Lee Kern, Clinical Director, Structure House
What do Simon and Garfunkel, Lennon and McCartney, Abbott and Costello, and Burns and Allen have in common? These icons of music and comedy rose to greatness through partnerships in which the collective creative sum was greater than their parts. Successful lifelong weight control works much the same way. To ensure long-term success you must partner your surgery with other tools. One of the most powerful tools is the food diary, frequently recommended by nutritionists and behavior therapists, yet at the same time the bane of most dieters’ existence. Diaries are avoided because they require time, attention, planning, and analysis, yet their ability to enhance success is supported by numerous studies. Perhaps the best resolution to this paradox is to view the diary as your faithful partner and accept that this alliance will produce what you cannot do alone.
Consider the results from a study whose overweight subjects saw themselves as doing everything right toward losing weight, yet they were not losing. Subjects were asked to use “recall”- to remember everything they had been eating. The findings indicated that the average person recalls only half of what they eat, meaning that without the aid of an external tracking device, we do not attend to our entire food intake. We consume many calories unconsciously – we nibble at the fridge or the sink, we snack while on the phone or in the car, we graze while watching television. Call it denial or inattentiveness – all these calories add up and can undermine our efforts to lose the next pound. A food diary puts a stop to this lack of accountability and becomes a partner to the commitment to heighten awareness of what we do with food. If success is like building a house, then this level of honesty is its solid foundation. I consider a food diary to be a bit like a Swiss Army Knife – one tool that can perform many useful functions. While a diary can be done in a variety of ways, there are several targets that will be hit if it is done properly. Those targets include the following: meal planning, food tracking, calorie consciousness, identifying unwanted eating, trigger awareness, weight monitoring, exercise and benefits log. Let’s look at these in more detail.
Meal planning Many weight loss and obesity experts have concluded that this culture has become a “toxic food environment.” It is a food jungle out there and the best way to get through it safely is to have a written plan for meals for each day before the day starts. Overeaters simply cannot afford to leave things up to the last minute and say, “what do I feel like having?” A meal plan is like a map that makes it more likely you will get to your destination.
Food tracking Let’s face it – not all eating will go according to plan. The diary needs to be a way of tracking everything that is consumed, whether on or off the plan. If you eat what is on the plan, then be sure to record the quantities or portion sizes. For off plan eating, you need to write things down as soon afterward as possible: including what, and how much was eaten. In the end, the diary is a record of everything you eat, planned and unplanned.
Calorie consciousness While magic diets come and go, most nutritionists recognize the basic energy equation of “calories in/calories out” as fundamental to weight loss over the long run. Therefore, part of effective diary keeping is accounting for the calories in the food consumed. Calorie awareness needs to be part of the meal plan as well. Meals should be balanced, maximizing nutrition, and designed to hit a daily calorie target that will result in either maintaining the weight lost, or a slow and steady rate of losing weight.
Identify unwanted eating Driver’s education teaches us that when we approach an intersection that has a yellow blinking light, we should slow down and pay careful attention. Proper use of a diary should distinguish between on target (within the plan) and off target (outside of the plan) eating. If we assume that the planned eating was balanced, nutritious and designed to meet daily nourishment, then unplanned eating is likely to be using food to meet non-nourishment needs. The diary is a beacon that highlights food misuse and serves as a signal to slow down and pay attention.
Trigger awareness A food diary enables the user to take an in depth look at the relationship with food, and heightening awareness of the reasons for unwanted eating. Was it repetitive habit eating that occurs at the same time every day? Was it an automatic response to food cues? Was it using food to entertain or reward? Was it eating to escape, distract or numb emotions or stress? These questions enable a food diary to stretch beyond planning and tracking, becoming a tool for self- reflection. Insights gained from this process become the foundation for relapse prevention.
Weight monitoring Experts have differing opinions about the role of the scale in weight loss. Some believe in frequent weighing, some do not. One way to resolve this question is to study “successful losers” to see what they do. Perhaps the largest study of successful people is the National Weight Control Registry, which is tracking more than 4,000 weight losers for more than 12 years. One common denominator that links many of these subjects is frequent (often daily) weighing. Don’t ignore what works for so many; your diary keeping should include a way for you to record (and graph if you like) your daily or frequent weights.
Exercise and benefits log Another finding from the National Registry is that successful losers are active exercisers. Exercise improves health and fitness, burns calories, boosts the metabolism, and maybe most importantly helps create the right mindset. I have heard clients say they refrained from a binge by remembering the calories burned in that morning’s exercise session. Using the diary to record all your exercise will help you see the big picture of change and progress. There are other long-term markers of success to track, too. For example, one of my clients noted when she could first go up a flight of stairs, instead of using the elevator; and another client cited her first plane flight without needing the seat belt extension. This use of the diary insures that you will see the forest of accumulated benefits and not just the tree of today’s weight.
When it comes to long-term weight control, no man or woman is an island. Strength of character and willpower are useful qualities to draw on, but they are not enough. You need to partner your surgery with tools, strategies and support systems that will empower your efforts. Making a food diary your partner will improve your ability to plan and monitor your food intake, as well as heighten your awareness and help you appreciate the benefits of your hard work.
About the Author Lee Kern, M.S.W., L.C.S.W., is the clinical director for Structure House, a residential weight loss facility in Durham, NC, that offers a unique behavioral approach to weight loss and healthy lifestyle change. Structure House provides a Post-Bariatric Surgery Program, designed to combine specialized classes on nutrition, psychology and exercise to enhance the long-term effectiveness of obesity surgery. This one-of-a-kind program includes treatment options specifically designed for post-surgery patients, such as surgery-focused medical assessments and development of personalized eating and relapse prevention plans. This revolutionary program is anticipated to be the missing link in ensuring lifelong weight control and improved health.