Winning Mental Strategies for Weight Loss

Last Editorial Review: 8/16/2005

Realistic expectations lead to lasting lifestyle changes.

By Pamela Peeke, MD, MPH, FACP
WebMD Weight Loss Clinic - Feature

Reviewed By Kathleen Zelman, MPH, RD, LD

What's keeping you from losing weight successfully? Chances are, it's not just what you're eating and how much (or how little) you're exercising. For most people, a major part of the problem is how they think about their food, their exercise, and themselves.

(Not So) Great Expectations

Life's greatest stresses come from unmet expectations. Here you are, expecting to lose precisely 2.5 pounds per week. Where did you get that? Develop realistic expectations. Most people who are 20 to 50 pounds overweight can count on shedding one to two pounds per week, if they're on top of their game. (But we're not always on top of our game. More about that later.) You get excited and want to take care of this problem all at once, and that's not what this is about. Learn how to take off the weight commensurate with what your body can give you.

You might be saying, "Peeke, that's too slow. I want to do it faster." Well, then, you'll suffer. With short cuts, I'll guarantee you consequences -- consequences you don't want. Short cuts give you consequences, patience gives you progress.

Regroup and Recover

Now, let's talk about how to handle it when you're not at the top of your game. Life happens. Maybe you're doing very well and have lost 10 pounds of the 50 you're trying to lose. Then life hits. Your mother gets ill, your husband gets depressed, or you're having serious problems at work. Since life has obstacles, expect them. If you do, you'll be much better prepared to handle them. People who do best at maintaining a healthy body weight over time are people I call "master regroupers."

How do you regroup? First, expect to have multiple starts. Maybe you did pretty well this week, but then winter hit and it killed your plans to exercise outside. When something comes along, don't feel hopeless, helpless, defeated. Have in the back of your mind a plan A, B, and C. A is wonderful, B is OK, and C is not so great, but it'll do. A might be a beautiful walk outside, B might be, "If it snows, I'll be on the treadmill at the gym." C might be, "If I can't get to the gym, I'll climb the stairs at home for 20 minutes." It's the people who are paralyzed in plan A who fall apart. They find it impossible to sustain any kind of lifestyle change.

Your Own Worst Enemy

People have way too much negative speak. One of my patients is a lawyer in downtown Washington, married to a lawyer, and they have three kids. You can imagine her balancing act. She came to me last year at 5'5" and 250 pounds -- at only 44 years old. She was not in great shape. But she started in with me and plugged along on her weight loss plan, losing two to five pounds a month. Well, she just hit 198 pounds. While she still has a way to go, she's knocked off 52 pounds! She looks like a brand new woman. But you know what she said to me? Instead of rejoicing and saying "What an achievement!" she said, "God, why did it take me so long?"

She completely missed the point. I don't care if it took her 25 years -- she dropped 52 pounds. Although she hit plateaus several times, she never went back. She didn't gain weight during her most stressful times. I caught her at it and she said, "I had no idea I was thinking that way." Don't beat yourself up! When I trained Olympians, I asked them how they handled a crappy day or a bad week. Invariably, they never beat themselves up. They acknowledged what it was, and just got over it.

Talk To Yourself

To do that, substitute positive self-talk for negative self-talk. Come up with your own repertoire, a new vernacular of encouragement. Sometimes I say to myself, "You're having a crappy day, but you go girl. You're doing just fine." Find something that speaks to you, something that's all yours.

I have another patient at high risk for diabetes, her blood sugar and cholesterol levels were terrible, and she was terrified. But that only lasted so long. In the morning she was motivated, but by 3 p.m. she was in an eating trance at the vending machine.

I said, "You've told me about health risks and diabetes, and obviously that's not motivating you enough. Tell me something that really ticks you off." She said, "The other day my mother told me that if I get any bigger, I'm going to have to start shopping at Omar the Tentmaker's. I own this fabulous Armani suit, it's size 12, and I can't fit into it."

"Substitute positive self-talk. Sometimes I say to myself, "You're having a crappy day, but you go girl. You're doing just fine."

So this woman's motivator, when 3 p.m. rolled around and she had a choice of a healthy snack or stupid stuff from the vending machine, wasn't about diabetes or cholesterol -- it was about Armani. If you elect to eat appropriately, then the answer is Armani. If you eat badly, then the answer could only be Omar. By honoring Armani, she's stepping away from diabetes. That's one of Dr. Peeke's "get real" rules. Health is important, but you've got to make it more personal. It may be superficial, but it was worth it to her.

There's No Reaching "It"

Just because you've lost 30 pounds and are at your goal weight doesn't mean you get to sit on your laurels. If you're thinking, "I'm here, now I can be normal," I have a news flash for you. Normal means that you have to work at healthy eating and exercise every day. It does get easier with practice, but you must surrender to the fact that this is necessary to do. There's no negotiation. You just go to another phase of your new lifestyle, and you just get better and better and better.

Originally published May 18, 2004
Medically updated Dec. 9, 2004.

Pamela Peeke, MD, MPH ( is the author of Fight Fat After Forty and assistant professor of medicine at the University of Maryland in Baltimore. She advises former Surgeon General C. Everett Koop for his national Shape Up America program, and serves as medical director for the "Race for the Cure" campaign against breast cancer. Dr. Peeke is a medical correspondent for "PBS Health Week" and writes a monthly column, "The Peeke Prescription," for Prevention magazine.

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