Evolving into a healthier, fitter, new you
By Wendy Oliver-Pyatt, MD
WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Oct. 16, 2003
Dealing with plateaus; eating for hunger, not emotional need; removing stress from your food and fitness goals -- our guest Wendy Oliver-Pyatt, MD, author of Fed Up: The Breakthrough 10-Step No Diet Fitness Plan, helps us pull it all together. Dr. Oliver-Pyatt joined us on Oct. 16, 2003.
The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Welcome! Our guest today is Wendy Oliver-Pyatt, MD, author of Fed Up! and director of the Center for Hope of the Sierras. She will answer your questions about putting together a new food and fitness attitude for a lifetime of good health feeling good about yourself. Welcome Dr. Oliver-Pyatt.
Oliver-Pyatt: Thanks for having me.
Member question: I am ready to start a healthy lifestyle, but my spouse practically lives at McDonald's. How can I get him to start with me and if he doesn't want to, how can I avoid all the temptations that are around my house?
Oliver-Pyatt: Your question is probably familiar to other members and so I'm very glad that you did ask this. Just as it would be unhelpful and possibly hurtful if your spouse were pressuring you to either lose weight or get fit, which often leads to retaliatory eating or exercise resistance, so, too, is it unfair to expect our significant others to do and want at all times those things that may be important to us.
Certainly making your needs known and sharing with those you love your new approach is a positive step; however, they may or may not wish to participate with you as you make your changes. If your spouse chooses to eat fast food consistently, this will provide you with an additional opportunity to really work out your relationship with fast food.
You used the word tempted to describe how you felt about this food. I would encourage you to then focus on step four of Fed Up! regarding experiencing, trusting, and enjoying hunger and satiety, and indeed, when you are hungry and McDonald's is what you're hungry for, to sit down at the table, lie your food out before you, relax, and absorb and appreciate the presence of the food you're able to eat. Rather than seeing the food as a temptation that is off limits, you can focus on whether or not you're hungry and truly what you are hungry for. Is it really going to always be the Big Mac? Maybe yes, maybe no. But until you and Big Mac have worked out the tension, it will be difficult to achieve a relaxed state of mind.
Oftentimes people who are chronic dieters believe themselves to be gluttons who can't be trusted and who want too much. This reinforces in our minds the idea that we must diet and follow somebody else's rules. Remember, long-term health relies on a relaxed relationship with food. What I mean by health is fitness of body and mind, recognizing that the two are connected.
Perhaps after eating a Big Mac four or five days in a row, it may not have so much power over you. This relies, of course, on your eating the Big Mac in a mindful way, where you are experiencing the act and the sensation associated with feeding your body.
Member question: Will there be place for us to go if we want to get support once class is over?
Oliver-Pyatt: Thanks for asking. I periodically provide seminars based on availability of time and interest. Please feel free to email me or visit my web site for updates.
Moderator: And of course we have lots of lifestyle, food, and fitness message boards here at WebMD. You can exchange questions and comments with other members there, or ask our message board experts for their advice.
Member question: Plateaus -- some are terrible! If I'm faithful to exercise and diet, and patient when these happen, what's a reasonable time to keep reassuring myself that all is OK? I've had some occasions where for a month I've had neither weight loss nor any extra stamina/strength during exercise, at least as far as I could determine.
Oliver-Pyatt: What is our alternative to learning how to wait? Is it going back on another diet? Is it deciding you're going to take on a harsher exercise routine? We are constantly inundated with thoughts and ideas about quick fixes. We hear statements like, "Lose a dress size by next week, be 60 pounds lighter by Christmas." Where does this lead us? To an expectation that decades of dieting and weight cycling should be resolved in a few weeks or months.
Let's recall that your body reacts to the semistarvation caused by dieting by going into survival mode, slowing its metabolism, and even holding on to water. Even when you wise up and stop dieting it can take a very long time to reset your metabolism. Also, you need time for your body and mind to recover from the stress of dieting. Dieting is traumatic. It does place enormous stress on your body, as well as on your mind. Every time you diet you invest energy, pride, and self-esteem in the effort. All of this stress plays a toll on us.
Even the stress that can be caused by the demands of excessive exercise can backfire. Research shows that your body produces elevated cortisol, sometimes called the stress hormone, and changes in cortisol can cause long-term alterations in your appetite and metabolism. A study of 62 women showed that high food restrictors exhibited significantly higher cortisol levels than low food restrictors, a finding the researchers hypothesize is due to the "psychological stress of constantly trying to control and monitor food intake." Studies link elevated cortisol levels to increased appetite, weight gain, and night binging.
It may be useful to look at your exercise regime. Are you allowing yourself exercise that unites your mind and body and reduces stress? Or is your exercise routine consistently harsh and demanding?
I recall, after my second daughter, Jada, was born, for reasons still unclear to me, I had accepted an extremely demanding position as the state medical director for the division of mental health. My work seemed to be nonstop, and my worries even interfered with my sleep. I also happened to notice that my weight loss following Jada's birth seemed to be rather slow. Be sure, however, the thought of dieting never even crossed my mind.
Just after her second birthday, thankfully I left this position and was determined to work three days per week. As shocking as it may be, without any changes in my exercise routine or my intake of food, within three months the 10 pounds my body had been desperately hanging onto in its highly stressed state faded away. Indeed, everything I'd been reading about with regard to cortisol and stress seemed to play out in my own life.
Instead of fighting your body chemistry by harsh exercise, find ways to de-stress and help your body work with you. Allowing time for your body to recognize that it's not stressed or starving allows your cortisol levels and metabolism to adjust.
Member question: all this touchy-feely stuff sounds great: Like yourself, and you have no problems. Well, I do have problems. I need to lose weight, probably 100 pounds. So telling myself that what other people think doesn't matter isn't true, because one of the other people thinking about me is my doctor. I don't want pills, I don't want surgery; I want to lose weight, and that means eat less and exercise. I understand moderation has a better chance of long-lasting results than fad diets, but it's still a form of diet, and that's not a bad word.
Oliver-Pyatt: Whatever works for anybody works for me. Indeed, 3% to 5% of dieters do lose weight and keep it off. Maybe you'll be one of the lucky ones. My philosophy and approach is directed towards those individuals who have recognized within themselves, and within our society, that dieting has proved, in general, to be an ineffective tool for long-term weight loss.
You used the word moderation and somehow link that with dieting, which I would agree with. However, I'd like to point out that what happens when a person relearns to eat based on internal versus external cues, what naturally results is a moderation. When a person learns to redefine exercise in a way where mind and body are connected and exercise becomes something pleasurable and something we want to do from within our heart, this is when exercise becomes a part of our life for life, when the desire to exercise is spurred from something within our heart, and not something forced upon us.
Psychologist Erich Fromm notes, as I point out in step 5, Straight Talk About Exercise, "How does one practice discipline? It is essential that discipline should not be practiced like a rule imposed on oneself from the outside, but that it become an expression of one's own will; that it is felt as pleasant, and that one slowly accustoms one's self to a kind of behavior which one would eventually miss if one stopped practicing it. It is one of the unfortunate aspects of our western concept of discipline that its practice is supposed to be somewhat painful, and only if it is painful can it be good. The East has recognized long ago that that which is good for man (or women) for his body and for his soul must also be agreeable."
Focusing on the process of living your life in the present moment may be more helpful than focusing on the goal of weight loss.
Member question: How do you deal with that feeling that you know how to eat right, and know all the tricks and psychology behind it, but you think, "I can always do that tomorrow" (or next week)? And this goes on for years.
Oliver-Pyatt: I'm curious about your definition about "how to know how to eat right." For the past three decades, our society has become obsessed with focusing on what it is OK to eat and what it is that it's not OK to eat. Eating right or not eating right is somehow constantly connected to what it is that we are eating. Let's focus, instead, on how it is that we're eating and why it is that we're eating, rather than what it is that we're eating.
Clearly, a person has to be ready to want to change in order to begin the process. You mentioned that you're always thinking about eating right at some future point. Perhaps focusing on discovering the difference between physical and emotional hunger and taking the time to respect and nurture both your physical and emotional hunger would be a way to take your physical and psychological needs seriously and to start the process of healing your mind and body.
If "eating right" is something that you see as stressful or in a negative light, perhaps it's because the idea itself represents your disconnecting from what it is that you need. Maybe that's why it is aversive to you. The exciting thing about the approach I am proposing is that it is not about denying your needs any longer; it's about tuning into them and responding to them in a meaningful way. This includes both a physiological need to satiate our physiological hunger, and the physiological need to take our emotional selves seriously.
Member question: Can plastic surgery ever play a role in developing a healthy body image?
Oliver-Pyatt: You raise an interesting question here. Many people do, indeed, feel compelled to undergo plastic surgery, and for some people this can provide them with a new outlook. My greatest concerns are for those individuals who undergo plastic surgery without appropriately addressing the issues that surround binge eating, emotional eating, and the diet mentality. If a person has learned how to develop a relaxed relationship with food, then the changes they may see with plastic surgery can be lasting. My concern is for those people who see plastic surgery as a quick fix for weight loss when their relationship with food is still tense and chaotic.
Member question: What role do you think psychological counseling can play in achieving a physically healthy lifestyle?
Oliver-Pyatt: I think that psychological counseling, in many cases, is critical in achieving the fitness of mind and body that we are looking for, and is perhaps what has been neglected all along over the last several decades. Until we provide ourselves the opportunity to explore our emotional needs and to learn how to address them in an emotionally meaningful way, we will take the path of least resistance when dealing with emotional hurt. In our society, that path of least resistance seems to be into the kitchen and either straight to the refrigerator or pantry. We quiet our emotional hurt through the act of eating, but only temporarily.
As I've said before, until we learn how to distinguish physical from emotional hunger and address both of these important needs in a meaningful way we're not able to achieve the balance we are looking for. When I talk about taking our physiological needs seriously, what I mean is being able to detect hunger and to feed our hunger with foods that truly are satiating.
I recently spoke at a spa on the subject of weight management. I ate my dinner, and then gave my talk at about 7:30 p.m. We were finished by about 9:00 p.m., and I noticed that I had become hungry again. I went down to the lounge looking for food and found that my choices were apples, oranges, or pears, and air popped popcorn. I found myself feeling somewhat anxious and irritated. I was trapped! I really needed something more significant. Reluctantly, I dished up two medium-size bowls of the tasteless popcorn and grabbed a pear and went to my room. Sitting down I ate it all, realized I was still not satiated, but had no choice but to go to bed.
There is a reason that our bodies can tell the difference between being full and being satiated. Sure, my tummy got full after the two bowls of the tasteless popcorn and the pear, but I was not satiated. So when I'm talking about treating our emotional hunger or our physiological hunger in a serious way, I mean focusing in on ourselves, determining what it is that would satisfy us, releasing ourselves from guilt about this, sitting down at a table, eating off a plate, respecting, appreciating, and enjoying the act of eating, and then noting the pleasant sense of satiation or of really having had enough and really just not wanting any more. Not because of following someone else's rules, but because your inner being is OK.
Taking our emotional hunger seriously can be frightening. It may mean speaking unspoken words, talking about the elephant that's in the room, no longer dancing around conflict, no longer taking guesses about what other people need and then attempting to reconstruct ourselves to fit into whatever box we think we need to fit into to meet those needs. Taking our emotional hunger seriously may require an intense focus on ourselves, and indeed the focus may be aided by the process of psychotherapy.
What's really exciting is expressing your authentic self; although it may bring conflicts to the surface, it doesn't create conflicts that don't already exist. Bringing our emotional selves to the table provides us for a real connection, real conflict resolution, and real emotional growth.
One of my psychotherapy patients recently did the hard work of confronting her husband with his drinking problem, which had gone unaddressed for 10 years. This required considerable effort and made my patient very anxious. Shortly after she confronted her husband he did emotionally withdraw from her and spent several evenings very quiet and uncommunicative. My patient became very anxious, wondering where this would all lead. Certainly she could have backed down and reprimanded herself for identifying and addressing a very real problem in her life, but she stuck with her emotions and her husband eventually did start talking with her. Their level of communication now is far more intense and authentic and he is now asking for the help that he will need in order to stop drinking.
For 10 years my patient dealt with her anxiety by binging and emotionally grazing on food. For 10 years she was kept quiet; now she can hold her head up high and she feels less anxiety and her relationship is also improving.
Certainly a byproduct of this change will be weight loss, as she is no longer binging and grazing on food on a daily basis. Her goal was not weight loss; her goal was to take herself seriously, and that is what she did when she gently but firmly confronted her husband.
Moderator: Do you have any final words for us, Dr. Oliver-Pyatt, before we wrap up our four weeks with you?
Oliver-Pyatt: Thank you so much to WebMD for inviting me to participate. It's been, as they say, an honor and a pleasure.
I sincerely hope you will all reconsider if you are thinking about dieting, and learn to trust your inner voice.
Moderator: We are out of time. Our thanks to Wendy Oliver-Pyatt, MD, author of Fed Up! and director of the Center for Hope of the Sierras, for being our guest today. Please be sure to check out all of the nutrition, exercise, and heart health information the WebMD Weight Loss Clinic has to offer!