In This Chapter
Focusing on the types of support you need to succeed
Developing skills for day-to-day eating and living
Monitoring progress with a reliable team of experts
“No man (or woman) is an island; entire of itself.”
—John Donne, poet
You are not alone in your journey toward total body wellness. Dialing into your health needs involves embracing the value of a support system around you. Whether you’re carving out new lifestyle changes or reinforcing healthy lifestyle changes that you’ve made already, developing a supportive environment goes a long way. You may look at people who have been successful with weight loss or maintenance and wonder, how do they do it? Many times there’s a lot of behind-the-scenes work, such as social and online support, professional guidance, and group meetings.
According to the American Psychological Association, sticking with a weight loss plan is easier when you have support, share tips on diet and exercise, and have an exercise buddy. A study in the International Journal of Behavioral Medicine, which looked at the factors to weight loss maintenance after a two-year weight loss diet program among 12 women (54 to 71 years old), revealed through interviews with the participants that clear personal goals and support from family and friends seem to be of major importance for long-term maintenance of new dietary habits. Relationships inside the home as spouse support, according to this research, was a big factor in maintaining weight loss goals.
In this chapter, I take a deep dive into the numerous ways to access support for your total body wellness goals.
These support techniques and tools can be used together or separately. There are no right or wrong ways to go. Support systems are dynamic players in your continual journey toward total body health and wellness. Experimenting with what works for you is the best bet. You may find group support beneficial at one point, but then turn to one-on-one counseling as your go-to method of support. Do what works for you — and if one method is not working, try another.
Understanding the Importance of a Support Team
Your need for support is unique to you. Before you leap into assembling a team, consider some ways that support teams — which can include many different people like family, friends, co-workers, as well as healthcare professionals — can benefit you. Support teams can
· Offer guidance and new resources, tips, and tools
· Be a sounding board to overcome obstacles and setbacks
· Point out areas of progress (because it’s sometimes hard to see it yourself!)
· Create new connections for you by providing a new community
· Foster growth and confidence (as you push past your comfort zone)
· Help you to create realistic expectations for growth and change
· Motivate you when boredom or fatigue sets in
Now that you know what a support team can do for you. Let’s look at ways to find one that fits with your personality and lifestyle needs.
Assembling a good healthcare team
Part of your support group can begin with your healthcare team, which can start as one healthcare professional. For example, your initial support can begin with a registered dietitian nutritionist (RDN) who can offer you support with making healthful food choices and meal planning. The RDN can then make referrals to other appropriate professionals as needed, such as:
· Physician/physician’s assistant: Can offer medical support and answer questions based on overall health and disease prevention and management
· Nurse/nurse practitioner: Can offer medical support and guidance for disease prevention and management
· Psychologist/counselor: Can offer psychological support through therapy, which includes skill building, goal setting, and work to do at home
· Personal trainer/exercise physiologist: Can offer exercise support with individualized physical activities that can fit into your lifestyle and assist with disease management and prevention
What to look for in a nutrition expert
A registered dietitian (RD) is a nutritionist, but a nutritionist is not necessarily a registered dietitian. When looking for a food and nutrition expert, look for the letters RD or RDN after the person’s name. When you see those letter, you have the added assurance that the person has
· Received nutrition education and training from an accredited dietetics program and passed a competitive registration exam. A bonus is that about half of the RDs and RDNs hold graduate degrees and many have certificates in specialized fields like weight management, sports, culinary, pediatric, renal, oncology, or gerontological nutrition.
· Completed a dietetics internship. An internship is 900 hours of supervised practice in multiple areas of the nutrition field, including a healthcare facility, foodservice operation, and community agency.
· Continued to foster learning through continuing professional education units (CPEUs). At least 75 CPEUs must be completed every five years to maintain the RD/RDN credential.
· Tailored individualized nutrition programs. These programs offer creative, out-of-the-box meal plans, grocery shopping, and culinary tips, as well as food journaling and mindful eating strategies.
When a variety of healthcare professionals work together offering their unique skills and expertise, that’s called an interdisciplinary team approach. If you’re working with more than one healthcare professional at a time, there should be open communication among all of you. Each of the healthcare providers should feel free to call, email, or meet with the others to discuss your work together. This establishes continuity of care and keeps everyone on the same page!
Part of finding the right healthcare team is knowing what the best fit is for you. Support teams come in many different packages and all these professionals may not be necessary. It’s good to know what types of professionals are available, but don’t forget that family and friends can offer vital support, too!
Shopping around
Every healthcare professional comes at their work in a unique way and you want to be sure that it’s in agreement with your philosophy from the beginning. Finding a healthcare professional is a bit like dating — not everyone is right for you!
Here are some questions to ask during your initial meeting with your healthcare provider:
· How often do you want to follow up with me?
· Can I ask you questions via email as they come up, or would you prefer I save them for face-to-face visits?
· How many sessions do you require with a typical patient?
· How do you assess progress in your patients?
· Do you accept insurance for services? Under the Affordable Care Act, certain preventive services are covered, such as diet counseling for those at high risk for chronic diseases. For a complete list, visit www.healthcare.gov/preventive-care-benefits.
· What is your cancellation policy? There is typically a fee for service if someone cancels within 24 hours.
· Will we set goals together at every session?
· Do you allow your patients to take the lead or do you prefer to?
How do you even know where to begin to find healthcare professionals to comprise your Total Body Diet team? There are a number of ways to go about shopping around for a support team. Here are some options:
· Ask your current healthcare provider for recommendations. Whether you’re asking your doctor for a referral to a clinical psychologist or an RDN, use your current healthcare provider as a multidisciplinary springboard. Primary care doctors are a great resource because they have access to a plethora of providers locally and nationally.
· Inquire at your local hospital. Hospitals offer in-patient services, as well as outpatient services for people seeking assistance who do not need to be admitted to the hospital. Hospitals also have community relations specialists who organize a plethora of support programs to assist with all facets of healthcare needs and can link you up with departments and provider referrals.
· Contact your local chamber of commerce. They can assist you with finding local experts in your area. Many expert groups hold monthly roundtable discussion on various health topics for the public to attend. This is an easy and comfortable way to mix and mingle with more than one healthcare provider at a time and gain connections in your community.
· Ask your local grocery store if there’s a registered dietitian nutritionist (RDN) on staff. Many supermarkets employ RDNs as part of their team inside the store to point out better products to the customers, highlight recipe ideas, and offer one-on-one nutrition counseling to answer individual questions pertaining to food choices, meal planning, and overall health.
· Ask your friends and family for referrals. If you feel comfortable inquiring within the close network of people around you, that’s a viable way to find support and assistance. Plus, the people who know you best may be more apt to steer you toward someone who is well suited for you.
· Use an online referral service. A myriad of web pages are devoted to finding healthcare professionals from every discipline. For example, to locate a local RDN that specializes in what you need, go to the Find an Expert page at www.eatright.org. You simply search in your area and contact names will come up — it’s that simple.
Don’t get discouraged if right off the bat you aren’t in sync with your healthcare professional. It takes time to develop a working relationship based on mutual trust, respectful communication, and give and take. One or two meetings don’t make or break your success with your support team member. It’s important to give it a little time and learn to lean on your team before you begin.
Leaning on your team
When you get a couple healthcare members on your team, you can begin to build a relationship with them. Just as with any partnership, a healthy relationship is a priority to your happiness and success. At first, you may want to forge ahead on your own, but over time you may realize that learning to lean on a team of professionals, friends, and family members is a safety net that gives you the security that you can quickly recover from minor setbacks.
For a quick way to think about how to LEAN on your support team, think of it this way:
· Let someone know about your successes and setbacks this week.
· Evolve with gradual communication. A small interaction goes a long way.
· Actively seek out support and don’t wait for it to come to you.
· Navigate your own path to success by listening and taking recommendations at your discretion.
At first you may have a hard time trusting and revealing your daily doings about your eating and exercise to your support team, but over time you’ll see the value of asking for guidance and help if you feel like you aren’t on the right path. Remember: Support runs the gamut from a quick check-in email to a phone call to a face-to-face meeting. Whatever you see fit as support, that’s what will work for you.
Ask yourself some questions after your interactions with your support team:
· Do I feel encouraged?
· Are our interactions constructive and do they move me to make and maintain positive changes?
· Am I learning anything about myself?
· Do I want to meet or communicate more or less frequently?
· Are there ways that I can better utilize my support team?
If you aren’t happy with the support you’re receiving, there is nothing wrong with politely moving on to another provider. If the connection isn’t there, it’s not there. Here are some signs that it may be time to call it quits with a member of your support team:
· One-way communication: You don’t get return emails or phone calls in a timely manner.
· Brief interactions: The responses you get are short and don’t offer much information.
· Lack of enthusiasm: Meetings aren’t positive and encouraging.
· Chronic rescheduling: The team member makes frequent last-minute cancellations.
The Total Body Diet mentality is as much about what you eat and drink as it is about how you gain a sense of responsibility for taking charge of your health with your choices, actions, and the support you gain along the way. With small steps and the will to keep moving forward regardless of the obstacles, you’ll feel more fulfilled, moving through life with a sense of ownership toward your own health and happiness.
Looking at Your Support Options
Support comes in a variety of ways these days. You can find
· Solo support with one-on-one counseling
· Group meetings with interactive discussions
· Online support with food diaries and photos and professional feedback
There are pros and cons of each. There is no one-size-fits-all solution and you may find that what works at one point in your goal setting may not work at another. You can also do these methods together — attend group meetings, seek out one-on-one support, and track foods with a smartphone app at the same time. In this section, I fill you in on the pros and cons of each type of support system.
Support groups: Becoming a groupie
Since the beginning of time, men and women have met in support-type groups to discuss family news and the world around them. Dan Buettner, author and longevity expert, talks about the most primitive of support groups in his book, The Blue Zones: 9 Lessons for Living Longer. For example, Buettner found that the women of Okinawa who live to 100+ years old meet every day for tea time discussions about the news of the day and to support each other’s lives with laughter, love, and healthy gossip. They offer same gender support and Buettner counts this as longevity therapy for these centenarians. It’s the same with modern-day book groups, bible study groups, and sports enthusiast groups — they offer support for a common purpose.
For Total Body Diet enthusiasts, group support can have pluses and minuses. Here are some of the most common advantages of support groups:
· They generate creative eating solutions and recipe ideas.
· They offer meal-planning tips.
· They can help you brainstorm exercise strategies.
· They foster creativity and exchange of thoughts and ideas.
· They offer a sense of community.
Nothing is perfect, and support groups are no exception. Here are some drawbacks to meeting with support groups:
· You can be given inaccurate information and unhealthy dieting practices by group members.
· Dominant members can lead the group off track.
· One person’s negative thinking can spread through the whole group.
· Quieter participants may not feel comfortable revealing their thoughts.
· Personality conflicts can occur among group members.
· Meeting times may not be convenient.
A good facilitator can help keep the group heading in the right direction with all members keeping their individual goals in mind — without getting side-tracked and causing members to lose interest. The positive nature of the group should always be a priority.
Finding support online
People are more reliant on computers and computer technology than ever before. A review in the Journal of Diabetes Science and Technology showed that the use of tech tools can result in improved long-term weight management and cost-effectiveness by allowing
· Treatment recommendations to be delivered to individuals remotely
· More opportunities for self-monitoring and tracking health-related data
· Widespread and speedy dissemination of health information and recommendations
· Increased patient-dietitian/physician contact
A more recent review in the American Heart Association’s journal, Circulation, examined mobile health technologies in the prevention of cardiovascular disease. It revealed that although more research is needed in determining how mobile devices can aid in creating lasting lifestyle changes, there’s big potential in this arena. Mobile health technologies are seen as an important adjunct to face-to-face appointments and counseling because information can be shared more rapidly and target individual behavior change. In addition, mobile health allows patients to record blood pressure and blood sugar readings in their natural settings, which can contribute to greater accuracy. Therefore, researchers encourage the use of new technologies in conjunction with traditional healthcare to generate more evidence of its effectiveness over the long haul.
All you have to do is sit down at your computer or with your smartphone, and you have access to a support system. With an estimated 63 percent of Americans having access to the Internet by way of a smartphone, according to a recent research by Pew Internet, web-based applications for delivery via mobile devices are at the forefront of many health conditions, including diabetes, overweight/obesity, mental health, tobacco use, and many others. Now you can track your food and beverage intake very easily with a variety of online apps and websites, such as www.supertracker.usda.gov.
Many people like the convenience and comfort of support online, whether with groups or individual one-on-one counseling. With numerous programs available — from apps to websites to chat rooms devoted to health and wellness — this is a viable option for a broad spectrum of age groups and health needs. In fact, researchers are suggesting that that next era of weight management will design virtual clinics, in which data will be transmitted from individuals remotely in their home to the healthcare team.
Using apps to track dietary intake instead of using traditional pen and paper, people lost significantly more weight, according to a pilot randomized control trial in the Journal of Medical Internet Research. For more about online tools and apps, check out Chapter 16.
Some of the benefits of support online include the following:
· It saves time with no travel.
· It’s less expensive than traditional methods.
· You can participate from anywhere.
· It may not be as intimidating as face-to-face meetings.
· You can track your own dietary intake and physical activity.
On the other hand, support online can have drawbacks, such as the following:
· You need a smartphone or computer with Internet access.
· Technology can be intimidating, if you don’t know how to use it.
· Support isn’t as intimate when you’re in front of a screen instead of face to face.
· You may not be as invested emotionally without interacting with other people in person.
· It’s easy to get sidetracked and miss online meetings.
· User burnout causes dropout.
Whether used alone or as support to a more intensive intervention, web-based apps and tracking tools have shown to be successful. They have universal applications because they can be isolated to an individual, encourage family participation, or be connected to a larger social network.
According to Circulation, for weight management there are a number of mobile methods, such as texting, smartphone apps, handheld personal digital assistants (PDAs), interactive voice response (IVR) systems, and e-scales and wireless physical activity monitoring devices (like the FitBit and JawBone). The evidence shows the greatest weight loss success is achieved with comprehensive, multicomponent programs that are personally tailored, promote regular self-monitoring, and involve a qualified professional to provide the intervention. In other words, web-based care should be integrated into traditional care plans to increase treatment effectiveness (weight loss and permanent lifestyle changes).
One-on-one counseling
The most intimate of all the support methods, one-on-one counseling allows for an exchange of ideas, thoughts, and feelings. With personalized recommendations, this form of support allows for interpersonal communication between you and your healthcare provider. There may even be a contractual agreement, whether written or spoken, that sets the goals of the working relationship. The contract cements the expectations for the meetings, creating an ongoing set of boundaries.
Some of the benefits of one-on-one counseling can be the following:
· There’s a greater sense of accountability when meeting face to face.
· It’s more intimate than meeting online or in a group.
· You’re obligated to make appointments and come prepared, which holds you accountable.
· You get concrete recommendations within the meeting time frame.
As with other support methods, one-on-one counseling can have pitfalls, such as the following:
· Failing to follow up will not get you the desired results. You won’t get all the answers to your questions and concerns at one visit. Progress is best tracked when working with someone over a period of time.
· It may take longer to get follow-up appointments (depending on how busy the provider is).
· You may be uncomfortable revealing important pieces of information when face to face.
Tackling Behavior Change Head On
Although behavior change is essential, it can be challenging. Many behaviors become habits (recurrent patterns of behavior acquired through frequent repetition). When you do things on autopilot, like brushing your teeth, tying your shoes, and eating breakfast in the morning, these are habits. The science of habits shows that these repeated behaviors forge strong neural pathways in our brains that can be difficult to change. If you need to break a habit because it’s not good for you, such as smoking, excessive drinking, or overeating, it’s possible — it just takes time and patience to establish a new neural pathway.
You didn’t gain weight overnight. You aren’t going to lose it overnight either. It takes time and patience to allow changes to happen in your life.
Here are some of the challenges of behavior change, which may explain why change may be hard in your own life:
· Fear of the unknown: Stepping outside your comfort zone and delving into new behavioral territory is difficult. What’s out there waiting for you? It could be great things!
· Fear of lack of control: Letting go of control is hard because it allows for the unknown to happen, but that can be a positive thing in the long run.
· Fear of failure: What happens if you don’t succeed at your behavior change right away? You get back on the horse again and take it one day at a time. Before you know it, you’ll find success!
In Susan Jeffers’s book, Feel the Fear and Do It Anyway, she enlightens readers on using fear as motivator to drive you forward versus halting you in your tracks. Fear can be debilitating, but by recognizing it, feeling it, and pushing through it, you’ll get to the other side of it, which is a new you full of change and possibility.
Change is a constant, inevitable part of life, yet many people resist it. There’s no doubt that you have to be ready to change. If you aren’t ready and you’re resistant to change, it’s not the right time to make the change. Here are some signs that you may be resistant to change:
· You’re forgetful.
· You complain a lot.
· You’re always procrastinating.
· You’re disorganized.
· You make excuses for yourself.
· You sabotage yourself by missing scheduled therapy sessions or not doing your “homework” between sessions.
On the other hand, here are some indicators that you’re full steam ahead and ready to make changes:
· You’re optimistic.
· You’re determined.
· You have a strong support system in place.
· You have plans in place for avoiding setbacks.
· You’re willing to ask for help.
· You’ve set realistic, doable goals.
There so many ways to tackle changing behaviors. Keep in mind that simple, small changes lead to big results down the road. Change is a process that evolves over time. Over time, small changes add up!
Staying on track with behavior change is the key to success. Falling back into old familiar ways of eating with foods that aren’t as healthy or lifestyle habits like sitting on the couch and watching TV as soon as you get home from work can be easy. However, with a system in place to set new habits, you won’t relapse (go back to old habits).
Here are some things you can do to establish new habits, as well as prevent relapses:
· Keep a daily food and activity log. Include gold stars for progress!
· Call a friend or family member for support.
· Don’t let minor setbacks get you down. Think positively and forge ahead.
· Define a realistic goal. For example, “I’m going to take a brisk walk today.” (Start with a short distance and then increase that over time.)
· Plan for progress. Make a grocery list or plan to try a new recipe.
· Reward yourself with non-food rewards, such as a massage, facial, or new item of clothing.
Cognitive behavioral therapy to the rescue
You may find that your behaviors are so ingrained that it takes a little more assistance to help create new neural pathways or ways of thinking and acting. Cognitive behavioral therapy (CBT) is a type of treatment that looks at the relationship between thoughts, feelings, and behaviors. CBT allows you to work with a professional who is focused on the process of problem solving with goal-setting tools and strategies.
In CBT, goals are
· Specific: You define your goal in detail. For example, “I am not going to sit on the couch and watch TV at night; I am going to do an activity after work.”
· Measurable: You set the goal and are able to assess your progress. For example, “I am going to be active at least three times a week.”
· Achievable in a realistic time frame: You start by setting the goal for one week and then evaluate at the end of that week.
Another example entails a goal of not eating empty-calorie foods at night. CBT enables you to establish a plan to change what you do when you walk in the door from work and helps you create a list of nutrient-dense foods (instead of empty-calorie foods) to keep in the house. Again, it’s about equipping you with realistic, simple ways to attain your goals — and change detrimental, self-sabotaging thinking patterns and behaviors.
According to the Journal of Affective Disorders, the majority of online interventions are based on CBT because it has been found to be the most beneficial type of therapy (comprising learning-specific skills and techniques). At the heart of CBT is identifying your core beliefs (hidden inner thoughts about yourself) that may be stopping you from making healthy lifestyle changes. Core beliefs are complex — you have to look at the emotions that feed the belief. Here are some examples:
· Maybe you feel fear when you eat in public. If so, ask yourself what’s driving this fear. Do you not want people seeing what or how much you’re eating because you think you’re overweight?
· Maybe you’re angry if there’s nothing “healthy” on the menu when you dine out. What’s driving this anger? Is it because you feel like you can’t make menu substitutions or eat less of a high-calorie food?
· Maybe you feel guilty if you eat a piece of chocolate cake because it’s not allowed on your weight loss plan. Is this bad feeling about yourself coming from the fact that you feel like you may not be able to get back on track after eating this cake?
Think about it, how do your emotions define who you are — in your mind? Emotions are powerful windows to what you think and say about yourself.
Do your homework
CBT is all about you, and the work you do at home is important! Psychologists who specialize in CBT recommend a process called self-monitoring. It allows you to see what’s working and not working for you.
Looking at your behavior every day allows you to
· Anticipate, prevent, and react to potential lifestyle problems every day
· Track the relationship between eating and exercise patterns and weight
· Gain immediate accountability
· Get help with weight loss and maintenance
You can monitor yourself by jotting down your feelings in a notebook, on a smartphone, or on your computer.
Can you self-monitor right now? Think about what you’re eating or drinking, and how you feel about your choices. The more awareness you create around your behaviors, the more apt you’ll be to make changes and stick with them.
Being patient: Old habits die hard
It takes time to create new habits. Some research says to give it at least a month, if not more. Don’t lose hope — keep plugging away. By slowly making a change a day or even once a week, you’ll see that you’re reaching small milestones pretty quickly!
In her book Eat, Drink, and Be Mindful, Dr. Susan Albers advises readers to make small eating changes by mindfully adapting with an exercise that illustrates how little changes can lead to healthier choices down the road. To work your way gradually toward healthier, fewer highly processed foods in a step-by-step manner, Albers advises to gradually and mindfully make eating changes to adapt slowly over time.
For example, if you like salty chips, check out how much sodium is in your current chip choice. Find one with less sodium. After you get used to that one, try switching to one with even less sodium. As you slowly decrease the salt, your body and tastes will adapt and you’ll hardly notice it. Eventually, you’ll enjoy the taste of the less salty ones better!
Here are the steps to carving out a new habit:
1. Decide on a habit you want to change.
For example, maybe you want to drink an 8-ounce glass of water when you wake up in the morning to hydrate after your overnight slumber. To help reinforce this behavior change, keep a pitcher of water on the nightstand by your bed.
2. Repeat the new behavior over and over again.
Try for at least three to four weeks.
When the new pathway in your brain is set down and it becomes a habit, it will become second nature.
Old habit pathways in your brain never go away. That’s why old habits die hard! You always have to be vigilant to avoid the triggers of old habits (like eating ice cream in front of the TV at night or munching on chips while working on your computer).
What is your plan if you fall off track? Think about the Olympic figure skater who falls during a performance or the toddler learning how to walk. What do they have in common? They get back up again and forge ahead. Life is a series of stops and starts, ups and downs. It’s a matter of getting back up and not letting the downs keep you there.