Ditch the Dieting!

Evelyn Tribole is very enthusiastic about getting the word out that dieting doesn't lead to permanent weight loss.  Here's a clip of Evelyn getting her message out:

We've got very preliminary evidence that supports what Evelyn is saying. Cool, huh?   The message that dieting is associated with weight gain is a great example of why my work here at Otago, looking at weight gain prevention, is so important...we've got a fair amount of women who maintained weight over 3 years without controlling weight through dieting.  How did they do it? We'll see!

Weight ("Mis")Management

I had an incredible weekend: the kind where it was so simple and so relaxing that I have hope it can happen again and again and again and...

The best part is that I've been able to start my Monday off with the most clarity that my mind has had in a very, very long time.  It's a great feeling to sit down at my computer and have a refreshed sense of being and wanting to really dig in to my research rather than just peck words into Google and hit "search" and calling it "work".

Today, I am reading an Acceptance and Commitment Therapy for diabetes self-management therapist manual by Jennifer Gregg, Steven Hayes and Glenn Callaghan.  I only got a few paragraphs into the background before my mind started going off on tangents about why it's so damn difficult to control the behavior that affects our health.

So, being the visual person that I am, I started playing around with trying to put it into picture form.

Basically, I started thinking about the typical weight loss program.  The participant is told "Eat less. Exercise more."  Easy enough, right?  Ehhhh, well...  

What you see in this picture is that I made a rectangle and split it exactly in half.  On the left side, I plopped in two hexagons to represent the diet and exercise that an individual must focus on inorder to have the desired effect on their weight.  I had plenty of room to type a note to myself and have a representation of diet, exercise and the individual.  

But, then I wanted to see a more accurate picture of what a typical person is dealing with because it's unfair to assume that anyone can devote all of their attention to just trying to lose weight or maintain weight.  I didn't have enough room to squish in all those factors that influence our ability to manage weight... in fact, the circle that is labeled "individual" (ironically) is being pushed out of the picture!  

Oooooh!  Ahhhhh!!!

So, here's what I'm thinking:

As we look at factors influencing an individual's ability to manage weight, we see that when we look closer there are so many things that the individual gets crowded out!  *ACT/IE can help put the individual at center of their own life.  It gives them a point of view where they can handle things as they come rather than being overwhelmed.  Skills learned can help a person not only moment-by-moment, but also help them plan for the future.

Over the next few weeks, months, years I'll work hard to keep in mind that weight management isn't simple.  With that in mind, I need to help come up with a simple way to help people with a complicated issue.  Otherwise, it won't work.  Bariatric surgery, diet pills, and fad diets are "easy" solutions, but they come with nasty side effects.

I have a hunch that helping the individual learn to take a hot second to assess the present moment and act in a way that they nod to what they value is sooo crucial.  But, it's not enough.

It's tough to battle all those forces (on the right side of that picture above, plus all the ones that are missing) day after day after day by yourself.  It doesn't have to be/feel that way, though.  Social support is great.  Having a friend or family member that values healthy living can be great motivation to make decisions and carry them out so that the outcome leads to weight management (a.k.a. health maintenance/improvement). Yet, I don't think it's enough support for entire populations on a quest to be healthier.  I truly believe that we need to tackle the factors related to climbing obesity rates from many directions.  For example, making cheap, tasty foods less available (do you ever walk around and notice how readily available food is?!) or downsizing food packaging.

That last part, downsizing food packaging, has never been more obvious to me than now.  Living in New Zealand has been GREAT for observing differences between here and the United States.  The availability of foods in large packages is so much less common here.  I think that if the large package sizes of common foods (like peanut butter) were available in the large jars that we see at home then New Zealand's prevalence of obesity would match the U.S.

Now, ain't that food for thought?


*Acceptance and Commitment Therapy researchers have suggested that people avoid their overwhelming thoughts rather than accept them as thoughts.  When it comes to eating behavior, we may avoid our overwhelming thoughts/cope with these thoughts by eating.  In a culture where food is tasty, cheap and readily available it is no wonder how easily we can self-medicate with food; but, rather than overdosing and facing instant death, it's a slow process that leads to high blood pressure, diabetes, cancer and all sorts of problems that we don't see until we're further down the road.  Deciding, now, what we value may help us change our course of behavior when we have thoughts that conflict with our values.  Cool stuff, eh?

Jean Kristeller, Ph.D "Mindfulness Based Eating"

Mindfulness-based eating... can it help with weight maintenance?  There's potential to incorporate bits of Dr. Kristeller's work into my intervention.  Cool, eh?

Research articles: I eat this stuff right up!

Two friends were teasing me yesterday because I don't use the Internet as I should.  I don't spend free time (wait, should I even have free time these days?!) searching meme-things or scrolling through that other site... what's it called? Tumblr??  Instead, I read research.  Yes! Throw an article on the latest and greatest randomized controlled trial in my direction and I'll be happy as a clam to sit down and read it line by line, making little notations in the margin.  Don't believe me? Refer to the post on how I spent my birthday!


For those looking for something to whet their appetite for more posts related to my research, I'll share an abstract from a review that just hit my inbox.  It's written by Simone A. French, Leonard H. Epstein, Robert W. Jeffery, John E. Blundell and Jane Wardle from Appetite (supposed I should tell you volume  59 and pages 541-549, too, huh?):

But, *geek alert* you know what really excited me about this review? I KNEW WHO THOSE AUTHORS ARE! I was giddy that I've been reading their stuff for years (okay, some of them I've only probably been reading since 2008-ish when I was gearing up for the intervention for my master's thesis, but still...).  It's Oh! moments like this that reinforce my decision to be in research. Wahoo!

The purpose of this review is to spark integrative thinking in the area of eating behaviors by critically examining research on exemplary constructs in this area. The eating behaviors food responsiveness, enjoyment of eating, satiety responsiveness, eating in the absence of hunger, reinforcing value of food, eating disinhibition and impulsivity/self-control are reviewed in relation to energy intake, body mass index and weight gain over time. Each of these constructs has been developed independently, and little research has explored the extent to which they overlap or whether they differentially predict food choices, energy intake and weight gain in the naturalistic environment. Most available data show positive cross-sectional associations with body mass index, but fewer studies report associations with energy intake or food choices. Little prospective data are available to link measures of eating behaviors with weight gain. Disinhibition has the largest and most consistent body of empirical data that link it prospectively with weight gain. An overarching conceptual model to integrate the conceptual and empirical research base for the role of eating behavior dimensions in the field of obesity research would highlight potential patterns of interaction between individual differences in eating behaviors, specific aspects of the individual's food environment and individual variation in state levels of hunger and satiety.

So, some good things to think about.

Eureka?! Me vs Traffic: A Lesson in Behavior Change

What do eating behavior and crossing the street have in common?  I'll give you a second to ponder that (cue the Jeopardy music)... 


Are you ready for it?  

They are both things that, in general, we do everyday.  Not only that, BUT when we try to change how we do them something in our little mind goes: Whoa, buddy! Something's wrong here!


Genius, right??

So, this thought came about when I was walking down Cumberland Street in Dunedin today.  I was recapping a conversation that I had with my supervisor on Monday.  Before our meeting I was trying to think of things we could talk about related to the research and other just chit chat topics.  I was preparing for things he might ask me such as, "Sara, how are things going?" to which I'd reply, "Well, I  only have an outline for my literature review (I was supposed to have a first draft completed at the end of May) and I have a first draft of my manuscript on the use of financial incentives with a mailed survey (I started it in February and haven't done anything related to the statistics section yet), but I'm crossing the street much better!"  I assure you, he'd find this last part funny. On one of our walks to our building a few months ago I was not at all used to traffic coming at me from the "wrong" direction and admitted I'd have to follow his lead - even at cross walks.

Well then why does this make me think of eating behavior?

Lately, I've been reading some disappointing articles about the efficacy of weight management programs.  Years after Ancel Keys taught us that restricting our caloric intake (similar to dieting) isn't all it's cracked up to be, we still have research coming out where researchers are trying to tweak dieting programs to achieve safe, successful, long-term weight loss.  It's just not happening.

So, now we've got a few of us out there thinking about weight maintenance.  But, if I'm supposed to develop a weight gain prevention intervention for my PhD thesis, how on earth can I move forward knowing that brilliant researchers haven't come up with anything spectacular already?!

I think we need to stop thinking like researchers with specialty knowledge in diet and exercise and human behavior.  Instead, we need to think like the average Joe and start there.

That's what got me thinking about things that we do so often that it'd be a downright pain in the butt to change them.  Like, for example, putting on socks. Or...crossing the street!  Americans are taught to "Look left. Look right. Look left again."  If you do that in New Zealand, you're going to be flattened into a pancake during an attempt to cross the street.  Things are not hopeless, though.  Luckily, after enough practice, it becomes more natural to look right first for oncoming traffic.  Then, over time, you can cross the street with confidence!

In my experience, I needed to be aware that traffic patterns are different in this new country.  Then, I had to recognize the situations where I'd have to adjust my behavior.  Next, I needed practice changing where I looked for oncoming cars.  Now, I'm almost in a maintenance phase of naturally looking in the "correct" direction for the traffic.  It was like a Crossing the Street Correctly in New Zealand intervention!  I think the same can be said for any new behavior, but particularly for eating-related behavior.

The real challenge now will be deciding what behavior(s) to focus on (e.g. speed of eating, portion size, mindless eating - all of which, and more, are being examined through our survey) and figuring out how to approach that behavior change the way I approached my own street crossing behavior.

I really think I'm on to something here...

Sign. Fold. Stuff. Repeat.

The fun has begun!

We're getting ready to send out questionnaires for the three-year follow-up of our Women's Health and Well-being study.  For the last two days, we have handwritten over 1,000 women's names in the greeting line of our letter that summarizes last year's findings and announces the questionnaire coming next week.

In the midst of signing, folding, and predicting what it will be like when we start our work preparing the questionnaire mailing, I got my first taste of survey research methodology humor.  Someone asked why we have to go through the hassle of adding personal touches here and there;  after all, it is taking hooouurrrrss to get this all done.

Then someone, with her best Jerry Seinfold imitation, simply said, "Dillman!"

At the end of today, we finally started stuffing the envelopes.

Heidi and I took a break from the action to speak to parents at a nearby preschool.  The school is implementing the Healthy Heart Award program and wanted nutritionists to speak about healthy lunchbox choices.

When we walked in, we saw a room full of under 5s eating cut up pineapple, apples, grapes, slices of cheese, crackers, celery, hummus, pita bread and other deliciousness for lunch.  On the wall behind the little ones was a collage of food wrappers from items found in the kids' lunch boxes earlier this year.  Cookies, chips, gummies and other sweet things were all represented on the wall.  I thought it was a great reminder to all of us that the children are just as happy eating the fresher, nutrient dense foods.  The teachers hope that the education parents are getting through the program will reduce the amount of high fat/sugar/salt foods in kids' lunch boxes.

Heidi talked about reading food labels.  One father pointed out that fresh foods cost more.  He made a valid point.  I replied that what we're doing for children by buying them fresh fruits/vegetables, leaner meats, whole grains, etc is actually investing in their health to improve it down the road.  It is hard to imagine the eating habits of a 3-year-old affecting them at 13, but I hope I helped him think about things a little differently.  I also mentioned taking small steps - when they look at food labels at the grocery store this week, buy foods with less sugar.  Then, the next trip to the grocery store they can pick a different nutrient to focus on.  If we had more time, I would have busted out some of my knowledge from a "Balanced Diet on a Budget" talk I did in the senior centers at home.

Tomorrow will involve more envelope stuffing, but I don't mind!  The others on my research team are tolerating the music I put on our special Envelope Stuffing Party playlist which includes such great tunes as "Are You Gonna Be My Girl" by Jet, "Jump Around" by House of Pain, "and "Groove is in the Heart" by Dee-Lite.  They all agree that the dance party vibe makes getting the job done a lot more fun!

Mindful Eating

I have a hunch that most readers will be interested in reading about life in New Zealand.  For those of you who are interested in the research side of things...

Recently, The New York Times posted an article titled Mindful Eating As Food For Thought.  I thought I'd share the article since it was passed on to me by a friend who found it interesting.  I definitely agree that once in a while we should take a moment to enjoy our meal. What do you think?