By Ann E. Goebel-Fabbri, PhD | December 23, 2009 11:40 am
If you are overweight, you probably have had this experience more times than you care to count: being told by a health-care provider that if you could “just lose weight and keep it off,” your health would improve. You may have tried numerous weight-loss programs, gym memberships, and diet books in an attempt to follow that advice. Over the years you may have lost somewhere between 50 and 100 pounds. But keeping that weight off over the long term poses its own, unique challenge.
Advice to lose weight is given routinely, yet losing weight and maintaining weight loss are very difficult goals to achieve. However, there are practical tools and strategies that can help you reach your weight-loss targets and (most important) keep that weight off over time. This article presents some of those strategies that have stood the test of time.
The most important strategy for successful weight loss — or behavioral change of any sort — is to learn how to set realistic, achievable goals for yourself. Losing weight and managing diabetes both require attention to diet and exercise. But nobody can change everything at once, so it helps to set small, achievable goals that can build on each other.
Start with any goal you are ready to tackle. For example, if you see some areas in your meal plan that you are ready to “tune up,” focus on them first. On the other hand, if the weather is getting warmer and you are interested in starting a regular walking routine, go for it. Any positive lifestyle change you make that you are able to build in as a regular habit will result in improvements in your energy, mood, and motivation.
It’s also important to be realistic about the amount of weight you wish to lose. Even a 7% to 10% weight loss has been proven to have significant health benefits, but this often strikes people as too small a goal. For example, someone who weighs 300 pounds and loses 30 pounds is still overweight. However, keeping this weight off over time will result in improved insulin sensitivity, lower blood glucose levels, lower blood pressure, lower blood lipids, increased mobility, and improved energy.
Setting a weight-loss goal that is too high and aiming for perfection are a recipe for burnout and make it more likely that you will give up on the overall goal of improving your health. Diabetes is a chronic disease that will be with you for your whole life, so your goals and expectations need to be maintainable and sustainable over a lifetime.
Keeping track of your progress daily can be a powerful tool. Research shows that people who routinely monitor their progress are more likely to maintain weight loss and stick to an exercise program. Monitoring your progress could mean maintaining a logbook to regularly record meals, exercise, and weight, or it could mean designing your own personalized system. Keeping track of your weight-loss pattern will also help you decide when it is time to set a new goal. When you notice weight-loss plateaus, or a slowdown in your rate of weight loss, it is time to set a new small goal, such as increasing the duration or intensity of your exercise or making another change in your meal plan that will contribute to your progress.
Using a tracking system also helps you to increase your awareness of risky situations or foods that trigger overeating. For example, if you learn from your logbook that whenever you take home a doggie bag from a restaurant you polish it off the same night, it probably makes sense to rethink your doggie bag strategy. Keeping temptations out of your home and workplace will help you to create an environment that promotes your success.
Approach your weight-loss goals with strategic planning in mind. Since you are working on lifestyle changes for the long haul, give yourself variety in your exercise and meal plans so that feelings of boredom and deprivation don’t pull you off track. Schedule time for exercise so that you don’t feel rushed by other demands. Similarly, schedule time for meal preparation so that you have nutritious foods on hand to eat when you are hungry and won’t be tempted by vending machines or fast-food restaurants.
By sticking to a schedule and creating a routine for your new behaviors, they will gradually become more reliable habits for you. However, it’s still a good idea to devise a game plan ahead of time for how you might handle times when you are feeling bored or too stressed to exercise or cook, as well as for how you will handle changing seasons and unpredictable weather. Over time, your new habits will become your everyday approach to how you live your life. They will be just part of “what you do.”
Be prepared to give yourself a break when life intervenes and pulls you off track. Slips and setbacks are a normal and expectable part of working to change longstanding habits. Accepting that you cannot anticipate every crisis before it happens will help you to bounce back from those times when you are faced with the unpredictable. This is when it becomes necessary to take a deep breath, look at the situation with fresh ideas, and try to recommit to healthier choices. Self-criticism will only pull you further off track.
You may also sometimes experience setbacks in your weight-loss progress even when you’re doing everything “right.” This is normal. You can expect some ups and downs along the way, but you should see a gradual downward trend over time. Losing one or two pounds a week is considered a healthy rate of weight loss, but this is often too subtle to keep people motivated. Focusing on your monthly weight-loss pattern instead can help you recognize the progress you’re making.
Find the supports you need. This may include your spouse, other family members, friends, and coworkers. In addition, consider joining a club focused on an activity you enjoy, such as walking, hiking, or biking, or a support group focused on weight loss and health. Reach out for exercise partners or weight-loss partners and connect to advocacy groups such as the American Diabetes Association.
Be on the lookout for people in your life who offer misguided helping, or who take on the role of the “diabetes police” or “food police.” These are usually people who love you and are worried about your health but simply do not know how to express their concern in a way that feels supportive to you. Help them to understand what it is that you need from them through patient and assertive communication. This involves first knowing yourself and tuning in to what it is that you need for support. For example, do you need someone to take care of your kids while you exercise? Or do you need the companionship of an exercise partner? Perhaps you need both.
It helps to assume that your family members and friends love you and are doing what they are doing out of love and concern. That does not mean that you should just put up with what they are doing. But it may make it easier to approach them and communicate your needs clearly and openly so that they can change their behavior to something that really is helpful to you.
In addition to finding supports in your social and family life, take the time to build a supportive medical team. This ideally will include a primary-care doctor and an endocrinologist and may also include a nutritionist, nurse educator, exercise physiologist, and mental health practitioner. Look for team members who are willing to help you define specific and clearly achievable goals together as a collaborative process. If you’re not sure which targets to prioritize, ask your team members for advice. For example, should you focus first on improving your blood glucose levels or your blood pressure? Or should you focus on establishing a maintainable exercise routine? Keep in mind, however, that your input is important because you are the one who will be carrying out the steps to reach your health goals.
Decide that you and your health are worth the effort it will take to change your eating and exercise habits. This can be the most challenging part of the process for some people because of feelings of low self-worth or because of the feeling that it’s impossible to achieve an “ideal” thin body size.
How to overcome these feelings? One way is to note how much better you feel when you are actively engaged in the process of improving your health and well-being. Another is to remind yourself that it’s not necessary to be thin to be healthy. Look for role models who aren’t thin but are healthy, and aim to emulate them rather than, say, slender fashion models.
Nobody can deny that the possible complications of diabetes are real and can be frightening; this is truly a “high stakes” disease. However, fear and self-criticism are not good motivators for behavior change. In fact, they often make people feel powerless and stuck. Rather than focusing exclusively on avoiding complications in the future, determine what the “here and now” positive rewards for your behavior changes (and their short-term results) will be. When setting goals for behavior change, don’t forget to build in positive rewards for yourself once you meet targets along the way. Get creative in finding non-food-related rewards that are personally meaningful.
By using these weight management strategies, you will soon notice changes in your blood glucose levels, and you may need to cut back on your insulin doses or doses of other diabetes medicines. (See your health-care provider for help in making these medication changes.) Make a point to also take time to register the subtler, “real life” rewards that come from feeling healthier: Notice whether you have improved energy and stamina, feel stronger, have better concentration and improved mood, and feel more self-confident. These are meaningful changes that will influence your overall quality of life.
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