flounder in regard to a potential partner’s eating ideology, because a vegan and meat eater may be incompatible for long-term relationships.

Conversion to a healthy, weight-maintaining or weight-losing lifestyle should ideally give the dieter access to a community that follows a similar lifestyle. If dieters can find others who understand and support them in adhering to an eating and exercise lifestyle that will maintain a healthy weight, they may succeed in doing so themselves. The problem is that unlike vegans, raw food adherents or gluten-free eaters, individuals who follow a healthy eating and exercise pattern are effectively anonymous excepting people who write blogs on the subject or offer professional help. And even though a vegan or someone who keeps kosher will reject offered foods by invoking an eating belief system, I have never heard a ‘healthy eater’ invoke a healthy eating belief system and say, “Sorry, but this food has too much sugar/fat/calories, and so I cannot eat it.”

A Perfect Storm for Obesity: Depression, Drugs and a Bad Back

“Let’s go for a walk and catch up,” I replied to an email from a former weight-loss client whom I had not seen since she moved several years earlier. She was back in town and wanted to talk.  But the walk was not to be. “I can’t move very well,” she told me. “My back and leg hurt so much I can barely stand. If I want to go anywhere, I use the van for the handicapped. “

When we did meet, sitting down, I understood why walking was daunting. A cocktail of mood stabilizers and antidepressants had so intensified her overeating that she had gained over 200 pounds. The depression diminished her opportunities to find work, so she spent much of her time at home, alone and, as she admitted to me, eating. Earlier in the year she was still able to walk to do errands and see friends, but eventually her weight exacerbated a chronic back problem. Her pain became so intense she had trouble sleeping, and this further increased her depression.

I figuratively wrung my hands when I saw her. She needed to lose weight to relieve her back pain. But how? She was taking a mood stabilizer known to cause weight gain, and no physician would consider any type of surgical intervention to help her back pain until she lost weight. Substantial weight loss combined with physical therapy might be sufficient to allow her full mobility. But if she didn’t lose weight, or lose it sufficiently fast enough to prevent further stress on her back, she might need a wheelchair.

The good news and the bad news is that she now had to have her groceries delivered because it was too hard to go food shopping. Theoretically her food order could be limited to the healthy nutrient-dense, low-calorie fruits, vegetables, grains, lean protein and dairy products that will support weight loss. If she doesn’t keep junk food in the house, she can’t eat it. But of course she could order junk foods from the supermarket and supplement that with high-calorie take-out. Some hints about what she has been eating confirmed that she was doing the latter.

I had to keep reminding myself (and her) that she was not paralyzed. She had not suffered a stroke, progressive neurological and muscular damage, or spinal injury from an accident. Exercise was still possible, albeit limited to movements she could make sitting or lying down along with whatever walking she could manage. If she remained inert because of her back pain, and to some extent because she was depressed, then weight loss would be frustratingly slow—and maybe too slow to prevent further damage to her back.

She had been thin once, many years earlier, before her mood disorders and treatments to ameliorate them led to her massive weight gain. The problem now is that adding or subtracting medications cannot remove her unemployment, medical issues, social isolation and pain. And there is no support network to help her or indeed countless others like her who are isolated and unable to stop eating.

Where to begin to reverse and improve her situation? A psychiatrist was overseeing her mood disorder and her physician was aware of the obesity and back problems. But what Jane (not her name) needed was belief that she had the ability to do improve her situation herself. Attaining weight loss significantly great enough to relieve her back pain will probably take months, but every pound lost will help.

How can she be convinced to start?

The answer may be in advice I was given decades ago when I started recreational running. An experienced runner told me, “When you start your run, don’t focus on how far you have to go.  Measure your progress not in miles, but in houses or telephone poles. Every time you pass a telephone pole or a house, you are getting closer to your goal.”

Jane should regard her weight-loss efforts like counting telephone poles. Even if it takes weeks to lose a pound, that pound is lost just as running past the telephone pole means some distance has been covered. Every day that she increases her physical activity, even if it is for five more minutes than the day before, she passes another ’telephone pole.’ Every time she wills herself not to order high-calorie takeout and eats healthy, low-fat, low-sugar foods, she is passing another telephone pole.

She won’t be able to do it alone. When I began to run in road races, usually coming in toward the end, there was always someone shouting, “Looking good, you can do it.” I knew I was not looking good and sometimes I wasn’t sure I could do it. But the encouragement helped me continue to the finish line, even if I was almost the last person crossing it.

Jane probably will be able to cross the finish line of weight loss if she believes that she can lose a pound, and then another, and then another, especially if someone is telling her, ‘You can do it!’

Now she just has to start.