I ask all of my new patients what their barriers to success are going to be. Some people are completely surprised by this question – they’ve never really thought about it. Others have clearly thought a lot about it and can rattle off their obstacles like most of us can recite the Pledge of Allegiance.
For these people, one of the things I hear a lot is that they are an “all-or-none” person – that they are always completely compliant to an eating plan during active weight loss but that once they step off the balance beam, they fall down completely and quickly undo all of their hard work and regain the lost weight. Most people say this like it’s a natural way to describe their behavior – as though it’s just a personality quirk that I’m going to have to learn to accept and work with.
I’m a pretty open-minded kind of doc – I’m willing to consider a lot of alternative things if you approach me with logic and reasoning. However, 99% of the time, this is a bunch of nonsense. There are a few people in this world that are truly all-or-nothing people – however, chances are pretty good that they aren’t holding down a steady job or for that matter, that they finished high school. Chances are pretty good that these all-or-none people are in a huge amount of debt and probably don’t have any friends either.
See, if you were truly an all-or-none person, then the minute you messed up at work, you would give yourself permission to really mess up at work – over and over again – and that series of deliberate mess-ups would quickly get you fired. If you were truly an all-or-none person, the minute your eyes & thoughts strayed away from your spouse to your kid’s really attractive basketball coach, you would go all out pursuing that person until you did something that would put a huge wedge into your marriage. For that matter, a real all-or-none person wouldn’t stop with the coach, they would go after the entire staff. If you frivolously spent some money on Amazon, as an all-or-none person, you would follow that purchase by buying everything your heart desired until your credit card was declined.
Again, there are a few people like this in the world (most of the time, in medicine, we describe them as being in a manic state and we medicate them)! However, there are a ton of people that consider themselves all-or-none people ONLY when it applies to weight management. These are people that commit to health and wellness and weight loss for a while and make some good progress in that direction – then they follow that behavior with destructive, unhealthy behaviors (consciously or unconsciously) undoing all of their hard work. Then they repeat that sequence again. Over and over again.
These are some of my most difficult patients to treat – as many of them firmly identify with this personality trait and see it as part of who they are – as something they can’t (or don’t want to) change. Pointing out the difference between a true all-or-none person and someone that is all-or-none regarding weight & health only is a first step – and a very necessary one.
I usually ask these people what they would say if their 6th grader told them that he failed a math test.
Scenario #1 (as an all-or-none person), they would say, “well, if you screwed up, you might as well fail science and social studies and even band – you can always start over again in 6th grade next year”.
Scenario #2 (as a person that strives for balance and accepts moments of less-than-perfect behavior), they would say, “well, you need to work a bit harder on math for the next few weeks to balance out that goof-up – and continue to do well in your other classes while you are doing it”.
Seems logical when you apply it to schoolwork – but for some reason, many people think differently when it comes to health and healthy eating. We have to work on changing that all-or-none, on-or-off, perfect-or-flawed mentality.
Treating these crash dieters uses up a lot of my emotional energy and is very unfulfilling, knowing they are going to come back 6-8 months later, back to their starting weight (usually with an additional 3-5% gain) and repeat the process. Changing their mentality during that short window that they have decided to be good is key. I’m not always successful – but it’s not for lack of trying!
One of the important things is stopping the language of good or bad. Getting rid of the word cheating as it applies to eating. To me, those words indicate that a patient sees the process of losing weight and being healthy as a punishment for past eating sins – doled out by an authoritative figure (me) that they are someday going to defy – like a rebellious teenager.
The way we say things is really important. If you’ve been a patient in my clinic, you know that I refer to some foods as being not right (meaning they aren’t going to help us achieve our goal right now but we don’t talk about them as being bad or good. When someone talks about how they have been cheating – I always try and reframe it as “eating off plan” or “indulging”.
We obviously don’t start this on day one, but as patients progress through the program and I see that we have to conquer this all-or-none idea, we have to start deliberately eating off plan from time to time. Some of my patients are given crazy, weird assignments. Things like “eat a piece of cake on Sunday and then return back to your normal eating plan on Monday.” Then I ask them to keep a journal of their indulgences – not as a reminder of how they have been bad but to be able to look back and say, “I ate cake on my kids’ birthday and then returned to healthy eating the next day and have continued that behavior”.
Sometimes we need to be reminded that we have done something before and using that information, we can logically reason out that it could be done again. I know that I can operate on a person – because I’ve done it before. Was the first time really hard and scary? Heck, yes – the first hundred times were hard and scary – but with practice and intense concentration came a level of confidence and comfort with the process. I know that I can drive a car – because I’ve done it before. It’s been so long that I’m completely guessing here, but I bet the first few times I sat behind the wheel, I was terrified. Back then, I didn’t have any frame of reference or any past experiences to draw upon – to remind me that I could. Now I have loads of experience to draw from.
Being a healthy eater instead of a dieter may be a new and uncomfortable experience for some. Eating really well most of the time and balancing that with occasional indulgences may feel strange at first. However, doing it over and over again creates a level of comfort with the process. This is the real work of Obesity Medicine. I can teach someone how to eat healthy in about 15 minutes – and I can give someone a medication that helps them with cravings or hunger, but the process of putting knowledge into practice takes a lot of time and energy and honesty and discomfort.
Discomfort isn’t a bad thing. Discomfort causes growth. And if we aren’t growing, we are stuck. And being stuck isn’t a great way to live our lives!
If you need me, you know where to find me! Keep growing…
Courtney Younglove, M.D.