Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
How you lose weight is how you are going to maintain your weight loss. And today that’s exactly what we’re talking about is what does weight maintenance look like? And before you sign off and say, I don’t care about this, maybe I haven’t started my weight loss journey or I’m in the middle of my weight loss journey, that is actually also the perfect time to be thinking about weight weight maintenance. I am Dr. Sarah Stombaugh, obesity medicine physician. And today we are going to talk about why weight loss attempts often fail and why people have weight regain over and over again. Why they have in the past set themselves up for yo-yo dieting. And this is how you are going to create a situation where you have long-term weight loss success. And the key to weight maintenance is that when you are losing weight, it needs to be done in a sustainable way.

When you hear people say things like, “I’m not on a diet, it is a lifestyle change.” That is I think maybe one of the ultimate cheesy things that someone can say, but when you are truly adopting that type of mindset, it makes all of the difference. How you lose weight is how you keep weight off. And when you have thought back to weight loss attempts that you’ve had in the past, and maybe attempt isn’t even the right word, weight loss successes, you’ve lost 50 pounds in the past, you’ve lost a hundred pounds in the past and then all the weight crept back on or maybe came back on really quite suddenly. It is often pretty obvious why that was the case. Very commonly we are engaged in these lifestyle modification programs that are very extreme diets. They are extreme exercise programs. All of the time I talk to people who say the only way that I’ve been able to lose weight in the past is when I’ve been in the gym seven days per week for on hour per day.
When I’ve been eating a 800 calorie diet or a 1200 calorie diet, feeling like I’m living in extreme restriction. People doing medically supervised weight loss programs where there are food supplements, for example, and they’re eating very low calorie diets, often on the order of five or 600 calories per day in the form of meal replacement or meal shakes and it works phenomenally. They lose significant amount of weight and then they finish the program and all of the weight comes back on. There is nothing more physiologically and honestly psychologically damaging than having those yo-yos because it just sets you up to feel like a failure. So in my weight loss program, what I am thinking about is not just how do we lose weight, but how do we help to keep that weight off in the long-term fashion? Now this is going to look like a lot of things, but most importantly, it is going to be understanding what your relationship with food is.
Now we’re thinking about all of the psychological support oftentimes alongside the support of medications, for example, like the GLPs, like Zepbound, like Wegovy, but it does not require that you do those things necessarily. And I want you to talk to your own physician about what makes sense for you, but let’s talk about some of that psychological relationship with food and how during your weight loss journey that you are going to be set up for a sustainable type of plan that you can continue for the rest of your life. Now, most importantly, there should be no foods that are off limits. The only reason that I think food should be off limits is if you are allergic to them or have some sort of intolerance to them. Obviously, these are situations where you are going to avoid that food for the rest of your life, but unless you’re planning on following a diet for the rest of your life, I want you to question what the role that diet is having in your life right now.

When foods or entire food groups are eliminated from our diet, if this is not done in a forever type of fashion, it can often create a significant rebound effect where we’ve restricted a food or a type of food. Oftentimes this is sugar or carbohydrates, for example. Someone says, “I’m eating low carb or I’m eating no sugar.” That might be fine and dandy. But if you find yourself in a situation then where you’re thinking about those foods and you’re craving your foods, what often happens is we set ourselves up for a binging and restricting cycle where we’ve restricted, restricted, restricted, we’re thinking about those foods, we’re craving those foods. And when we finally do have access to them, we eat them in a way that is really not in line with our goals at all, eating huge amounts of them, eating them rapidly. Honestly, a lot of times not even enjoying them, just eating them because we can, because we’re finally able to, it’s like this flood gate has let loose and we’re finally able to eat the food.

I do not want you to ever feel that way about your food and especially if you have a known history of eating disorder. I feel like sometimes I have an emotional relationship with my food. I eat for reasons beyond hunger. This is something I really want you to clue into. Now this weight loss needs to be done alongside the support of someone like myself, an obesity medicine physician who’s additionally trained in a psychology of eating and/or alongside a health psychologist who can help support you in this way. I think one of the things that’s really important to recognize is that the foods that we eat go so much more beyond just eating for pure physiological reasons. We eat for all sorts of reasons beyond hunger and that’s not necessarily a bad thing, but it’s really powerful to start to recognize when we are eating for reasons beyond physiological hunger.

One of the tools that I will encourage my patients to do during their weight loss journey, and this that can be something even done during weight maintenance, maybe it’s not at every single thing day, but something you can do from time to time is to log your food. I want you to log the food that you’re eating, what time of day you ate and what you ate. Now it doesn’t necessarily have to be calorie counting or weighing or macro counting or anything like that. It can be if you’re working with someone in a very specific setting to set those type of goals, but what’s much more powerful is to recognize the patterns that we have throughout the day. And in your food log, you can start to incorporate in some other data. You can add in things like a hunger and satiety scale. So am I hungry? Am I full? How did I feel at the beginning of a meal? How did I feel at the end of a meal? Anytime food is offered to me and I’m thinking about eating it, let me check in with my body and am I feeling hungry right now? Answering that question can be really helpful. You might also include information about any sort of stressors in your day, anything that was out of the ordinary. If you felt like you were emotionally eating, what was going on? Was there a particular emotion that was coming up? One of the things that’s really powerful is we start to recognize sometimes that we’re eating in response to our emotions. When we are having significant cravings for food, for example, there may be an emotion that is underlying that whether it’s frustration, it’s anger, it’s shame, it’s guilt, it’s boredom. Even boredom is a negative emotion.
When we start to eat food in response to our emotions, that can be a really big clue that we are eating for reasons beyond our true physiological hunger. And even just being aware of that can be incredibly powerful. When we think about intentionally planning our days, one of the things that is so valuable both during active weight loss and then as you transition into maintenance is thinking about what is my day going to look like. This does not mean that Sunday night you are planning the entire week ahead of you. This can be on a morning. On a Thursday morning, you have a couple of minutes at the beginning of your day and you’re thinking about what does my day look like today? What are the meetings I have? What are the commitments I have? Who am I getting together with? What does work look like?

What is going on in my life and how am I going to eat around that? What will my breakfast be? What will my lunch be? What will my dinner be? Now, ideally you’re going to plan that in as much as detail as possible. So it might mean that you’re eating breakfast at home, you’re packing a lunch to bring with you. You know what is going to be prepared or what restaurant you’re going to for dinner, for example, so that you can have this idea of what your day will look like. And then if another eating opportunity presents itself, here is one of the most important things is that our relationship with our food, our relationship with ourself, this idea of I’m going to do what I said I was going to do is incredibly powerful. And when we know that we have our own back, it makes a huge difference in our relationship and our trust with ourself and our ability to stick to and stay with a weight loss program.

So for example, it’s a Thursday morning, you’ve planned out your day, you know what you’re having for breakfast, lunch, dinner. Maybe you know that you get hungry in mid-afternoons, you have a snack that you’re planning to have at that time as well. Now let’s say that you’re presented with the opportunity to eat a cookie during that time. How you respond to that will be one of the biggest indicators and it’s not like a pass-fail thing, this is something you can learn and grow over time. But if you have planned out your day and that day does not include a cookie, I want you to pass on the cookie. Now it doesn’t mean that you can’t ever have a cookie, but I want you to recognize why am I craving this cookie so significantly? Am I hungry right now? Is there emotion that’s coming up right now?

Is that cookie actually a really delicious cookie? And yeah, I would like to eat that cookie. If that is the case and you’re like, “Yeah, I love that cookie. I want to eat that cookie. I want to plan for that cookie.” That’s awesome. I want you to put that on your meal plan for Friday. So pick up the cookie, wrap it up on Friday when you’re hungry for it, go to the bakery and buy one. I want you to very intentionally plan to have it because that feels incredibly different than just living in response to our environment. So then on Friday morning when you’re planning your day, you’re knowing that you’re going to have this gigantic chocolate chip cookie in the middle of your afternoon and that’s awesome because you might decide to make other plans around it. You might decide that lunch needs to be a little bit lighter or maybe needs to be really vegetable and protein forward so that that cookie isn’t going to feel like this huge blood sugar spike and crash afterwards.

You might know that you’re going to have your cookie for your lunch and instead of just having the cookie, you’re going to partner with some other things so that you feel really good and really sustained. You might recognize that, oh my gosh, I’m having this 300 calorie cookie and it’s a lot of sugar and so I’m definitely going to want to make sure I go for a midday walk, for example. And these things do not have to be punishment to your body. These things can really just be understanding, okay, I’m having this significant amount of sugar, so how can I help my body to process that? How could I do this in a way that feels loving, that feels kind? And then most importantly, and here’s really the key guys, is that when you’re eating the cookie, I want you to sit down. I don’t want you to be doing anything else.
No scrolling social media, no being in a work meeting with your Zoom camera off or anything. I want you to be sitting at your desk, at your kitchen table, wherever it is at the bakery. I’m going to sit down with no distractions and I want you to really enjoy the cookie. I want you to taste it. I want you to savor it. I want you to understand how awesome this cookie is because it is okay to enjoy your food and to eat for reasons beyond physiological hunger, but the experience of eating it in a very intentional way where we’ve planned our day around it feels very different than just like this back and forth battle that we often have. And we start to realize, okay, what are the times that I’m having those back and forth battles? Seeing that maybe there are certain emotional patterns that you find yourself in where you start to think about food or desire food as an escape from those negative emotions and seeing some of those patterns can be really important to process alongside the help of a mental health professional.

So seeing that is incredibly, incredibly powerful. And then we’ve started to develop this relationship with ourself where I do the thing that I say that I’m going to do and it doesn’t mean that there’s anything wrong with the cookie, but the cookie is eaten for a reason that is pure enjoyment of the cookie rather than in response to a negative situation that you’ve had throughout the day. Starting to find these type of patterns is incredibly important. So that is one of the really big things that we pull out as we’re intentionally planning, we’re looking at our food log and what is happening. We might start to see other patterns as well, like noticing when I eat in a certain way, I feel a lot differently. So it might be very common that people recognize when they eat a very carbohydrate forward breakfast, for example, that it sets them into a rollercoaster of blood sugar just up and down throughout the day.

And so they can make a very intentional decision that when I start my day, whether that’s breakfast or whether that’s mid-morning, depending when they start their eating, that I need to choose something that’s very protein forward because that helps me get started in the right way and that all of a sudden looks very different than just you should eat protein in the morning, but seeing this pattern of, oh my gosh, when I have a slice of banana bed for breakfast, I am ravenous an hour later. And honestly, I end up eating seven times throughout the day if it’s very small amounts or even if it’s like a few cherry tomatoes or an apple, I am just constantly fueling my body with carbohydrate, carbohydrate, carbohydrate as healthy or unhealthy as that carbohydrate is, major air quotes on that healthy and unhealthy. But recognizing that when I eat in a certain way, it sets me into a certain pattern, feels very differently than just some random person on the internet or someone just, “I heard of that I should eat protein.” It starts to be really different when you see those patterns playing out in your own body.

I also want you to really pay attention to what foods do you like? What foods do you already like, you already easily obtain that you can eat in a day-to-day fashion. One of the biggest mistakes that I see people making is that they get some sort of external food plan and they start following it and they’re like choking down salmon and Brussels sprouts when those are foods that they absolutely hate. And it doesn’t matter if I love eating salmon and Brussels sprouts. If you hate salmon and Brussels sprouts, don’t eat salmon and Brussels sprouts. By all means, go eat tillapia and broccoli, whatever the thing is, have an entree salad with chicken on top of it. Whatever it is that you like to eat, there are a million different foods out there that can be in line with your goals, but do not eat something that you hate.

That is just stupid, right? That’s just dumb. Why would we eat foods that we don’t even enjoy? So what are the foods that you enjoy that feel in line with your goals? And over time, as you’re incorporating this of being able to eat foods that feel good in your body, that fuel your body that you really enjoy when you start really intentionally planning when you’re having dessert, when you’re having alcohol, we start to see things shift in this really meaningful way. And one of my favorite things is when patients say to me, “Wow, that wasn’t easy, but it was simple.” It was something that day to day I’ve had so many struggles on weight loss journeys in the past and this has felt a lot different. It can become this layering on. I like to think about if we do every single day 1% better than the day before, what it means is that we’re not doing perfection.

We’re not trying to just eat perfectly follow this beautiful Instagram worthy diet. We are trying to improve our habits one by one, slowly by slowly. So it doesn’t matter what somebody else is doing. What were you doing yesterday? What are you doing today and how are you helping to shift things in the direction of your goals? That will oftentimes too look like taking a very layered approach. So it’s not like, “Hey, I’m doing this diet and I’m doing this exercise program and I’m doing this sleep thing,” that over time you’re tackling one goal and as that becomes part of the habit, then you’re layering on the next thing. And I think one of the things that’s so powerful is there’s no going back to my old self then, these become your new and sustainable habits. And it’s so powerful for me to see because very commonly I have patients who go through a really stressful life situation, for example, and they recognize that all of a sudden some of these patterns are now just the new habit.

The healthy eating is the new habit. The default grab and go out of the door option that they have is something that’s in line with their goals. And it feels really amazing to recognize that they’ve transitioned this from a very intentional every single day I’m making these decisions to now this is just the new habit. And that is really where some serious, serious magic can happen. Now what absolutely does happen sometimes is that we just get a drift. We’re not as focused on it. Maybe things have been going well, we hit a weight loss goal and we’re just in some sort of holding pattern. It is important in this place that we have some way of checking in. This can be that you’re checking in with your weight loss doctor, with your primary care physician, with a therapist, that you’re checking in from time to time on how things are going. This oftentimes looks like weight checks and making sure that once a week or once a month that you’re stepping on a scale and feeling like, “Hey, how are things looking? Is it stable or am I seeing that there’s some weight creep?” A lot of times if you’ve been doing food journaling, for example, in the past, it may make sense to bring that on for a week or for a couple of weeks of, “Okay, what’s going on? Where do I need to make some adjustments? Am I taking a medication? Do I need to change my dose of medication? Do I need to consider a different or an addition of a medication?” All of those things could be possibilities, but it’s important that we’re checking in and during your weight loss journey that there’s this focus on reestablishing that relationship with yourself, seeing, for example, numbers on the scale.

A lot of times the scale can be incredibly traumatizing to people and that’s something that you should work through with your own personal physician. But very commonly in my practice I will have patients who when they have that history of trauma with the scale that we will incorporate something like a blind weight scale, for example, where they’re stepping on a scale very regularly, but they are getting feedback in a alphanumeric type of way. It’s like A74 is their weight. And I’m making that up. The codes are a litle bit different than that, but they get some sort of code and it means nothing to them. They send that to us. We enter it into a calculator and we can see what their weight number is. And over time, as it makes sense, we can start to share some of that data in a way that if we can, transition them to seeing their own weights. But even if we don’t do that, let’s say you’re still stepping on a blind weight scale. Is that something that your doctor could have where you’re seeing, okay, am I still seeing this weight stability? Is my body fitting into the same clothes? Am I feeling strong? Am I feeling energized? I think one of the most amazing things is that when we start to leave behind what I should eat or what’s good for me and recognizing how does my body feel? How is my body fitting into clothes? How is my body functioning for me throughout the day? What foods feel good in my body and feel like I’m really fueling and nourishing my body? And when you start to see your weight journey from that angle and it takes time, it’s not going to be an overnight thing. When you start to feel that, start to see that and start to connect with yourself in that way, the magic absolutely happens both from an active weight loss standpoint as well as from a maintenance standpoint.

So if you find yourself in a situation right now where you’re very in an all or nothing thinking mindset, you’re in this very intensive diet program, for example, and wondering, how do I transition out of this in a way that’s not going to cause my weight to just skyrocket? I want you to seek professional help from someone like myself, a board certified obesity medicine physician, maybe from a nutritionist, from a therapist, from someone who’s experienced in this area. I see patients in person in Charlottesville, Virginia, and throughout the states of Illinois, Tennessee, and Virginia by telemedicine. It would absolutely be my honor to help support you in your weight loss and your weight maintenance journey. Thank you so much for joining me today. To learn more about me and my practice, go to www.sarahstombaughmd.com/glp. See you all next week.