Laugh Yourself Thin Making Happiness, Fun, and Pleasure the Keys to Permanent Weight Loss potx

Laugh Yourself Thin Making Happiness, Fun, and Pleasure the Keys to Permanent Weight Loss Melanie W.. Laugh yourself thin : making happiness, fun, and pleasure the keys to permanent we

Laugh Yourself Thin

Laugh Yourself Thin Making Happiness, Fun, and Pleasure the Keys

to Permanent Weight Loss

Melanie W Rotenberg, MD

With Mitch Rotenberg, PhD

All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher

Library of Congress Cataloging-in-Publication Data

Rotenberg, Melanie W.

Laugh yourself thin : making happiness, fun, and pleasure the keys to permanent weight loss / Melanie W Rotenberg with Mitch Rotenberg.

p cm.

Includes bibliographical references and index.

ISBN 978-0-313-38636-7 (hard copy: alk paper) — ISBN 978-0-313-38637-4 (ebook)

1 Weight loss—Psychological aspects 2 Weight loss—Humor 3 Laughter—Health aspects I Rotenberg, Mitch II Title

This book is also available on the World Wide Web as an eBook

Visit www.abc-clio.com for details

Praeger

An Imprint of ABC-CLIO, LLC

ABC-CLIO, LLC

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Santa Barbara, California 93116-1911

This book is printed on acid-free paper

Manufactured in the United States of America

The information published in this volume or any related e-book, Web site, or database is provided for informational purposes only and is not intended to supplement or replace the advice of a trained medical professional The information provided here should never be used for the purpose of diagnosing or treating a medical or health condition Readers should consult their own physicians before making any decisions or taking any actions that might aff ect their health

Aaron, growing up in our joyful and off -beat household, you have happily borne the brunt of our jokes But, in so doing, you have learned the ways of the humorist Your comedic talents and level-headed disposition have led us to conclude “Our work here is done.”

—Aristotle *

*Just not that Aristotle.

Contents

Introduction: Laugh the Pounds Away Forever xi

PART I: ATTITUDE AND BEHAVIOR

ONE: Turn Your Head and Laugh: Happiness, Joy,

and Pleasure in the Pursuit of Weight Loss 3TWO : I’m Allergic to Food, It Makes Me Swell:

Thought and Mind for Success 23 THREE: Tossing Your Cookies: Food Behavior That Works 45FOUR: Laugh Your Butt Off : Activity Behavior That Works 67FIVE: I’m on the Duct Tape Diet: Handling Hunger 83

PART II: INPUT—FOOD AND DRINK

SIX: Eat Right, Die Anyway: What Are Good Foods? 105 SEVEN: Put the Muffi n Down and Slowly Back Away:

What Are Not-So-Good Foods? 125

EIGHT: Water Intolerant: The Right Drinks 143NINE: Living Extra Large: How Much, When, and How to Eat? 153

PART III: OUTPUT—METABOLISM AND ACTIVITY

TEN: That Which Doesn’t Kill You Makes You Fatter:

Increasing Metabolism 173 ELEVEN: Dinosaurs Refused to Exercise and Look What

Happened to Them: The Right Activity 195 Conclusion: I Told You That There Would Be a Quiz at the End! 215

Resources and Further Reading 229

Acknowledgments

First and foremost, I must thank my agent, Ellen Pepus, of Signature Literary Agency Without her terrifi c guidance, great advice, and gen-tle coaching, this project would never have come to fruition

Thank you as well to my editor, Debbie Carvalko, and all the derful people at Praeger/Greenwood for encouraging my passion to teach and entertain

And a big thank you to all who off ered stories and advice or their time by reviewing the manuscript The friends and family who assisted include Debbie Bernier, Joe Bernier, Amelia Torre, Marcia Weinstein, Marylee Fennell, Terri Hamilton, Laura Fausone, Dawn Mineo, Pam Wheeler, Dawn Fuller, Bob Taylor, Rick Fennimore, Fred Mullins, Christine Folkes, Susan Jackson, and Sherri Garafolo

I am truly grateful to all the enthusiastic participants of the annual conference of the Space Coast Writers’ Guild You people helped me ferment this crazy plan, and I do appreciate all the wonderful guidance through the maze of the book industry

Real gratitude goes out to comedian Kevin Hughes, for inspiring

my husband and me to start writing humor and for encouraging me to get up in front of a crowd and tell jokes

And I’d like to give a huge thank you to my son, Aaron Rotenberg, and my husband, Mitch “Long-Suff ering” Rotenberg, for putting up with me all these years

Finally, the biggest thanks goes out to my patients, who inspire

me to write, to teach, to learn, and to grow Where would I be out you?

Melanie Rotenberg, MD (aka “Dr R”)

Introduction: Laugh the

Pounds Away Forever

Roller Coaster Haiku

Oh my Freaking God

I think I’m Going to Die

Oops, There Goes my Lunch

The weight-loss journey, for most people, is a lot like a theme park ride, a very stressful and scary one It doesn’t have to be Ideally, it should be more like a fun, exciting adventure, with a safe and pleasant outcome

Although I hope you will think this book is funny, please realize that the weight-loss concepts are serious Healthy skinniness can’t occur without laughs, since negative emotions undermine successful weight loss Laughter is the hallmark of a life lived better, a life full of pleasure and joy

LIFE IS ALL ATTITUDE—LUCKILY, I’VE GOT LOTS OF THAT

A warning to my readers: my husband, Mitch, has a black belt in humor, and I use his material every chance I get If you aren’t in the mood to

laugh while you read, put the book down and back away I am intent on making the experience enjoyable for you In my spare time, when I’m not seeing patients, I’m writing or practicing comedy I started doing stand-up routines just after my 40th birthday; you could say I’m hav-ing an unusual midlife crisis

When I asked Mitch if he would help me write this book, his sponse was “I’d rather put eye-hooks through my hands.” The man blurts out funny stuff all day long, and then I run and write it down Let’s just get it straight—his blurting got him credit for co-authorship, but I did the hard work, and that’s why the book is written from my perspective

I also have to tell you this: most of the stories here about my tients, friends, and family are true, but the names have been changed to prevent unwelcome visitors to our house in the middle of the night

GONE WITH THE CHIN

One other thing you need to know: this is not a quick-fi x diet book If you are looking for a way to lose a few pounds and then want to go back to your previous lifestyle, look elsewhere This book is meant for people who are tired of traditional dieting and are now looking for

permanent, healthy weight loss I’ll teach you how to do it by taking a

humorous, positive, joyful approach

Here you will fi nd information about wellness I discuss not just food choices but approaches to eating, exercise, behavior, and thinking I talk about mood and activity I don’t tell you what to eat and what not

to eat, but I do advise on good choices and not-so-good choices

I will talk about activity and exercise I have to because, ultimately, regular exercise is how successful people lose weight and keep it off permanently Besides, I am an exercise doctor, and I’d be a fool if I did not talk about something near and dear to my heart Activity works, and in this book I’ll tell you why it works and how you can make it successful for you, even if you’ve never thought of yourself as an exer-ciser Many of my patients in my medical practice can’t even get out of

a chair on their own when they meet me, yet they all learn to exercise I’m very creative

Most people gain back all the weight they lose through a traditional diet plan shortly after going off the diet In fact, the saddest part of weight-loss research reveals that the majority of dieters not only gain back their lost weight; they gain even more than what they lost This

does not have to happen It will not happen to you if you follow the

scientifi cally based suggestions in this book

People gain back their lost weight for one very important reason: they haven’t embraced weight loss through a thinking and behavioral whole-life approach For most people trying to lose weight, the word “diet”

implies a temporary state of food restriction Either types of foods or amounts of foods are restricted until the desired weight is achieved

However, there are three parts to successful and permanent weight loss: (1) thinking and behavior; (2) input, as in food and drink calo-ries; and (3) output, as in metabolism and activity calories Most diet books, even those written by physicians, have an overemphasis on the

“input” part of the equation A typical diet book will give you pages and pages of food rules and recipes These books rarely talk about the behavior, attitude, and cognitive processes that go into how and what

we choose to eat They rarely give more than a page or two to the issue

of activity and exercise Weight loss can’t be permanent unless all three

areas are addressed in a balanced manner

It’s like everybody and their brother has written a diet book or a book Even dead people and fi ctional characters are getting in the act

cook-I’m afraid it won’t be long until we see Noah Cooks for Two

Now remember, health advice works only if you act responsibly with the information Which reminds me of the time my hospital off ered

a breastfeeding course but had to cancel it because more men signed

up than women

Back to weight loss: calories are just a convenient way to measure our bodies’ fuel Weight loss occurs when there is more fuel burned than taken in Activity (output) is just the way we burn the fuel that we get through food (input) If we put out more calories than we take in,

we lose weight Maintaining that loss permanently is just maintaining the balance between input and output It’s really very simple

STUDIES SHOW THAT WOMEN PHYSICIANS

ARE 100 PERCENT MORE LIKELY THAN MALE

PHYSICIANS TO HAVE BABIES

I have a lot of experience with health and weight loss, personally and professionally When I was pregnant, I suff ered severe morning sick-ness and ate anything I could to calm my queasy stomach (Patients don’t think it’s very professional when the doctor barfs on them.) By the time I gave birth, I was 50 pounds heavier than before my preg-nancy It took me a long time to lose that extra weight, but I’ve kept it off for more than a dozen years More important, I’ve been a disabil-ity physician for a couple of decades, and I’ve counseled thousands of patients on weight-loss techniques Obesity is the number one cause of disability in the United States and also the leading cause of prevent-able death

Youthful fi gures and activity levels are not just for the young but can be in the grasp of anyone who is willing to make health a priority

My goal is to teach people how to avoid becoming chronically sick or disabled in the fi rst place and then stay in great shape for the rest of their lives I have a wild fantasy that if enough people read this book, I’ll put myself out of the disability business for lack of patients Truly, that would make me ecstatic Read this and enjoy a slimmer, more vi-brant, fun, and happy life, permanently

The key to weight loss is to start from a good point and go to a ter one—the joy, laughter and happiness that you develop will be all your own

—Melanie Rotenberg, MD

(Oh, and one more thing: pay attention throughout My husband and I are professors Don’t be surprised if there’s a quiz at the end.)

PART I

Attitude and Behavior

ONE

Turn Your Head and Laugh:

Happiness, Joy, and Pleasure

in the Pursuit of Weight Loss

People want quick results, but there are no healthy ways to rapidly slim down Health spas often promise serious weight loss with only one ex-pensive session of an exotic treatment Usually it involves being slath-ered, enveloped, and heated None of those techniques really work; they are only sucking water out of your system However, I guarantee that you will experience rapid and dramatic weight loss with the piranha swim

Laughter is the key to weight loss Well, really, it’s those things that cause laughter, like happiness, fun, and pleasure But we can use laugh-ter as a good gauge of how happy and content we are Stress, negative emotions, and misguided thought patterns are a leading cause of obe-sity Yet diet books almost never address an overweight person’s men-tal state or level of joy They might have pages of dietary restrictions and recipes, but rarely is there more than perfunctory prose on reliev-ing negative emotions There might be a chapter or two on exercise, but nowhere is there a description of the cardiovascular benefi ts of a good pillow fi ght

And we all need a good pillow fi ght on a regular basis The way to lose weight and to keep it off permanently is to lower stress, depression,

and other negative emotions through positive thinking, humor, fun, and lots of laughter A lighter approach to life leads to a lighter waist line

A recent study by Dr Mark Wilson at Emory University brings home this point He off ered unlimited nutritious food to two groups of mon-keys, high-status, contented, happy ones and their miserable, stressed-out, low-status subordinates 1 All the monkeys ate about the same number of calories However, when Dr Wilson substituted high-fat and sugary junk food pellets in unlimited supply, the high-status monkeys ate about the same calories as previously, but their stressed-out brethren couldn’t stop munching Those miserable primates continued to eat the junk food all day long and well after sundown, similar to human snack-food grazers The researcher concluded that eating high-calorie foods

is a common coping mechanism to deal with daily life stressors, even

in those who don’t have a cranky boss, prolonged commute, or nasty mother-in-law

YOUR PERSONAL WEATHER FORECAST—CHANCE

OF SCATTERED BRAINS

Unfortunately, the majority of modern people live stressed-out, manding lives Most of us spend our days rushing from responsibil-ity to responsibility, with little time to relax, enjoy, or meditate A while back, my son saw my driver’s license and read the words “organ donor.” He exclaimed, “Oh, cool, mom, which organ did you donate? ” That’s when I informed him that normally people wait until they’re dead to donate their organs, but, in my case, I had already given my brain at the offi ce

The biggest stress in my life is keeping house I’m not much of a tic engineer I was completely stumped one time when I had to wash

domes-a bldomes-ack-domes-and-white-striped swedomes-ater domes-and the instructions sdomes-aid to “wdomes-ash with like colors.” To me that was a laundry IQ test, and I had to be Ein-stein to fi gure it out

And, speaking of chores around the house, I’ll never forget the tient I had who went home from the hospital with hospice care That nurse was so terrifi c, she took days to help the elderly gentleman clean his completely unkempt house before he died Exhausted, she fi nally reached the bottom of a huge pile of junk The last thing she picked up

pa-was a book titled How to Clean Practically Anything

HELP! I’VE EATEN AND I CAN’T GET UP

People say they want to lose weight for a lot of reasons, like “I want

to look better in my clothes” or “I just want to get back to my college weight.” But the real reason is only twofold—either it’s for health or it’s for happiness There’s no point to being thin, sick, and miserable We all know people who are like that Generally they’ve got cancer or they hate themselves, and, either way, you don’t want that for yourself Mental and physical health is the primary goal in permanent weight loss This book is about accomplishing both When you set yourself on the path of mental and physical health, the weight loss will follow If you try to shortcut the process, you won’t get very far A positive at-titude and a focus on pleasure and joy are an integral part of losing weight forever

Laughter is a key component to weight loss There have even been research studies looking at laughter as a weight-loss technique But I’m not particularly interested in seeing how many calories a day you can burn by watching reruns of television sitcoms I’m more interested

in the bigger picture—how can positive thinking and happiness bring about better health?

We medical types know a lot about the physical implications of being overweight We know that obesity leads to all sorts of bad medical out-comes, including cardiac disease, diabetes, arthritis, and cancer Hav-ing extra belly fat even increases your risk of developing Parkinson’s disease! However, we’ve had a tough time getting people to lose weight Even those who lose the weight usually can’t keep it off But the focus has been lopsided Most weight-loss programs concentrate on the physi-cal issues, usually the food and sometimes the exercise It is my belief that the most important component is often ignored: the brain Our thoughts, emotions, and behaviors drive every action and decision that

we make, and they certainly drive our weight problems The bottom line

is this: we know that permanent weight loss will not occur in people full

of fear, unhappiness, and boredom

IF STRESS CAUSES HIVES, I OUGHT TO BE ONE

GIANT RED BUMP

So if a person is stressed, depressed, or bored with life, attempts at manent weight loss will be futile The best hope we have for true success

per-is to start with our most critical fat-preventing organ, our brain, and whip it into the best shape possible The rest of the body will follow

This chapter is about ways to increase happiness, lower stress, improve coping mechanisms and social relationships, and reduce self-critical behavior in pursuit of thinness All of these are crucial to mental and physical health and permanent weight-loss success Even if you think your life is going well emotionally and mentally, there are things you will learn in this chapter and the next that will make the journey to nor-mal weight much easier Take the time to read Part I of the book (Atti-tude and Behavior, Chapters 1–5) before delving into the later sections Chapter 2 deals with the proper mindset for weight loss, and Chapters 3 and 4 address the behavioral aspects (Chapter 5 is about hunger) Once you have read the entire fi rst section of the book, you will have a much better foundation to approach the specifi cs of the rest of the equation, that is, the input and output of fuel When you have a good understand-ing of the thoughts and actions that lead to success, you can apply them

to your own situation and immediately start making positive changes

THE UNIVERSE IS EXPANDING, AND SO AM I

A study done at Northeastern University, in Boston, in 2003 showed that the more depressed adolescent girls were, the more likely they were

to become obese later in life 2 That same year, Johns Hopkins published

a study showing that in adults, there is a strong link between depression and weight, particularly in those who are very obese 3

I have a patient who is extremely overweight, as is his wife Recently, the wife underwent surgery While coming out of anesthesia, she was particularly anxious and upset Her doting husband off ered all his emo-tional support Later that day, apparently still suff ering the eff ects of the medications, she turned to her spouse and said in her most grate-ful manner, “Oh, honey, thank you for being there for me when I really needed you You are my Rock of Giblubber.”

I’VE ALREADY LOST THREE SIZES:

SMALL, MEDIUM, AND LARGE

Think about ways to increase your pleasure and happiness in day-to-day life Fun with food will lead to weight loss, not weight gain, as is often assumed It’s an exciting paradox: the more you truly love and enjoy

food, the less you will eat of it (We’ll talk more about that in Chapter 9.)

Weight loss should be approached as painless Eating is pleasurable

Having fun and laughter around meals and playing with food are portant Additionally, exercise and activity are not burdensome but in-vigorating Those who are most successful with permanent weight loss are those who consider regular physical activity an enjoyable, integral part of their daily life forever

WHO KNOWS IF A CLAM IS REALLY HAPPY?

So what are the keys to happiness? In my experience, there are several keys that drive most people toward happiness Loving and sharing in meaningful relationships is a big one Having a purpose is very impor-tant Being present-centered, living life here in the moment, is another (Don’t dwell in the past or constantly dream of the future.) Having au-tonomy and control over one’s life is extremely important to happiness,

as is being rewarded for eff ort

All of these keys to happiness are relevant to weight loss People who are in meaningful, supportive relationships are more likely to follow good health habits People who feel that their actions have a purpose are more driven and motivated and stick with a plan Those who live now, in the present, are more attuned to their bodies’ needs It’s been shown that personalities that are more autonomous and independent, sometimes called “having an internal locus of control,” are less likely

to be obese Finally, those who feel that they are getting positive back for their eff orts are more likely to continue those eff orts That’s why there is so much emphasis in some diet programs on the regularly scheduled weigh-ins

THE CABLE COMPANY SAID THEY’D BE RIGHT OVER,

SOMETIME BETWEEN BIRTH AND DEATH

If you want to get skinny for the long term, it’s time to embrace ter, compassion, and contentment and abandon anger, cynicism, and pressure There is a very clear and consistent relationship between how stressed and unhappy people are and how obese they are Stress also re-sults in anxiety; people who have the most work and life stress are the most anxious and overweight

A study by Paula Rhode, PhD, of the University of Kansas, showed

a direct correlation between the frequency of everyday life stressors (like

arguments with family members, waiting for the repairman, or being stuck in traffi c) and obesity 4 Her results demonstrated that for weight loss to be permanent, one must address the psychological factors of daily stress and loss of control, thus preventing the need to soothe fraz-zled emotions through eating

When people have passion in their lives, true meaning, deep pleasure, and feelings of living a worthwhile life, it is much easier to achieve goals, including weight-loss goals Ah, I know what you are thinking: “Sounds great, but I live in the real world.”

So do I, and I’m a physician, mother, wife, daughter, sister, friend, comedian, volunteer, bad golfer, worse surfer, writer, speaker, and con-sultant, and I play a host of other roles We all live in the real world, with loads of responsibilities Unfortunately, sometimes people use their roles and responsibilities as an excuse to stay unhappy and not work toward changes Don’t do that

I believe eliminating stress is one of the keys to permanent weight loss You can be very busy and not be stressed They are not the same thing Indeed, having too little meaningful work to do results in bore-dom, which is a pervasive but often overlooked cause of stress

CUSTOMER SERVICE IS OUR MIDDLE NAME

NOPE, WE DON’T USE IT EITHER

How can you eliminate stress in pursuit of permanent weight loss? Learn more about yourself by carefully studying your reactions to everyday events Start examining what really makes you happy and what turns you off Gravitate toward those things that really give you pleasure, and don’t worry about what others may expect of you

Nothing aggravates me more than dealing with rude and incompetent companies I swear some of them must use the motto “Why buy from the best when you can buy from us?” The worst is when I want to talk

to a real live person, and I have to navigate an unending phone saging system or leave a message and hope that someone will call back

mes-A friend of mine told me that her church recently got rid of purgatory, and now I understand why We don’t need purgatory anymore; we have voice mail

Are there things that you do that feel purposeless? Realize that a role that feels important and satisfying to you (such as work or houseclean-ing) may feel unfulfi lling to others Examine your own values and emo-tions while in those roles What do you enjoy about them, and what do you dislike? Are there responsibilities that you could eliminate, that give you too little pleasure? Are there ways to make them more pleasurable? Are there roles that you enjoy and would like to expand? Much of our lives is spent fulfi lling functions that we never question One of the best ways to decrease stress is to question assumptions that you have made about your day-to-day activities Examine everything you do, take a step back, and begin to look for ways to increase your happiness and pleasure

IF YOU’RE NOT BUSY LIVING, YOU’RE BUSY WORKING

There are some pressures that may be daunting to you to change, such

as work environment or overload Back in 1976, psychologists strated that if you stress lab rats by pinching their tails repeatedly for weeks on end, they will become severely overweight, much more than those rats that weren’t stressed 5 Do you come home from work feeling like the equivalent of that pinched rat? Americans are the most over-worked, and therefore overstressed, people on the planet It’s no sur-prise that they are also the fattest

Some people’s idea of work stress is diff erent from others’ I’ll never get the attendant who ran the canoe rental at my favorite remote vaca-tion site She sat under a palm tree and read novels in between handling her three or four customers a day Last time I saw her, she was com-plaining about how she couldn’t wait to go on vacation I wonder where she goes to relax: Manhattan’s Friday afternoon rush hour?

Take stock of what isn’t joyous and humorous, and approach sonable ways to fi x the pressures Note that if you constantly worry about your weight, you can take the issue so seriously you stress your-self into weight gain Conversely, many people who are chronic dieters report that they feel exhilaration when they start a new diet The excite-ment of a new diet likely comes from the enjoyment of envisioning your

rea-new body, your rea-new energy level, and perhaps all the other things you think a slimmer body will bring to you (perhaps an improved social life) Unfortunately, traditional dieting is all about deprivation and discom-fort Abandon that mindset But if you are the type that has gotten some enjoyment at the beginning of a new diet because you are envisioning what a thinner, healthier you will do, maintain that vision, but without all the pain

While you are examining what brings you more joy and less stress, think about things like walking, biking, singing, dancing, meditating, music, and sounds of the beach or the woods I’m always surprised how few people I see outside enjoying nature and using their muscles Exer-cise is an antidepressant and works as well or better than medications,

so not only will it help you to lose weight, it will also relieve stress and improve mood

HAVE A FOOD FIGHT, BUT STOP FIGHTING YOUR FOOD

Traditional dieting doesn’t allow eating to be pleasurable because it comes with a deprivation mindset But eating the healthiest foods for the body isn’t restrictive and is always sensual (That subject is covered

in detail later in the book.) Make a point to have fun around meals, with lots of laughter One of my favorite memories from middle school was the day the cafeteria erupted into a food fi ght, I remember laughing so hard I almost split my seams (Yes, I am giving you permission to have

a food fi ght, but, no, I am not coming over to your house to clean up.)

What’s wrong with playing with your food? Try doing this with a straight face: put black olives on all your fi ngers, then eat the rest of your meal You’ll be laughing so hard, you might forget to clean your plate

Eating for pleasure can come from the company you keep at your meals or the silence and quietness of the moment In Chapter 9 we talk about increasing the enjoyment of savoring what you are eating with the art of meditation

MY BOSS IS HAVING A NEAR-HUMAN EXPERIENCE

I am good friends with a lot of nurses Nurses are some of the most stressed-out people on earth because of all the problems in health care

It seems that no matter how hard they work, someone above them is saying that it isn’t good enough As a physician, I observe the coping

mechanisms of great, loving, smart people under tremendous pressure What I’ve discovered is a very high rate of lousy coping mechanisms, including smoking, eating, and drinking to excess These are very de-voted people, putting everybody else’s needs ahead of their own Does this sound like someone you know? If you are the caring, compassion-ate, put-everybody-else-fi rst kind of person, perhaps you are using self-destructive coping mechanisms to deal with the stresses in your own life Just remember, you are no good to those you love and care for if you are running down a self-destructive path

It’s time to put your needs fi rst, even if others aren’t used to it You have the right and the responsibility to take care of your health fi rst Think about the instructions you are given when oxygen masks drop

on an airplane You are told by the fl ight attendant to put your mask

on before helping others Treat all aspects of your health that way The stronger you are physically and emotionally, the better you are for those you love

There is so much aggravation built into health care I was scheduled to see my eye doctor for a checkup Before the appointment, his offi ce sent

me a list of things to bring with me that day You know you are going

to be in the waiting room a long time when they tell you to bring your lunch, a sweater, a book, and a tent

You have coping mechanisms for each major person in your life and each part of your life But are they successful, positive coping mecha-nisms, or are they self-defeating? Do they reduce stress in the long run

or add to it? If you take a drink when you get home from work and then a couple more before you can face the kids or the spouse and make dinner, is that the best way to treat your body and your mind? What would benefi t you both physically and spiritually and be better for you and your family? How about stopping for yoga class on the way home, walking in the park on the good weather days, meditating for 15 min-utes in pure silence before the gang gets home, or dropping that extra project at work that’s been causing you all those extra hours? Perhaps your best coping mechanism could be setting limits for the superwoman

or superman inside of you and refusing to push yourself harder or fusing to let others push you into responsibilities that you don’t want

re-or need

HEY, DID THE BED GET SMALLER?

Once you’ve targeted self-defeating coping mechanisms, you must place what you don’t want with something that is uplifting If you only vow to stop doing the destructive habit, you will not succeed You must

re-fi nd something that is extremely pleasant to do instead When one of

my overweight friends whom I coached fi nally admitted that she and her husband were drinking too much every night after work, she wasn’t able to eliminate the habit until they came up with other fun activities to substitute for their nightcaps (hint: let’s just say it involved more calo-rie expenditure) She and her husband have both lost substantial weight from just that simple substitute in behaviors

WHAT’S IT GOING TO BE LIKE WHEN THESE WERE

THE GOOD OLD DAYS?

Think of a list of easy, stress relieving good-for-you activities These can be as simple as taking a walk, getting into nature, listening to calm-ing music, or having game night with the family They might include reading a joke book, calling a supportive family member, or sharing time with friends These do not need to be time-demanding activities but should be included every day in your schedule Add more active things

to do, not because you have to but because you want to

Try to laugh, joke, sing, dance, or fi nd pleasurable activities for at least an hour a day Keep it positive and mentally and physically ac-tive If you are doing something more passive, like television or movies, choose uplifting and humorous or silly topics Avoid the depressing—search out comedy, joy, giggling, friends, and spontaneity

When picking good-for-you music, be selective I was a child in the 1960s Everybody always thinks the 60s was about people doing drugs and that the music was a consequence of that There’s this idea that Jimi Hendrix and “Puff the Magic Dragon” came out of heavy inappropriate drug use In reality, what people don’t realize is that it was the other way around Folks did the drugs because the music was so bad If you don’t believe me, we could test this Take a bunch of laboratory scien-tists and expose them to 60s music for 18 hours straight and see if they don’t start drinking hydrochloric acid right from the beakers

I’m a big believer in a daily regimen of at least 15 minutes of what I call “nonactive moments.” Perhaps this could be prayer, meditation, or something that you would otherwise feel is indulgent time For me, it’s time at the beach just watching the waves Increase your “me” time away from energy- and mood-sucking activities Practice a habit of quiet mo-ments, whether it is sitting on your porch and listening to the birds sing before you begin your day, or listening to some calming music while sit-ting in a dimmed room, or soaking in a warm bath before bed This sim-ple daily activity will not only lower your blood pressure; it will lower your stress level and improve your coping skills Defend that time daily, and don’t let anyone, particularly yourself, steal it away from you The way that you cope with life is critical to your weight Back in

1990, the University of California and Kaiser Permanente showed that obese women who confronted problems directly were much more likely

to lose weight and keep it off permanently 6 Ninety percent of the merly obese women who successfully lost the weight used that coping mechanism, whereas only 10 percent of those who gained the weight

for-back did so! That’s a remarkable statistic In fact, if you take away

noth-ing else from this chapter, understand that the way you choose to cope with life’s challenges will determine your weight This fact is more important than what you eat or how you exercise

A brand-new speech therapist was working on cognitive tasks with a tient of mine to determine whether the patient had good coping skills The dear old lady had macular degeneration in one eye and glaucoma

pa-in the other The therapist quizzed her with a theoretical scenario to

fi nd out how well she could problem solve She said to the patient, “You drive your car to Wal-Mart and get out, realizing that you’ve just locked your keys in your car What would you do?” The patient responded, “I’d say, thank God I’m blind and I shouldn’t be driving.”

SHE WAS SO MATERIALISTIC, SHE WENT OFF

THE SHALLOW END

Another way to decrease negative emotions is to give up materialistic titudes The pressure to acquire the trappings of status tends to increase stress Besides, more things cause more aggravation, more bills, more

at-fi ghts, and more work Ask yourself, “What can I give up that might be

stressing me and making my life less fun? ” Then start searching for nonmaterialistic friends and have heart-to-heart talks with your family about what your real monetary goals need to be Consider moving to a less fancy neighborhood if you have the opportunity to move Even if you can aff ord the luxuries and a high-end neighborhood, what unwrit-ten messages are being transmitted to you and your family? Find places that “fi t” your personality; whether they fi t your fi scal abilities should be secondary I truly believe that materialism is rotting the American soul and leads to a great deal of unnecessary stress, anxiety, and depression

THE BEST THINGS IN LIFE ARE FREE—OR

AT LEAST LESS THAN $1.99

You’ll notice throughout the book that I emphasize frugal ways to complish weight-loss goals That is a refl ection of my personality It

ac-is unnecessary to spend large quantities of money to be healthy The most precious gift that you can give yourself, the gift of excellent health, should not be expensive

And there’s nothing wrong with a modest lifestyle, most of the time I read about a famous director who named all three of his kids after the locations where they were conceived I think one was named Houston and another, something like London Obviously, he traveled a lot I wanted to do that with my own kid, but Motel-6 Rotenberg just didn’t have the right ring to it

Another way to decrease negative emotions is to encourage your own positive health behaviors with what I term “benefi cial self-reward.” There is a diff erence between materialism and self-reward When you pamper and love yourself with positive behaviors, it is not decadent

or hedonistic During your weight-loss journey, when things are going right, like you slip into those jeans that haven’t fi t since forever, it’s time for self-reward No, I’m not talking about the trip to Dunkin’ Donuts But I am talking about the 30-minute bubble bath, the drive to the lake

to go fi shing, or the afternoon off to be utterly indulgent with your time Ask your partner for a luxurious massage, or drive an extra couple miles

to that really nice park for a walk or bike ride under the trees Better yet, plan to meet a friend there to join you These types of rewards are best

when they don’t involve excess calories or monetary expenditures Find behaviors that are truly rewarding and that will not result in additional stress on your waistline or your wallet

WHEN OUT IN THE COLD, LET YOUR NUCLEAR

FAMILY GENERATE HEAT

Remember that University of California study that I mentioned earlier about those study subjects who lost weight permanently versus those who gained it back? The women who permanently lost the weight were much more likely to lean on social support than those who gained it back 7

Find connectedness with people who are helpful to you and give you proper encouragement At the same time, move emotionally away from those who generate negativity Search out a positive community to sur-round yourself with, and constantly gauge if this community continues

to be positive and inspire you Avoid those who give unwelcome advice and criticism Find people who will listen in a nonjudgmental manner, and use a support group if you fi nd it helpful

Not everyone in your social circle will support your endeavor as you think they should Sometimes family members get comfortable with

a certain familiar lifestyle or partner, and they may be threatened by your attempts to change your habits Friends can quickly become jeal-ous They may be intentionally or accidentally undermining your suc-cess Sometimes it’s just a lack of education and understanding (such

as a well-meaning but misguided “Let’s go out for ice cream to brate the 10 pounds you just lost.”) Often the family member or life-long friend may have the same old self-defeating habits that you are trying to change You may need to do gentle re-education with them

cele-to encourage behaviors that are useful cele-to you Don’t get defensive if they are being well-meaning but stupid However, if repeated education

on your part doesn’t change their behavior, you need to fi nd someone else (or just rely on yourself) to continue your progress You can even look online for support groups that will help you feel less alone in your journey

Under the category of “people with good intentions doing stupid things” would have to be the people who planned the annual fundraiser at our local zoo It was a big evening barbecue They called it the Zoo-b-q

Approach social occasions (especially with food) with a positive, ful approach and concentrate on receiving pleasure from your dining companions Enjoy the small moments of life Take the time to notice not just the smell of the fl owers but the smile of a co-worker, the hug of

joy-a child or lover, the sound of new music Concentrjoy-ate more on enjoying these little pleasures, working them into a part of your daily life

Find new ways to recommit to your lover or spouse Be there more fully in your attention, and truly listen Be creative in your signs of af-fection, and act like you did when you were fi rst dating Be on your best behavior, and don’t expect anything back (but don’t be surprised if your new activities get a very positive response) Spend more time really lis-tening to your signifi cant other and your family members; take special time out for a friend that you haven’t made enough time for

A MIND IS LIKE A PARACHUTE IT WORKS BEST

WHEN OPEN—OR WHEN FALLING FROM A PLANE

Don’t hesitate to ask yourself daily, “What is my passion? What is my purpose, and what gives meaning to my life? ” Answer carefully, always keeping an open mind A happy life is driven by meaning and purpose The best, easiest stress-reducing activity that also lowers blood pres-sure and improves daily coping skills is physical touch This includes hugs and cuddling A fun little study done by the University of North Carolina and the University of Pittsburgh showed that women who hugged and touched their partners most frequently had the lowest blood pressures and the highest oxytocin levels 8 The hormone oxytocin

is thought to be involved in trust, relationships, sexuality, bonding, and maternal behaviors It is believed to decrease anxiety There has been research to demonstrate the health benefi ts from physical contact and the need to hug and touch others, from the time we are born until the time we are aged and dying Yet our modern world scorns physicality, leaving it for only a bedroom activity or the interaction between parent and child Adults have inadvertently sexualized touching and hugging, even when it is meant platonically Unfortunately, because of abuses by

They should have called it the “Let’s Celebrate Animals by Eating Them Night.” I’m glad Habitat for Humanity isn’t doing anything similar:

“This weekend, we’re having our annual cannibalism social!”

the perverted few, the rest of us are forced to abandon physical signs of appreciation with most of the people we interact with on a daily basis

In the proper and acceptable setting, put physical touch back on your

“to do” list

As a physician, I sit at the bedside and touch my patients on the arm

or hold their hand just to connect with them and make certain they derstand that I care (With the use of high-tech equipment, doctors have almost eliminated the need to touch patients Some of us have gotten lazy and have forgotten that medicine is still as much an art as a sci-ence.) Healing touch does matter I do hug my patients and their fami-lies often, and they appreciate and ask for it

There is one precaution I have about doctors touching patients It seems some don’t bother to wash up between patients, transmitting diseases I wipe my stethoscope between each patient I examine What’s amazing

is that most doctors don’t In fact, a study was done a few years ago that found that the typical physician cleans his stethoscope once a month, say about every 300–400 patients So why does he bother to wash his hands? Next time a physician comes at you with a stethoscope, remem-ber to yell, “Have you washed that? Where’s that thing been?” Just make sure you are pointing at his stethoscope and not any lower

My husband off ered to get me a pet; he wanted to know which animal I liked I suggested an elephant That way there would be more than one gray and wrinkled creature around the house

If you truly fi nd that you cannot increase your hug factor with family

or other situations, then by all means get yourself a huggable pet from the animal shelter Do a good deed and save an animal from destruc-tion, and watch that animal save you, as well

Overweight people feel less huggable because of the stigma society attaches to fatness Heavy people feel less desirable and less accept-able to others, resulting in less physical interactions, both sexually and

nonsexually If you believe that this may be a problem for you, ing the issue is not going to help Talk about this with your signifi cant other or make honest, frequent attempts to correct your unwanted habit with others Often we are our own worst enemy and undermine our own mental health Everyone needs to feel wanted and loved, and physical touch is one of the most immediate ways to express this

I’M FOUNDER OF THE ORGANIZATION DOCTORS

WHY DON’T WE DO FUN RAISERS?

When we are concentrating on the needs of others, we are less full of ourselves and our own problems Then our personal fulfi llment soars I believe that’s why there are so many problems with wealthy celebrities, particularly the young, hedonistic types They haven’t learned that the more you try to feed your own emotional needs (particularly with ma-terialistic objects), the hungrier you become Self-obsession, hedonism, and materialism inevitably lead to self-loathing This often results in de-pression, anxiety, and, for many, addictions to food and other things When you are tending to the needs of the less fortunate, you have the opportunity to build empathy There is a strong relationship between empathy and one’s level of happiness When you feel for others, your own positivity rises

Lessen negative emotions with gratefulness, including gratitude for food Whether you use words prior to eating, such as saying grace, or just pause in the realization that you are lucky to have food, this act brings joy We are blessed to live in a land of plenty, but don’t forget the hundreds of millions who don’t Gratitude should become a practice for you, if it isn’t now, for the health that you do have and for the abil-ity to make it even better In my family, we practice a ritual of gratitude

by getting together weekly and reciting the special things that we are grateful for at that moment, including our freedoms, our friends, and our community

REMEMBER, THE FAMILY THAT LAUGHS TOGETHER

IS LESS LIKELY TO KILL EACH OTHER

When stressed and overwhelmed by work, family, or life, remind self of the big picture Keep proper perspective on the small stuff and the little bumps in the road that we too easily enlarge A sense of humor

your-is especially important here People who are able to laugh at the smaller annoyances of life cope better in general

In terms of my own family life, I have to admit that I’m not your cal mom I’ve never been someone who fi ts neatly into the traditional mothering role So when my son was younger, I used to teach him nurs-ery rhymes that were a little diff erent, imbued with my own odd sense

typi-of humor For example, “The queen typi-of hearts made some tarts She ate them all and got the farts!” Which was great fun, that is, until the pre-school principal called me And then I had to pretend I’d never heard that rhyme before

I believe in what I call the “art of contentment.” Much of daily stress

is self-induced by dissatisfaction with ourselves or others Expect less, look at the positive side of life, and don’t be so hard on other people and yourself But, at the same time, work toward steady improvement You don’t need to be a perfectionist, but also don’t settle for mediocrity

NEWSPAPER HEADLINE: MODERATES DEMAND

TO BE HEARD, AT LEAST A LITTLE BIT

Eliminate negative thinking Be constantly aware of how your tion is framed, in positive approaches or with a sarcastic, negative, pessimistic, undertone Optimistic, positive thinking attracts success

cogni-in all areas of life Our society tends to focus on the negative, cynical, and sarcastic Note that the news emphasizes the violent, the angry, the ugly, and the unusual—that’s what makes it news Learn to tune out that emphasis, and embrace the beautiful, the compassionate, and

the positive Guard your brain from assaults by those who dwell on the darker, pessimistic side of life, and guard your own emotions to keep from dwelling on this Being positive-minded in your thinking is not improper or unrealistic any more than dwelling on the negative, the violent, and the miserable is proper (even if it has become “nor-mal” in our society)

THAT NEW TRAVEL AGENCY NAMED

“JUST DON’T GO THERE”

Concentrate on losing weight for the joy of feeling and looking better, rather than because of the fear of illness or the fear of being lonely Toss guilt, fear, and shame (the three most common emotions in diet-ing) out the window, and embrace joy, compassion, and contentment

as part of your new attitude about weight loss Learn to accept and like yourself as you are right now Understand that you are not perfect and are a “work in progress.” We all are Do not become defeated by lapses in judgment while you are on your weight-loss journey Don’t

go there If you learn to like yourself right now, even with tions, this will lead to greater happiness and better follow-through with weight-loss behaviors

Eliminate self-criticism Overweight people contribute to their tive emotions by being very harsh on themselves In the business world,

nega-it has been demonstrated that an uplifting management style is a much more eff ective way to change behavior permanently than a negative one Concentrate on positive feedback when things are going right, and leave it at that

Successful permanent weight loss occurs through laughter and ness Develop joy through positive physical and social activity Happy people are busy, unself-conscious, productive, fulfi lled, and realistic in setting goals Accept mistakes Forge close, loving relationships, and focus on the positive Then watch how easy it is to slim down forever

WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

• You will lose weight permanently with happiness and laughter

• Stress, negative emotions, and mistaken thinking are leading causes

of obesity

• Concentrate on mental and physical health, and the weight loss will follow

• The fatter you are, the more likely that you are depressed

• To get thin, believe that eating is pleasurable and exercise is rating

• There are several keys to happiness, and they impact weight loss

• To decrease stress and anxiety, eliminate unfulfi lling work and boredom

• Increase pleasure with music, dance, fi tness, and nature

• You are no good to those you love if you use self-destructive coping mechanisms

• Search out comedy, joy, giggling, friends, and spontaneity

• Use daily nonactive moments away from energy and mood-sucking activities

• The way you choose to cope with life’s challenges will determine your weight

• Decrease negative emotions by giving up materialistic attitudes

• Encourage your own positive health behaviors with benefi cial reward

• Those who lose weight permanently lean on good social support

• The easiest stress-reducing activity: hugs, touches, and cuddling

• Give more of yourself to others, and practice gratefulness

• Be positive-minded in your thinking; guard against pessimists and self-criticism

TWO

I’m Allergic to Food, It Makes

Me Swell: Thought and

Mind for Success

I’m a big believer in integrating delight, fun, and happiness into day life We humans underutilize our natural abilities to enjoy life I bragged to my husband one day, “I have an organ whose only purpose

every-is pleasure and you don’t.”

He retorted, “True, but at least I have two organs for thought.”

This book is about lifestyle change; it’s not about a “diet.” Good food choices and increased activity feel positive and are not restrictive When you follow the ideas of the book, you will say to yourself about your new habits, “I choose this lifestyle because of the wonderful way it makes me feel.” There is no guilt, nor are there any absolute restrictions or com-mands You will behave in a certain way because you are positively mo-tivated to do so Nobody will watch over you, because you will learn to motivate yourself That’s how permanent weight loss is achieved As a physician, I see myself as an advocate for my patients I don’t command

or even cajole; I only advise In this book, I can give you advice, but the ultimate responsibility for your health and habit choices is your own Once you make positive new habits your own, you will achieve a new level of health, happiness, and easy weight loss that is truly enjoyable, for a lifetime

A BALANCED DIET IS NOT SNACK CRACKERS IN ONE

HAND AND AN ORANGE SODA IN THE OTHER

I work with a nurse who is a 40-year-old single mom of two teenage boys Her kids are the center of her universe, and she proudly recites their latest perfect report cards and amazing athletic achievements every chance she gets She has more energy than anyone I know In fact, re-cently I asked her, “Linda, are you taking anything that makes you hyper?” She shook her head, laughed, and replied that people ask her that all the time “I’m high on life!” she exclaimed Then she showed me

a photo of herself from fi ve years ago I didn’t recognize the person in that picture That woman was 80 pounds heavier and looked absolutely miserable

Linda told me about how, when she was fat, her mom used to call her lazy because she had so little energy Finally, her sluggishness got to her, and she was determined to be a healthier person and a better role model for her sons She walks every day, drinks green tea, limits her sweets, and eats a balanced diet Now, she has boundless energy and an amazing positive attitude about life What an inspiration she is to her two boys, teaching them that they can reach any goal with patience, optimism, and perseverance She’s so happy and healthy, why wouldn’t she want to feel like this the rest of her life?

Linda is African American When she was 80 pounds overweight, not only did her obesity put her at risk for heart disease, but her misery and sluggishness put her at risk for a stroke Yes, the Centers for Disease Con-trol published a study in 2000 showing that depression is an independent risk factor for strokes, and that risk is signifi cantly higher in blacks than whites 1 Linda’s lifestyle changes are self-propagating She feels better mentally and physically, and she carries that old photo of her miserable former self to remind her of how far she has come

LIFE’S A JOURNEY, NOT A RACE

Weight loss and maintenance are lifestyle management issues You aren’t going to keep the weight off if you don’t practice a lifestyle that includes healthy eating and activity, as well as stress reduction Attitude adjust-ment is crucial for permanent weight loss Those who are still thinking

in the back of their minds, “When I get to my goal weight, I can go back

to my old eating and exercise behaviors” won’t succeed Don’t even try the ideas in this book if that’s your mindset You have to accept that this

new pattern of eating, exercising, and living is just the way it is, forever,

and it’s going to be terrifi c for you

Daily exercise works because it decreases stress, anxiety, and sion People who exercise as part of a weight-loss plan feel better physi-cally and mentally and are more likely to reach their goals And, since the goal should be to enjoy the journey as much as the destination, I can’t emphasize this habit enough

People say to me, “I wish I were thinner, but I don’t have time to

ex-ercise and eat right, even though I know I should.” Do you like feeling

tired and stressed and fat and out of shape? If not, then you have time to exercise and eat better because, in the long run, you haven’t much time for anything else

Exercise would be much more acceptable to the masses if we saw more regular people exercising on television, not just the elite athletes In fact, the Olympics ought to go back to being just amateurs only And let’s make it so all the contestants have to be naked because that’s the way it was originally Think of what that would do for the TV ratings!

Of course, then the Olympic rings wouldn’t be the only things locking

Throughout the book I avoid using the word “diet” as much as

possi-ble because that word implies short-term and restrictive behavior When talking about intake of calories, I prefer to use the term “food choices.” This implies active, positive, lifelong behavior

The truth is, most traditional diets do work for weight loss, but only for a little while And none has been proven to be superior to the others That’s because they all do basically the same thing; all diets make us think about what we stick in our mouths

But traditional diets fail eventually because we stop thinking about what we put in our mouths The only way to modify the input perma-nently is to ingrain the new eating habits But the bigger reason that tradi-tional diets fail is that we hate restrictions and commands When a human feels forced to do a behavior but doesn’t learn to enjoy it, eventually the behavior stops