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Everyday Fitness

with Pamela Peeke, MD, MPH, FACP

This blog has been retired. We appreciate the wisdom and encouragement that Dr. Peeke has offered the WebMD Community.

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Tuesday, May 21, 2013

Lessons From the “Weight-Release” Journey

By Pamela Peeke, MD

Kris

Remember Kris with the cookie jar filled with affirmations in place of cookies?

As you may recall, she’d just begun her journey to finally confront lifelong binging and addiction to sweets. Witty and authentic-to-the-core, Kris has continued to strive to be mindful and vigilant in a literal battlefield of overwhelming cues to overeat. When we began together, Kris was within eyeshot of 300 lbs. Flash forward to the present, she’s released 31 pounds and for the first time in years, she’s south of 260 pounds. It’s time to pause on her journey and cherish hard won lessons. Kris and I team up to share some gems to help you along your way to greater health and wellness.

Lesson 1: You’re not losing— you’re winning. Notice Kris said she’d “released” excess body weight. Years ago one of my patients Marlyn sat before me, crossing her arms across her chest, and, with a wicked smile, declared “Dr. Peeke, I didn’t lose my 60 pounds. If you lose your keys, don’t you want to find them? I don’t want to find the weight again. We have a national epidemic of losing and finding the same fat. Instead, I say ‘remove’ and then my mind sees it as a one way street, like removing the garbage.” Well, that stuck and now I tell people to use another verb in place of lose. It’s a mind game for you to win. Kris chose “release” because she felt lighter mentally, physically and spiritually. She visualizes releasing it to the sky to disappear forever.

Lesson 2: Do SMART goal setting: Early on I taught Kris an easy way to remember how to set and achieve goals. Here it is and how Kris has addressed it for herself.

1) Specific = Saying “My goal is to have more energy” or “I want to be healthy” is akin to wrapping your arms around fog. It’s a nice thought but not specific enough. Kris wanted to get off her medications, and achieve a dress size in which she felt comfortable enough to begin to date again. Other goals also included increasing her stamina while walking and her strength in the gym.

2) Measureable = You cannot know if you’ve achieved your goal unless you have some way to measure your progress. I tell all of my patients that as it relates to weight,  there are options. My clothes-o-meter is a great one in which you pitch the scale and simply note changes in your clothing size. Kris loves this and here’s a picture of her in one of her famous NBIT (Never Been In Them!) jackets (she bought it years ago, never wore it, and it still had the tag). She can not only get in it, but she can now zip it up with room to spare. Starting in a size 28, she’s now in a 22, and on the move. A tape measure is your friend to keep track of body shape shifting, especially if, like Kris, you’re trying to stay physically active. Kris has dropped 6 inches from her waist. Yes, Kris does use a scale but she chose to use it every other week. It works for her and decreases her obsession with that piece of metal that has always ruled her life.

3) Action-Oriented = A goal without a plan is only a dream. Kris showed up at my doorstep asking for a plan of attack. Detoxing off the sweets and beginning to practice her mind and body lifestyle habits was critical for success. She’s used the WebMD Food and Fitness Planner along with customized food preparations from The Hunger Fix to address her profound addiction to sweets. She schedules her physical activity. She’s back to church to meditate and pray as she calms the storms of daily temptation. Mentally, nutritionally and physically she’s locked and loaded, an armed warrior ready for the land mines awaiting her every time she watches TV, listens to the radio or reads a magazine.

4) Realistic = Together, we created a goal structure that is not pie-in-the-sky, but instead makes sense for Kris. We celebrate every single accomplishment, from walking a mile without having to speed dial 911, to successfully getting to bed earlier, to dropping another inch. Kris takes every day 24 hours at a time, starting the morning saying “Today I commit to___” and filling in the blank with small steps she plans to take. We avoid the “My goal is to be 150 pounds” place. That’s like a marathoner obsessing about reaching 26.2 miles, instead of facing each mile and relishing the journey. Kris is learning that the journey is the goal. I emphasize just heading south of where she began, and encouraging her to applaud and appreciate her own efforts. The key is to keep trying and moving ahead. One day at a time.

5) Time-Sensitive = Kris wanted to wear her lovely but smaller sized spring and summer clothes that had been sitting in her closet for years. She began in the winter and knew in her mind that having a time factor in her goal was important. It kept fanning the passion and fire inside her to make change, to do the work, to fall down and pick herself up time and time again as she became more street-wise about staying on track in a world seemingly bent on sabotaging her every effort to become healthy.

Lesson Three: Embrace the WOW moments along the way: Kris is now at a place where she’s experiencing all kinds of “WOW” milestones. Here’s a great one. She has no memory of having gone into a department store dressing room to try on clothes. This is a body image moment many of you can relate to. Kris never accepted her body. Instead, she felt shame, blame and guilt running down the laundry list of anatomical parts she rejected: “big boobs, heavy thighs, large belly”. A dressing room represented a nightmare scenario— staring at your semi-naked body and all of its imperfections. So, recently, Kris did something radical. Instead of buying clothes and taking them home to try on, she marched right into the dressing room and, go figure, it had a 3-way mirror! Undeterred, she peeled off her clothes and tried on the new dress— and it fit! Prancing in front of the mirror, she realized she was now beginning to feel self-compassion, self-love and a new acceptance of her marvelous, amazing and beautiful body, one that has masterfully carried her through 67 years of life. It was a milestone WOW moment she will always cherish.

Lesson Four: Learn to dust off your behind and keep going. Like everyone who embarks on this journey, Kris occasionally tried to test the system. Knowing full well she was guaranteed to lose control when consuming refined sugar, she would on occasion mindlessly “treat” herself with “just” (there’s that word again, always leading to a justification or excuse for an unhealthy choice) a slice of cake or one cookie. This, of course, led to overeating and as panic set in, Kris stopped her binge. Eventually she learned to better plan a strategy for how to eat in challenging situations, and if she did slip up, to quickly regroup. That meant halting the self-disparaging chatter— “I’m a failure”, “How could I let this happen”, “I’ll never get anywhere”— as well as ditch the shame, blame and guilt-speak. Instead, she’s learning how to accept what happened, look for the lesson to be learned, dust off her ever shrinking behind and mentally regroup, hopping right back on plan and not wasting a single body dollar with mean self-speak. Instead, she’s rocking with affirmations to fuel her regrouping process— “You go girl!”, “I’m better than this. I can achieve my goals!”, “Get out of my way ‘cause I’m getting this done!”, and “I deserve happiness, joy and health.”

There’s going to be plenty more to come from Kris. She’s using every day as a golden opportunity to learn. With every slip and slide on this journey, there’s a priceless lesson to be learned. As Einstein once noted, “In the midst of difficulty lies opportunity” and your job is to seek and embrace each chance to move forward. Kris wanted to share this part of her life journey with all of you. How about giving her a shout out through a comment to help support her? Share your own lessons and thoughts on Kris’s milestones and WOW moments. That’ll be your gift to her for the royal win win!

Posted by: Pamela Peeke, MD at 11:35 am

Tuesday, March 12, 2013

Practice Self-Compassion for Lifelong Success

By Pamela Peeke, MD

lady

I’m such a loser. I can’t get it together. I’m always caving and binging and shooting myself in the foot. I start out OK and then in no time everything falls apart. I’m so ashamed of the way I look and live. This is all my fault. I feel hopeless.” Sound familiar? At some point most of us experiences this dark place of feeling helpless, hopeless and defeated. It’s a place of shame, blame and guilt. Often, our response is to escape into mindlessness once again, dissociated mind from body, eating whatever and whenever, praying for that magical moment when we snap out of it and flip back on track into self-discipline. Do you want to hop off this emotional roller coaster and head down a new path toward the achievement of sustainable better health and weight management?

Here’s how. Balance self-discipline with self-compassion. Self-compassion means treating oneself with kindness and support when things don’t go well.

The first time I mentioned this to one of my patients years ago, she gave me a puzzled look. “How do I do that?” I asked her to think about the last time she expressed compassion for someone in her life. In this case it was her best friend who’d lost her job and was experiencing tough financial challenges. “That’s easy. I kept reminding her of what a wonderful woman she is, and that she’d get through this with the love and support of her family and friends. And then I’d show up and just do things for her, be her companion, and someone she could lean on.” Then she smiled. “Oh now I’m getting it. I’m supposed to do that for me. But, I’ve never really done that before. It feels odd.” Indeed it does. The bottom line is that we’re better at giving then getting. But it’s through the daily practice of self-compassion that you can increase your chance for success at anything from weathering a family crisis, to shedding extra mental and physical pounds and keeping them off long term.

And there’s research to prove that self-compassion works.

A 2007 Wake Forest University study found that when researchers asked young women who were dieting not to feel bad about eating doughnuts during a taste test (“I hope you won’t be hard on yourself—everyone eats unhealthily sometimes.”), those participants unconsciously chose to eat less candy later. Those dieters who hadn’t been encouraged to be self-compassionate and demonstrated more self-criticism overate the candy.

Researchers at the University of Wisconsin found that using functional MRI scans when studying Buddhist monks meditating on loving-kindness when exposed to stressful scenarios, the areas of the brain associated with empathy and maternal love (insula and temporal parietal junction) were stimulated. The brain can be programmed to go to a place of compassion in the face of any kind of stress, decreasing depression and anxiety, and helping to adapt and adjust without resorting to impulsive self-destructive behaviors.

Dr. Kristin Neff of the University of Texas has created a validated test to assess your own level of self-compassion. And it’s an eye-opener. Raise your hand if you’re constantly judging and criticizing yourself when things don’t go well in your life? Take a moment to complete the test to see where you stand.

Here’s how to get the ball rolling and self-compassion flowing throughout your day.

Watch out for Fat Talk: Think of the internal dialogue that flows through your head on a daily basis: “You look horrible in this.” “You have no control, you’re a loser and a fat slob.” This is the kind of self-talk we pollute our brains with every day. What about this commentary is helpful? Nothing. When you’ve had this automatic fat talk habit for so long, you start believing it. Don’t! For the next 24 hours, monitor all of your self-speak and write down all of your typical put-downs. It may be a shocker to see how you’ve been treating yourself.

Switch to Self-Compassionate Talk: Self-compassion is about treating yourself with the same respect, honor, loyalty, trust, and love you bestow on your family and friends. You’re learning how to coach yourself as you confront your daily stresses. Here are a few shifts from self-critical to self-compassionate when stress hits:

“I’m stupid.” is replaced by “Oh well, mistakes happen. Let me try again.”

“I suck at this.” is replaced by “I’m just learning—I’m a work in progress.”

“I can’t believe I let myself go again.” is replaced by “No one is perfect—I am    human and I’m going to start again to help myself.”

“I look like a fat pig at the gym.” is replaced by “I’m starting my journey at this gym and will simply do my best, stay focused, make some friends, and be patient because I know I can do this.”

“I feel like such a large, lumpy, undisciplined loser.” is replaced by “I’m a warm and wonderful friend and human being. I’m not a loser. I’m a winner because I’m showing up and trying to improve myself.”

When you don’t practice self-compassion, you are more critical of yourself, more apt to seek perfection and be angrier and competitive with others. You’re more likely to judge yourself solely on external, changing metrics. Your scale and size rule you. Your whole self-worth is unstable.

Self-compassion is the ability to be kind and understanding to yourself when you’re suffering or when you feel inadequate in some way. Self-compassion helps you key into your shared humanity, allowing you to see that pain, mistakes and failure are natural, unavoidable parts of being a human being. Unlike dissociation, self-compassion is not about running away from your feelings—it’s about facing them honestly, without resorting to self-pity or excess drama. You will gift yourself with unconditional love and compassion. This is one of the most powerful weapons against one of the most significant speed bumps along your weight management and healthy lifestyle journey— the harsh self-judgment and criticism that paralyzes you and leaves you feeling hopeless.

Loving-kindness combined with a reasonable plan of action for nutrition and fitness, is the recipe for long term healthy living success.

Posted by: Pamela Peeke, MD at 8:00 am

Monday, February 11, 2013

The Real Truths About Weight Loss

By Pamela Peeke, MD

scale

For years, weight loss experts, medical practitioners and consumers alike have held certain beliefs about how to shed weight. Now, a new analysis of these long-held assumptions has cast doubt on many of them. Dr. David Allison and his team published a groundbreaking article in the New England Journal of Medicine in which myths, presumptions and facts about weight loss were scrutinized and presented in a brand new light. Here’s what they found, and my thoughts about how it impacts upon your our weight management journey.

First up, let’s look at what these scientists are identifying as myths, which means each item is not backed by current science.

The Myths:

1)     Small things make a big difference, and that walking a mile a day can lead to a weight loss of more than 50 pounds in one year.

My take: Small things make small but important changes. However, you cannot drop 50 pounds in a year by walking alone. Significant changes have to happen in nutrition as well as stress management. This is a holistic journey.

2)     You need to set a realistic goal to drop weight.

My take: Although current science doesn’t support this recommendation, I still believe it’s mostly true. Scientists just need a better way to study this issue. After years of  working with men and women who have struggled with weight control, I have always cautioned against what I would consider unrealistic expectations— a 50 year old woman with 70 pounds to shed wanting to wear the size 4 skinny jeans she kept from her freshman year in college. I’m a firm believer in removing excess weight in carefully thought out phases— celebrating every single pound dropped and sustained, every decrease in belly girth, every extra mile walked. These are realistic objectives that build a strong foundation for weight loss, health and sustainability.

3)     Dropping weight too rapidly is not sustainable.

My take: This is a tricky one. Bariatric surgery results in substantial drops in weight over a fairly short period of time. So long as the individual is supported by a great team of mental health, nutrition and fitness professionals, that weight loss can be sustained. As well, I have witnessed some of my patients drop large amounts of excess weight in a relatively short period of time and keep it off for years. Once again, the greatest predictor for success was a healthy weight reduction plan, as well as a strong support system, both from the mental/nutrition/fitness side as well as personally. The key determinant is how the weight was dropped. Quick fix fads, radical diets, severe caloric restriction and any disordered eating habits are clearly unhealthy and not going to yield long term success.

Here are items in which scientists have some data but no solid proof they work.

The “We’re Not Sure” Beliefs:

1)     Eating a health breakfast leads to weight loss.

My take: Starting the day off with a healthy breakfast most likely is associated with sustainable weight loss. This is an observational finding of the National Weight Control Registry study . But, believe it or not, the actual clinical study has never been done. We just assumed this was true. The good news is that a definitive study (breakfast vs no breakfast) is in the process of being conducted. For the time being, I’d still recommend consuming a balanced and healthy breakfast every morning.

2)     Adding lots of fruits and vegetables to your diet will facilitate weight loss.

My take: Of course it’s terrific to incorporate these high quality carbohydrates into your daily food consumption. But that only works if you are monitoring your total caloric intake, balancing the intake of high quality protein/fat/carb and adding regular physical activity. Adding vegetables to your dinner and then consuming bags of cookies, chips and ice cream while watching endless Law and Order reruns is clearly not going to result in weight loss.

3)     Yo-Yo dieting results in increased death rates.

My take: Yo-Yo dieting has been a source of controversy for many years. Frankly, I have observed the full spectrum of  possibilities with the ups and downs of weight shifts due to switching from one diet to another. Some people continue this cycle for a lifetime or simply burn out and give up. Others Yo-Yo for some period of time and then find a lifestyle plan that finally works for the long run. The quality of the plan you’re on is critical. People can Yo-Yo with good as well as bad plans. The point is that the ultimate outcome is quite variable and we’re not certain about its impact on death and disease. So, it’s best to find the healthiest plan (check out the WebMD Food and Fitness Planner) and get regular with healthy lifestyle habits.

4)     Snacking leads to weight gain.

My take: Again, it’s how you interpret this statement. Most experts like myself believe that you should try to eat roughly every 3-4 hours ending at dinner time. The snacks are carefully planned for quality and quantity. One critical snack occurs in the mid-afternoon, and includes a healthy combination of protein, fiber, and high quality fat in a controlled portion. This helps to decrease food intake at dinner time. This kind of strategic snacking is not the traditional out of control, mindless 24/7 grazing that is most certainly a recipe for disaster.

And finally, here are rock-solid proven facts that really work to drop weight.

The Proven Methods to Lose Weight:

1)     Genetics is important but DNA is not destiny.

My take: I couldn’t agree more. As I noted in my book The Hunger Fix, there’s a new science out there called epigenetics. I say “Genetics may load the gun, but environment and lifestyle habits pull the trigger”. What this means is that despite any genetic inheritance, your own lifestyle behaviors affect the expression of your genes by dampening down bad genes and strengthening good genes. The end result is that you change your destiny. You actually help create a more positive destiny with every thought you think, every mouthful of food, and every step you take. Now that’s very empowering to hear!

2)     Exercise is crucial for weight maintenance.

My take: Amen! Science has clearly shown that to drop weight you have to add more physical activity to your daily living. But to keep it off, physical activity (both deliberately scheduled as well as activities of daily living) is absolutely critical. A major mistake so many people make is to become active, successfully shed pounds, and then literally sit on their laurels. Just remember, what helped you achieve your weight loss goal helps you to maintain it as well.

3)     Weight loss surgery can be effective in the long-term for certain individuals.

My take: I agree with the understanding that the success of bariatric surgery is based upon the presence of strong ongoing medical and personal support systems.

4)     Weight loss is greater with programs that provide meals, and some prescription drugs.

My take: There’s a wide spectrum of options for people to choose from as they attempt to manage their weight. As we learn more about brain and body functioning in weight control, there will be more drug innovations emerging. As physicians, we’ll be carefully reviewing what may be possible and appropriate for each individual. Regarding companies that provide meals, I would prefer people prepare and eat fresh whole foods. I also realize that in this 24/7 world that is not always possible. So long as people realize that the goal is to eat nutritious and healthy foods when at all possible, then the substitution of these products when necessary remains an option.

As Dr. Allison noted to me in a recent conversation, overweight and obesity is a complex condition affected by countless factors that interfere with an individual’s ability to do what’s right— eat less and move more. It’s never that simple. Socioeconomic, cultural, economic, environmental, food addiction, medical and genetic issues all play a vital role in either easing or complicating the ability to manage weight. This study is a milestone because it helps to set the record straight about some of our beliefs and assumptions, while also prompting experts to get to work to produce the kind of research that will provide consumers with scientifically  proven recommendations and guide us all to a stronger understanding of how to achieve optimal weight management.

Posted by: Pamela Peeke, MD at 10:38 am

Tuesday, January 8, 2013

Weight A Minute: Being Overweight is OK?

By Pamela Peeke, MD

fitness

Is it possible that carrying an extra twenty pounds doesn’t increase the risk of death, but may actually be safer than being of average weight? If this sounds sacrilegious and confusing, you’re not alone. Millions of Americans watched the evening news to hear the results of new research conducted by the Centers for Disease Control studying the relationship between death and weight. Of course there was the predictable data showing that obesity was associated with a rise in the rate of deaths from all causes. Based on mountains of studies, we’d all agree that’s a keen grasp of the obvious. However, there was a hidden surprise that needs lots of clarification to help you interpret how this new study affects you personally. This is especially relevant as you start the new year and are setting goals for yourself.

The researchers look at almost 100 studies that included 3 million adults from all over the globe and over 270,000 deaths. Their data noted BMI, which is the ratio of weight in kilograms divided by height in meters squared. Please note that BMI only covers height and weight. It says nothing about body composition (amount of muscle, fat, bone), nor does describe where your fat is located (inside/outside your belly, hips, thighs).

Here’s what they found:

Compared to people of “normal weight” (BMI of 18.5-24.99):

  • Extremely obese (BMI >35) had a 29% increased risk of early death.
  • Overall obesity (from moderate to severe) had an 18% increased risk of early death.
  • Overweight (BMI 25-29.99) had a 6% lower risk of early death.

Media headlines quickly ran with this last finding and this led to collective head scratching and quizzical looks from most of you. Overweight is OK?

Let me help to clarify how to understand what seems to be a contradiction to what you’ve been taught to believe in for the achievement of fitness and health.

1)     “Normal” Weight Does Not Imply Good Health: The study’s normal weight category included anyone who was slender or of average weight. In this group you’re going to find people who are practicing healthy lifestyle habits. However, you’ll also find skinny smokers; the ill who had lost weight or were still losing weight; the “skinny fat” people who starve themselves all day and/or over exercise to maintain a particular size; slender or average size food addicts who eat junk but keep the calories and their size down; those with eating disorders; people who may have dropped weight using fad diets but will most probably regain; people post bariatric surgery who may have complications; and, average size men and women who are sedentary and don’t eat well. It’s also probable that average weighted folks are not garnering the attention of medical professionals who write them off as healthy based only upon their weight and basic lab values within normal range. Nutrition and fitness is rarely discussed and it’s estimated that over 40% of pre-diabetics are of average weight. Bottom Line: Having a “normal” weight may not indicate optimal health, fitness or wellness.

2)     Not All Fat is the Same: The study looked at total body weight, not fat distribution. People who carry excessive weight inside their belly are at much higher risk for heart disease, diabetes and cancer. Bottom Line: You cannot draw the conclusion that fat in general confers some protection.

3)     Clarifying Who the “Overweight” Are: Just as you cannot conclude optimal health because someone is of average weight, as well, you can’t state that all overweight are very unhealthy. I have patients who have dropped 100 pounds through excellent healthy lifestyle habits and then ended up 20-30 pounds above the approved upper limit for an ideal body weight. Their metabolic profiles on lab tests are normal, their blood pressure and pulse are healthy, and their waist circumference is upper limits of normal or elevated but it’s subcutaneous, not intra-abdominal fat. And, they are more fit and living a healthier lifestyle than many people in the “normal” weight range who may be sitting around with excessive belly fat. When one of these folks is in an accident, they may do better than an average weighted but unfit person. Some experts note that it is indeed possible to be fit and overweight, as physical fitness confers an independent protective effect on disease risk. As well, due to increased medical attention, many overweight people are getting more guidance and help with healthy lifestyle education which may be decreasing their mortality rates. Someone dropping weight but still overweight may be included in this group, as well as those from an average weight who are gradually increasing weight. In other words, you have a lot of moving targets in all of the groups. Bottom Line: The overweight group, like the normal weight, includes a wide array of body composition, medical history, and lifestyle habits.

4)     Quantity, Not Quality, of Life Was Emphasized: This research was reviewing the relationship between body size and life span. Nothing was noted about incidence of disease or mental (cognitive decline) or physical disability (joint problems). Bottom Line: Although there was a difference in death rates, the enjoyment and functionality of daily life was not addressed, nor was the potential probability of problems occurring in the future (silent pre-diabetes becoming fulminant disease).

Most experts agree that this issue of obesity and overweight is much more complex than had been previously appreciated. I’m glad to see this kind of provocative research as it focuses the discussion to exactly what are the optimal goals and objectives for people striving to become healthy.

As you embark on your own journey, I’d recommend that you keep your healthy living habits simple and consistent. When you set your goals, try these guidelines to help you:

Create your own A team which can include any combination of: your medical support system, physical activity professional, registered dietitian, counselor, friends, family members and don’t forget that pets count!

Measure your progress by improvements in: energy, mood, inclusion of whole foods and elimination of refined/processed products, regular physical activity, better your medical lab values (blood sugar, cholesterol), medical conditions (high blood pressure, diabetes), physical performance (in exercise as well as activities of daily living), waist circumference (reduction in waist size to within normal limits <35” women, <40” men), and a continuing decline in body fat%.

Don’t obsess about a single weight number. It’s never about achieving that one number as most people’s actual weights vary within a range. Instead, start the journey and keep practicing your healthy lifestyle, do your best and review your improvements with your A team, reassessing progress and future objectives as you go along. The key is to keep heading in the right direction, and at some point, with a full discussion about your unique holistic personal profile and the agreement of your support team, you’ll acknowledge a point when maintenance can begin for a lifetime of health and wellbeing.

Photo: iStockphoto

Posted by: Pamela Peeke, MD at 12:46 pm

Wednesday, January 2, 2013

Your 2013 Plan: Twelve Months of Mental and Physical Transformation

By Pamela Peeke, MD

Tara Costa

Happy New Year to every WebMD member! Take a breath and hit the pause button. Let’s talk about how you want to live from here on out. If you believe you’re doing well— eating nutritiously, staying mentally and physically active— then keep it going, and try to continuously challenge yourself to stay engaged and on track. And share your thoughts on this blog and exchanges to help others. However, if you feel like making some improvements to boost your health and wellbeing, I’m going to roll out a simple, practical strategy to teach you healthy lifestyle basics while showing you how to coach yourself to sustain your success for a lifetime. You see, you have what it takes to help yourself. You just need to discover how powerful you really are.

I prefer to approach lifestyle as an ongoing, dynamic, holistic and integrative process. You’re not a robot that can be commanded to get up and exercise and eat well right away. You’re a human being who’s come to the table with a lifetime of triumphs and difficulties and you need to be honored for your uniqueness. As you look ahead at this new year, let’s think way outside any box, and instead be mavericks in how to craft a better way to live. You’ll notice I’m not emphasizing a 12 month weight loss campaign. This is much bigger. This is about a mind and body transformation that is sustainable for life— your life. Transformation is the goal.

For the next twelve months, you’ll be provided with a multilevel blueprint to help you navigate your mental and physical challenges. This will include:

Twice weekly blogs: You’ll be hearing wit and wisdom from the “Masters”, men and women who have achieved mental and physical transformations and are eager to share secrets of their ongoing journeys and success. In this blog you’ll hear from Tara Costa, well known from her Biggest Loser story and author of the foreword to my book The Hunger Fix. We welcome your comments on the blog and plan to reply to as many of one of you as we can.

Diet Community Exchange: Join the WebMD Diet Community Exchange and reach out to get support from other WebMD members who are at various stages of their transformation journeys. I’ll be there as well to answer questions, post tips and resources and participate in the discussion groups. Research now shows that when you can get ongoing support and coaching like this, you’ll be more successful in the long run.

Weight Loss Wisdom Newsletter: Sign up for the WebMD Weight Loss Wisdom Newsletter. You’ll see snippets from my blogs and the diet exchange interwoven into helpful new news to guide you on your journey. The wonderful editors do a terrific job of filtering through all of the new information coming in to drill down to the most helpful facts, tips and tools to arm you for your daily lifestyle challenges.

OK, are you ready to get started? Great. First, take my Are You Ready for Change quiz. It’ll help you get the reality check you need prior to embarking on your journey. This is meant primarily to help you start to think about the things you’ll need to change as you push forward. You’ll be addressing each of these on an ongoing basis so don’t worry about anything other than being aware that these are important issues.

1. Are you motivated to make long-term lifestyle changes that require eating healthy foods and becoming more physically active?

2. Have you fully identified the main stresses
in your life now and during the next several months?

3. Do you truly believe that there is no magic bullet, but instead patient work on your part?

4. Do you believe that you can change your eating habits?

5. Do you have family, friends, or both who will support your weight-loss efforts?

6. Are you willing to find ways to be more physically active?

7. Are you realistic about your mental and physical transformation goal?

8. Are you willing to record your food intake, physical activity, and mental focus, and will you make time to do so?

9. Are you willing to look at past experiences in starting a healthier lifestyle and other areas of your life to see what has motivated you and kept you working on obstacles to success?

10. Do you view changing your eating and physical activity habits as a positive experience?

11. Have you resolved, or are you in the process of resolving, any eating disorders or other emotional issues that make it difficult for you to achieve a healthy weight?

12. Do you believe that achieving your mental
 and physical transformation is a lifelong process that requires you to change your behavior, eating habits, and level of physical activity?

13. Are you ready to make that commitment?

There’s no right or wrong answer to this quiz. It’s an opportunity for you to review where you stand in your determination and ability to make changes in your life. Carefully examine the people, places and things in your life that may stand in your way to successful transformation. We’ll help coach you to how to adapt and adjust as you go along.

As many of you know, my baseline blueprint for change is using my infamous MIND MOUTH MUSCLE template. Let’s dig in with small steps in each element.

MIND:
We’re not doing any resolutions. We’re taking small steps to build a powerful foundation for lifelong health and wellbeing. Don’t stress yourself with lofty goals. Instead, practice staying mindful and vigilant for only TWENTY FOUR HOURS. That’s correct. Get through each day using my “Just for Today I Can_____”. Break up the day into segments highlighting the trouble hours (nightly eating, overeating in the afternoon, skipping lunch) and concentrate on your significant changes occurring during those blocks.

MOUTH:
I highly encourage you to log onto the WebMD Food and Fitness Planner. You need to have a basic plan to use and customize for your own needs. In future blogs, I’ll be talking about many of the new apps available and many resources to help you individualize your nutrition as you go along. For now, go to your kitchen and ditch any processed or refined food products lurking in your pantry and fridge. Give’em away or pitch them. Now, get to the grocery store and, using the Food and Fitness Planner’s guidelines, as well as my basic “how to prepare your kitchen for healthy eating” in The Hunger Fix, gradually stock up on whole foods. Vow “no more science fair projects in my kitchen!”

MUSCLE:
Assume the vertical more often each day. Just get up and move more. Walk for 30 minutes accrued at least 5 days every week. Add a little intensity by varying the speed or incline as you go along. Just take it gradually if you’ve been pretty sedentary. Grab a pedometer. Your eventual goal is 10,000 steps every day that you can. For now, just see what your start number is and plan on adding 500 or more steps per day every week until you hit your goal.

Finally, let’s end with the Voice of a Master.

I didn’t become 316 pounds overnight. Packing on the pounds was a process, one that, at times, I don’t want to remember. But finally facing what got me there is what has helped me realize that I never want to be like that again—lost, dissociated from myself, and hungering for the lies and the quick fix of my food addiction. I’m an emotional eater. Whether I was sad or extremely happy, it didn’t matter—every emotion was registered as “hunger” and filled with food. And the fact that most of my family has weight issues, and the majority of them are still obese, certainly didn’t help. Sunday dinners at Grandma’s house had four courses! There was no getting up in the morning to take a walk. We were clued out. Most of us do not understand that once we identify our true hunger, we can set the scope of our dreams—that no matter how powerful the influences are, we do not have to be trapped by our environments.” Tara Costa

Good luck and I look forward to hearing from you

Posted by: Pamela Peeke, MD at 10:24 am

Friday, December 21, 2012

Go Ahead and Reach Right into This Cookie Jar

By Pamela Peeke, MD

Cookie Jar

For most of her 67 years, Kris has waged war with her body weight. From early childhood, she carried much more weight than the other kids. As the years went on, she became hooked on the daily routine of overeating her favorite sugary, fatty, salty food combinations. Topping out at 325 pounds ten years ago, she’d had enough, detoxed off the junk, and managed to battle her way down to 220 pounds. She was going strong when her husband, the love of her life, passed away. Distraught, lonely, and grieving, she sought relief from her old “friends”– her food fixes — and packed on fifty pounds. Her expanded girth led to aching knees and back pain. Instead of retirement years filled with social activities and new challenges, Kris found herself hiding at home, filled with blame, shame, and guilt. Lost and feeling helpless, hopeless, and defeated, she finally realized she was addicted to these foods as well as her whole way of life. She’d had enough. That’s when she came knocking on my door.

Eager to start, Kris declared, “I’m ready to take on my munching monster”. As we began the journey together, she constantly amazed me with her ingenuity, always finding creative ways to switch out food fixes for healthier fare. Popping into my office shortly after our first session, Kris shared a little secret that I now want to gift you with. It’s called Kris’s Cookie Jar of Love and Inspiration.

Cookies were one of Kris’s go-to fixes, whether she was stressed, happy, or bored. Growing up, her mom would keep a constant supply of freshly baked cookies in a colorful jar. Sneaking into the kitchen day and night, Kris would dive into the jar, load up, and run with her precious stash back to her room. The cookies kept coming well into adulthood. When she hit 325 pounds, she knew the cookie binges had to stop. Staring at the cookie jar, she had mixed feelings. It had always conveyed a sense of comfort and safe harbor from life’s usual pains and angst. Yet, it also represented loss of control, a canister of cravings, and a mountain of anesthetics to numb her from the frustrations and anxieties in her life. Conflicted, she sat with it for a while and then had what I love to call an EpiphaME.

She loved that jar sitting in her kitchen and didn’t want to give it up. So she created a win-win solution. She’d keep the jar but redefined its role in her life. Grabbing a pen, scissors, and colorful paper, Kris set about cutting small circles and squares, the shapes of her familiar cookies. Then she inscribed on each piece of paper one of her favorite inspirational sayings. The collection included affirmations lovingly handwritten by her husband, who wanted to help cheerlead Kris through challenging times. Whenever Kris read or heard another great quote, she’d quickly make another “cookie” and toss it into the jar.

So, whenever she felt like caving to the craving, instead of diving into the jar to run from and numb herself with cookies, she now reached into the cookie jar and grabbed an inspiration or two. Reading “You go girl, you can do this to live the life you so deserve!” killed the craving on the spot. It also broke her addictive food trance and snapped her back into reality. Her mindfulness and vigilance was heightened. A deeply spiritual woman, she also prayed a little prayer of gratitude for her quick regrouping with the help of her cookie jar of love and inspiration.

The jar was her pal until her husband passed. Her grief was overwhelming and she sank into years of self-neglect, depression, and social withdrawal. The jar got pushed to the back of a kitchen shelf. When Kris awakened from this painful period seeking help, that’s when Kris and I began our journey together.

As we began her detox from her food fixes, we also began to reorganize her lifestyle habits to support the new program. And as we begun, she’d all but forgotten the jar. Until one day, she accidentally bumped the kitchen shelf and the jar landed in her lap. Smiling, she couldn’t help but think, “Coincidences are God’s way of acting anonymously”. Quickly, she reached into the jar, pulled out an inspiration and laughed out loud as she read “No, this isn’t a cookie — this is the rich and fulfilling life you deserve. That’s what you’re really hungry for.” Inspired once again, each week she now adds fresh new material to her cookie jar, which she now proudly displays front and center on her kitchen counter.

As we have worked together, Kris has been having countless EpiphaME’s. Perhaps many of you can identify with some of these as well. Each one has led to more inspirational “cookie” deposits in the jar.

1)     Practice Self-Compassion: Kris had never realized that she’d devoted her entire life to care giving others, mostly in deference to her own needs. This became apparent when her husband died. Suddenly she was left with a void. Who was she to care for now? It never occurred to her that she needed love and support and care giving as well. That’s when she realized she’d always believed she didn’t deserve that kind of attention. It was always about someone else. A milestone in her detox and recovery program occurred when she discovered that she not only deserved love and compassion, but without giving herself those two gifts, she could never be the best care giver to others. At the age of 67, she finally figured this out and realized it’s never too late.

2)     Pitch the Unhealthy Voices: “You’ll never make it,” “You’re too far gone,” “Give it up. It’s too late.” For most of her life, Kris listened and believed these Unhealthy Voices. In addition to feeling like she didn’t deserve happiness and love, she realized she was incorporating these voices into her sense of self-worth and self-esteem. When she did, she’d feel low and cave to the crave. Grabbing those cookie jar inspirations reminded her time and time again that she was strong and powerful and deserved every lick of love and support coming her way. This time she was angry and firm as she said “No more! I don’t believe those voices. I believe my own!” and set about writing more self-created messages of support.

3)     There’s Science Behind the Munching Monster: Like so many people, Kris was relieved and thrilled to realize that there was excellent new science to help her understand the biology of her relationship with food, specifically her food addiction. Armed with the new science (see The Hunger Fix book) and a plan of action, she was finally hopeful for lifelong recovery from being hooked on the hyperpalatables. She created more “cookies” that now said “Reclaim your brain. You can do this!”

As I write this blog, Kris has just emailed me another update. You can see she’s bound and determined to make this work:

“Things are going great as I go through some challenging times. I was invited to five holiday/retirement gatherings last week. I declined the buffet parties and chose the open house luncheon/tea and did very well sipping a cup of tea (trying different flavors) w/steamed shrimp & vegetables and staying away from the food on the Munching Monster’s tray and remembering that the party was about mingling, not munching!”

I have a suggestion for everyone. How about creating your own cookie jar experience? It could simply be a lovely box of affirmations, inspirations, and self-coaching thoughts that can help you when you feel the urge to cave and self-destruct. Hey, the jar’s contents are zero calories but heavy on the self-compassion, love and support. Give it a whirl!

For most of her 67 years, Kris has waged war with her body weight. From early childhood, she carried much more weight than the other kids. As the years went on, she became hooked on the daily routine of overeating her favorite sugary, fatty, salty food combinations. Topping out at 325 pounds ten years ago, she’d had enough, detoxed off the junk, and managed to battle her way down to 220 pounds. She was going strong when her husband, the love of her life, passed away. Distraught, lonely, and grieving, she sought relief from her old “friends”– her food fixes — and packed on fifty pounds. Her expanded girth led to aching knees and back pain. Instead of retirement years filled with social activities and new challenges, Kris found herself hiding at home, filled with blame, shame, and guilt. Lost and feeling helpless, hopeless, and defeated, she finally realized she was addicted to these foods as well as her whole way of life. She’d had enough. That’s when she came knocking on my door.

Eager to start, Kris declared, “I’m ready to take on my munching monster”. As we began the journey together, she constantly amazed me with her ingenuity, always finding creative ways to switch out food fixes for healthier fare. Popping into my office shortly after our first session, Kris shared a little secret that I now want to gift you with. It’s called Kris’s Cookie Jar of Love and Inspiration.

Cookies were one of Kris’s go-to fixes, whether she was stressed, happy, or bored. Growing up, her mom would keep a constant supply of freshly baked cookies in a colorful jar. Sneaking into the kitchen day and night, Kris would dive into the jar, load up, and run with her precious stash back to her room. The cookies kept coming well into adulthood. When she hit 325 pounds, she knew the cookie binges had to stop. Staring at the cookie jar, she had mixed feelings. It had always conveyed a sense of comfort and safe harbor from life’s usual pains and angst. Yet, it also represented loss of control, a canister of cravings, and a mountain of anesthetics to numb her from the frustrations and anxieties in her life. Conflicted, she sat with it for a while and then had what I love to call an EpiphaME.

She loved that jar sitting in her kitchen and didn’t want to give it up. So she created a win-win solution. She’d keep the jar but redefined its role in her life. Grabbing a pen, scissors, and colorful paper, Kris set about cutting small circles and squares, the shapes of her familiar cookies. Then she inscribed on each piece of paper one of her favorite inspirational sayings. The collection included affirmations lovingly handwritten by her husband, who wanted to help cheerlead Kris through challenging times. Whenever Kris read or heard another great quote, she’d quickly make another “cookie” and toss it into the jar.

So, whenever she felt like caving to the craving, instead of diving into the jar to run from and numb herself with cookies, she now reached into the cookie jar and grabbed an inspiration or two. Reading “You go girl, you can do this to live the life you so deserve!” killed the craving on the spot. It also broke her addictive food trance and snapped her back into reality. Her mindfulness and vigilance was heightened. A deeply spiritual woman, she also prayed a little prayer of gratitude for her quick regrouping with the help of her cookie jar of love and inspiration.

The jar was her pal until her husband passed. Her grief was overwhelming and she sank into years of self-neglect, depression, and social withdrawal. The jar got pushed to the back of a kitchen shelf. When Kris awakened from this painful period seeking help, that’s when Kris and I began our journey together.

As we began her detox from her food fixes, we also began to reorganize her lifestyle habits to support the new program. And as we begun, she’d all but forgotten the jar. Until one day, she accidentally bumped the kitchen shelf and the jar landed in her lap. Smiling, she couldn’t help but think, “Coincidences are God’s way of acting anonymously”. Quickly, she reached into the jar, pulled out an inspiration and laughed out loud as she read “No, this isn’t a cookie — this is the rich and fulfilling life you deserve. That’s what you’re really hungry for.” Inspired once again, each week she now adds fresh new material to her cookie jar, which she now proudly displays front and center on her kitchen counter.

As we have worked together, Kris has been having countless EpiphaME’s. Perhaps many of you can identify with some of these as well. Each one has led to more inspirational “cookie” deposits in the jar.

1)     Practice Self-Compassion: Kris had never realized that she’d devoted her entire life to care giving others, mostly in deference to her own needs. This became apparent when her husband died. Suddenly she was left with a void. Who was she to care for now? It never occurred to her that she needed love and support and care giving as well. That’s when she realized she’d always believed she didn’t deserve that kind of attention. It was always about someone else. A milestone in her detox and recovery program occurred when she discovered that she not only deserved love and compassion, but without giving herself those two gifts, she could never be the best care giver to others. At the age of 67, she finally figured this out and realized it’s never too late.

2)     Pitch the Unhealthy Voices: “You’ll never make it,” “You’re too far gone,” “Give it up. It’s too late.” For most of her life, Kris listened and believed these Unhealthy Voices. In addition to feeling like she didn’t deserve happiness and love, she realized she was incorporating these voices into her sense of self-worth and self-esteem. When she did, she’d feel low and cave to the crave. Grabbing those cookie jar inspirations reminded her time and time again that she was strong and powerful and deserved every lick of love and support coming her way. This time she was angry and firm as she said “No more! I don’t believe those voices. I believe my own!” and set about writing more self-created messages of support.

3)     There’s Science Behind the Munching Monster: Like so many people, Kris was relieved and thrilled to realize that there was excellent new science to help her understand the biology of her relationship with food, specifically her food addiction. Armed with the new science (see The Hunger Fix book) and a plan of action, she was finally hopeful for lifelong recovery from being hooked on the hyperpalatables. She created more “cookies” that now said “Reclaim your brain. You can do this!”

As I write this blog, Kris has just emailed me another update. You can see she’s bound and determined to make this work:

“Things are going great as I go through some challenging times. I was invited to five holiday/retirement gatherings last week. I declined the buffet parties and chose the open house luncheon/tea and did very well sipping a cup of tea (trying different flavors) w/steamed shrimp & vegetables and staying away from the food on the Munching Monster’s tray and remembering that the party was about mingling, not munching!”

I have a suggestion for everyone. How about creating your own cookie jar experience? It could simply be a lovely box of affirmations, inspirations, and self-coaching thoughts that can help you when you feel the urge to cave and self-destruct. Hey, the jar’s contents are zero calories but heavy on the self-compassion, love and support. Give it a whirl!

Photo: Photodisc

Posted by: Pamela Peeke, MD at 2:35 pm

Tuesday, October 16, 2012

Food and Addiction: Hand Over the Chocolate and Nobody Gets Hurt

By Pamela Peeke, MD

Pam, Katie, and Shayla

For years I have listened to my patients referring to their eating problems using a drug vernacular. “I need another hit,” they would say, “Withdrawal is killing me,” or “I need to score some more.” In the back of my mind and those of my colleagues, we collectively wondered if there was an addiction going on here.

At that time in history, there were some compelling research studies that suggested a food and addiction link. But all of us needed more. I waited somewhat impatiently until there was finally a critical mass of data from neuroscientists. When there was finally enough excellent, credible published information, I did what I’d planned for so long — write a book, translating this groundbreaking new science into practical tips and tools to help people who were hooked on certain foods and felt helpless, hopeless, and defeated about it. When I launched The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction I must have hit a nerve. Within five days of launch, the book became a bestseller. All I cared about was that people could benefit from knowing that, as many have shared, “I’m not crazy — there’s something real going on in my brain”. For that matter, at the Weight of the Nation conference in Washington, D.C., last May, Kathleen Sebelius, Secretary of Health and Human Services, stated in her keynote address, “Obesity can be caused by any combination of factors. For some it’s an addiction like smoking.” That was a first from such a high-ranking government official.

Food addiction is real.

Capsule Summary of the Science: The first chunk of new science presented in the book—based on NIH research by Dr. Nora Volkow, Director of the National Institute of Drug Abuse — was possible through the use of unique brain scans (PET and functional MRI’s) enabling scientists to  peer into the brain and identify changes that occur when someone is actively addicted to anything—from alcohol to drugs to food. Scans show damage and impairment in both the reward center as well as what I call the “smarty pants” part of the brain, or the prefrontal cortex (PFC). Tap your forehead. Right behind it lies the PFC. It provides you with executive function—planning, organizing, creating, and reining in impulses. It helps power up your willpower as well as your won’t power. If it is dysfunctional, moderation becomes a moot point.

Food is meant to be palatable, rewarding, and pleasurable. Our reward system secretes rivers of the pleasure brain chemical dopamine when we are cued up to find our favorite foods as well as when we’re consuming them. Dopamine drives us to love the smoothness of fat, and consuming it helps us survive in times of famine. That primal reward and survival system has been working beautifully for thousands of years.

 

Then something happened: we changed up the food supply. To feed a large population, food had to be manufactured, frequently with added sugar, fat, and salt to enhance taste. Your primal brain was overexposed to the 24/7 availability of the sugary/fatty/salty food combos—the “hyperpalatables”. Most brains were overwhelmed with this daily tsunami of reward and pleasure. Consuming these kinds of foods left people feeling out of control leading to overeating. As a result, the brain’s primal survival mechanism kicked in. It drove down the number of dopamine receptors so that you didn’t feel this overload of reward and were no longer over-stimulated. That’s the good news. The bad news is that now you can’t feel the usual pleasure with one serving of a certain food, and suddenly you need more and more. Before you knew it, your buttons were popping and fitting into your jeans became mission impossible.

 

The bottom line is that the sugary/fatty/salty combos hijack your reward center and impair the part of your brain that is supposed to help you be focused, stay vigilant, and rein in the urge to splurge. The end result is that you cave to the crave every time. That’s the vicious cycle of addictive eating.

 

Physical-Mental Changes: In the study of food addiction, biology meets psychology. They are inextricably intertwined. In all addictions, there are organic brain changes as well as conditioned behavioral responses that both have to be addressed in prevention and treatment. We’re saying goodbye to the days when we assume this is only about willpower. That’s one component, but based upon the new scientific findings, healing the organic damage must be integrated into any intervention.

Who’s affected? Yale University researchers created a validated science-based quiz to see if you have an issue with food and addiction. Take a moment to check it out here. People of all sizes and ages can be affected. Experts predict that after rigorous population sampling is conducted, the majority of overweight and obese people will be found to be food addicted to some degree. Folks who are cross addicted (have more than one addictive habit such as food and smoking) tend to have a more pronounced experience and during treatment, need to really hone their vigilance and focus to stay on track through recovery.

What This Means to You: This new research is a game-changer. No longer will people be foisted into a one-size-fits-all approach to weight management and wellbeing. Instead, we have now discovered a new category of folks, those with an issue with food and addiction, who need a more customized and individualized approach to their problem. What’s that going to entail?

You have to do direct battle with the hyperpalatables. Identify which foods and beverages lead you to lose control. As with any addiction, you have to go through a withdrawal, and then enter a lifelong recovery. I use my trademark three pillars: Mind, Mouth, Muscle to power you through the process. You’ll be changing up entrenched lifestyle habits as well as healing your brain’s reward and PFC centers.

Join Shayla on Her Journey: I was thinking about the best way to share this science with WebMD readers. The answer is to make it real. When I appeared on one talk show, I was asked to work with an extraordinary young woman, Shayla, who has a profound food addiction, especially to sugar. Watch the show and pay particular attention to her segment and the video of Shayla at home surrounded by her chosen hyperpalatables. It has been an honor to work with her as she has courageously taken herself on, detoxing while living her rich and full life as a mother, spouse, mental health professional, and part-time college student. Beginning this week, follow her experiences as she strives for progress, not perfection, and tackles the daily challenges of coming clean and staying that way. I’ll also be introducing other wonderful men and women who are looking for support in their journeys. Check out our Diet Community Discussion Group and help support your fellow WebMD members. Whether you have already achieved your health and wellness goals or are beginning or somewhere on the journey, everyone wins. It’s through sharing that the lessons come alive and become meaningful and relevant to your life.

We look forward to vibrant and terrific communication on the blog and the exchange.

 

Posted by: Pamela Peeke, MD at 1:00 am

Tuesday, July 24, 2012

Rebel Against the One-Size-Fits-All Definition of Fit and Healthy

By Pamela Peeke, MD

Woman Smiling in Mirror

Tired of someone else telling you what fit, beautiful/handsome, or healthy looks like? Every day, the media bombards us with images of their biased take on buffed and chisel-fit bodies. When WebMD members begin their journey from an unhealthy/unfit starting point to one much healthier, I’ll bet some of those Photoshopped pics float through their minds. My recommendation? Reject the pretty pics and concentrate on creating your own definition of what it looks like to be at your best, mind and body. Want some help with this? Log onto fitnessrebellion.com, read the manifesto carefully, make that commitment to self, and become a health and fitness rebel.

I love this approach. Look at the opening words:

‘I reject the notion that beauty, desirability, and worthiness are one size fits all. I think happy people are the healthiest people. It’s not enough to just look good on the outside. I want to feel good on the inside, too.

‘I will give my one, precious body the respect it deserves. We’ve been together a long time, and we’ve got miles to go. When my body is strong, I am strong. When my body feels good, I feel good. Wherever I go, my body goes, too. When I take care of my body, it takes care of me.

Who created this? My good friends and founders of Anytime Fitness, Chuck Runyon and Dave Mortensen. You might have also just seen them on the Secret Millionaire living in a struggling Omaha neighborhood and giving back to that community. They have a wily sense of humor too. Chuck and team recently authored the terrific book with the provocative title Working Out Sucks, accompanied by the subtitle And Why It Doesn’t Have To. It’s an easy and fun read and segues smoothly into their Fitness Rebellion website. Runyon’s voice is authentic, as he can relate to every man or woman who’s ever broken into hives just thinking about exercise. He gets it. As well, he asks you to do this as a personal journey and to dance to the beat of your own drums.

So many people look at themselves in the mirror and feel frustrated and hopeless. Why? They’re comparing themselves to others, whether from real life or from the media. That’s why you have to become a rebel and reject the hype, unrealistic expectations, and false promises of overnight miracles.

Now, take another look at yourself in the mirror and smile with compassion, kindness, and love. Here are next steps:

1)   Start every day with the following commitment: “Just for today, for the next 24 hours, I will commit to_________,” and then fill in the blank with one small step you’re going to stick to. It could be getting to bed by 10 p.m. or having a healthy breakfast. Frustration is born when you live in the future, fretting that you’ll never get to the finish line. Bag that, and stay mindful and in the present moment. Embrace it, live it, and stay focused and on track. You can do this for 24 hours. Take every day this way. Wake up with that daily commitment to self.

2)   Practice self-pride and love. Celebrate every victory (“Hey I ate a healthy breakfast three days in a row so far!”) no matter what size. Be proud of your efforts. Give yourself countless “atta girl/boys throughout the day”. Stop the negative speak to self. No, you’re probably never going to grace the cover of Sports Illustrated. So what? You’re powerful and wonderful and getting healthier all of the time. That’s what you want to concentrate on. Stay present!

3)   Take care of your body. Recall the words of the manifesto “When I take care of my body, it takes care of me”. It’s true! If you want to enjoy your vacation, or that next hike or swim or bike ride with the family, you need a fit and healthy body. You brush your teeth, so care for your body as well. And reap the rewards.

4)   Turn mistakes into lessons. You’re human. Everyone’s going to slip and slide. No problem. Just convert that digression into a lesson. What did you learn? How can you prevent future problems? Think it through. Spend zero time thrashing yourself for a mistake. Spend lots of time coming up with creative solutions so it doesn’t happen again. This learning process is lifelong, so get used to regrouping and moving on.

5)   Be a rebel. You define your best mind and body. You compete with you when you’re taking that morning walk. Today you’re faster, lighter on your feet than yesterday. Terrific! You’re down a pant or dress size. Well done! Just keep it movin’ as you continue to practice your healthy lifestyle habits every single day.

Bottom line: Own this journey you call life. It starts with taking a stand, defining your own success, and, of course, starting your own fitness rebellion.

Photo: iStockphoto

Posted by: Pamela Peeke, MD at 7:46 am

Tuesday, June 19, 2012

Secrets of Mindful Eating

By Pamela Peeke, MD

Chef Chad

You hear it all the time: “Eat mindfully and you’ll not only enjoy your meal, but it’ll be easier to shed weight.” Sounds like a win-win. But most of us hop out of bed at O’Dark Hundred and hit the ground running. We race out the front door either skipping a meal, doing a grab-and-go, or engaging in a bit of dashboard dining. Regardless, we’re usually stuffing food into our mouths…mindlessly. It’s hard to taste and savor when within seconds a meal or snack is gulped and out of sight. It’s also hard to drop that excess weight when our frenzied feasting doesn’t allow enough time — 20 minutes — for the mind to register you’ve eaten enough to satisfy your body’s needs.

Mindless eating like this messes with four key “friends” in our own body chemistry that work together to help us sense fullness and rein in over eating:

1) Cholecystokinin (CCK) is an intestinal hormone that tells the brain you’re in the process of consuming food.

2) Leptin is a fat cell hormone that monitors your fat storage and directs the brain to stimulate more or less eating based upon your energy needs. CCK and leptin work together to produce a sense of fullness.

3) Grehlin is a stomach hormone that stimulates appetite for more food, based upon the brain’s communication with CCK and leptin.

4) Dopamine is a brain neurotransmitter that works in concert with CCK to enhance your sense of pleasure and reward from eating.

By slowing down your eating pace, you allow your own body/brain chemicals to work optimally. Your reward is better enjoyment of your food and, studies have shown, far fewer calories consumed.

You can practice mindful eating anywhere. Always make certain you’re not overly hungry before eating by keeping up with your every 3-4 hour snacks and meals throughout the day. Next up, put that fork/spoon down after every bite. Take a breath and savor the moment.

The best way to practice mindful eating is at home. And here’s the catch: If you want to do this well, do some cooking. Yes, that means spending a little time in the kitchen preparing and then enjoying the fruits of your labors. Science shows that people who cook more drop more weight.

To help guide us on this mindful journey, I turned to my good friend Chef Chad Luethje, executive chef at the Miraval destination spa resort, famous for its mission to encourage people to be mindful and present as they live their lives. I’ve known Chef Chad for many years and have discovered countless handy tips, tools, and techniques while attending his demonstrations. I’ve also waited patiently for him to finally put it all together in a book. At long last “Mindful Eating” (Hay House 2012) landed on my doorstep and I dived in to find nuggets I can now share with all of you. Here are some highlights to help get you started.

1) Cooking is not rocket science. Don’t break out in nervous hives at the thought of cracking open a cookbook and trying some of the recipes. Perhaps the last time you boiled water or cooked an omelet dinosaurs ruled the earth. No worries. Establish a new attitude and look forward to having fun. Start with a few simple recipes that entice you. Build your own repertoire of snacks and meals from there. Don’t be afraid. You can do this.

2) De-Clutter your kitchen. Cobwebs in the pantry? Dust balls rolling around your pots and pans? Microwave functioning on overdrive? You’re not alone. Welcome to the new American kitchen. First things first.

a) Get rid of the processed and refined foods. Purge your cabinets, fridge and freezer of these unnatural science fair projects.

b) Pitch your ancient foods. Look at the expiration dates on any foods you’re keeping. I’ll bet you’ve got some scary museum-grade goodies for the garbage can.

c) Open up your working space. To cook, you need open spaces to work. De-clutter your counter tops. Seeing lots of wide open surfaces helps you feel less stressed, more creative, and organized.

3) Get the right tools. Most people are clueless about what equipment they actually need to cook with. Chef Chad to the rescue with some helpful hints.

a) Bag the knife block. Instead of laying down a lot of cash for that usual block of knives, Chef Chad says all you really need are a quality 8- or 10-inch chef’s knife, thin cleaver, long serrated knife, a 3-inch paring knife, and a carving knife.

b) Pots ‘n pans. The Miraval team recommends stainless-steel-lined pans with an aluminum core. They heat quickly and evenly. Nonstick pans are OK only if you hand wash them and keep an eye out for scratches, which can expose you to the toxic chemicals used to make the coating.

c) Mixing bowls. You’ve got options here — stainless steel, ceramic, and glass. Stainless steel may not go into the microwave like glass, but it tends to be more durable.

d) Heavy Lifting. You need a good perforated metal spoon for stirring stocks and soups. Silicone spatulas that can handle high heat are essential. Lift and turn hot foods with scalloped-edged tongs.

e) More. From food processors to vegetable peelers, there are many more suggestions in the book.

4) Let’s cook! The following is a sampling of cool cooking tips to spice up your mindful journey.

a) Kosher salt’s larger granules take longer to shake out than iodized, so you consume less salt. Plus Kosher salt tastes better and contains 30% less sodium than iodized.

b) Don’t pour oil straight from the bottle. Use less oil by reaching for a plastic spray bottle instead.

c) Herb it up to enhance taste. Dried herbs have more concentrated flavors so use them first. Fresh herbs are added last as their flavors dissipate faster.

d) You don’t need regular high-fat mayo when you can combine three parts plain nonfat yogurt to 1 part reduced fat mayo. No one will ever know!

Here are some general secrets for success for those of you embarking on your mindful eating journey:

1) Sit down and turn off the TV, don’t answer the phone, and get away from the computer while you’re eating. Distractions of any kind foster mindlessness.

2) To become aware of slowing down your racecar pace of eating, use your non-dominant hand and/or use a smaller fork or spoon on a smaller plate. For grins, use a timer to see how long you can go between bites.

3) Watch your portion size by using measuring cups. Almost everyone underestimates how much they really dole out on a plate. Keep a set of measuring cups around — ¼ and ½ cups are great to start with.

Finally, try to integrate mindfulness into all of your daily activities. When you walk, be mindful of your surroundings, inhaling floral aromas and the green spring and summer vistas. Listen carefully to people as they speak to you, being mindful of their body language and verbal cues. It’s amazing how much we miss when we’re not living in the moment. Start this mindful journey with small, gradual steps. I guarantee you’ll be rewarded with a life — and meals — you’ll savor for a lifetime.

Posted by: Pamela Peeke, MD at 6:34 am

Monday, May 21, 2012

Why the Marathon is a Metaphor for Life

By Pamela Peeke, MD, MPH

Pam and Beth

I wonder how many of you have a bucket list of items you want to do during your lifetime. I have mine. There are jewels of adventure and experiences I want to have while I’m still able to rock and roll physically and mentally. One of those was running the Boston marathon. Truth be told, I have no business running marathons, as I’m built for the sprint. But there’s something cool about that medal at the end of the long road.

When my colleagues at the American Medical Athlete Association (AMAA) invited me to speak at their 2012 annual meeting, which takes place the weekend of the Boston marathon, they also offered me an opportunity to run with them in the race. And of course I accepted. You see, this was going to be my last marathon, the end of long distance running in my life. So this marathon was very special. It was my swan song to the 26.2-mile challenge.
With outdoor athletics, the one potentially troublesome variable is the weather. As all of us Boston runners eagerly logged onto the predicted temperature for race day, to our amazement, the weather was becoming unseasonably warm. To make matters worse, the only day predicted to have a major temperature surge was race day. Worried race administrators began to send a series of emails to all runners inviting anyone with medical conditions to defer until next year. Four thousand of the almost 29,000 qualified runners took them up on their offer. About 25,000 of us decided to give it a go on April 16th. For me, there was no option. My mind was set on completing this bucket list item and having fun, somehow, out on the hot and hilly course.

On race day, as the bus filled with my fellow AMAA runners pulled up into Hopkington, I reflected on the fact that I would be running this race by myself, for myself. So often, I have brought my patients and other people along with me. But this last marathon was different. It was a personal journey, taking myself on mentally and physically. I’d done my calculations. For every 5-degree increase over 60 degree weather, I had to slow my pace by 30 seconds. This is frustrating but necessary to avoid heat injury. I looked ahead at a good 5 hours, took a deep breath, and when my wave was up, I was running, following trainer Jeff Galloway’s recipe for safety and success.

Soon enough it was over 90 degrees. As I reached mile 6, I spotted a woman I had noticed in my audience at the AMAA meeting the day before. She was remarkable because she was in terrific shape and she appeared to be older than the average audience member. I also noted that she seemed to be straining to the left, but was trying to keep a steady pace. I headed over and we greeted one another. Beth is a 75-year-old retired nurse practitioner from Wisconsin. This was her 8th and last Boston marathon and she was determined to finish it. As a physician, I was worried. Despite her wonderful health, 75 years old in 90-degree heat and running was of concern to me. She also noted some back pain, and thus her twisting to the left. OK, do I high five her and continue on my own journey, or do I hang out with Beth and make certain she makes it to the finish line and snags the medal? It didn’t even take a nanosecond to make the decision. Laughing at each other’s bad jokes, Beth and I passed mile 7 together and we were like two peas in a pod from that moment on. It was a win-win. I cherished her wit and humor and companionship and she had me to light a fire under her when things got tough.

Beth and I were keeping it safe with a slow and steady pace. As we hit half marathon and were being cheered on by hundreds of young Wellesley women, I noticed Beth was slowing up on the hill, her back bothering her a bit. The heat was punishing and after 13.1 miles, the medical tents were filled to capacity with people of all ages. I decided to generate a renewed spark of energy in Beth by shouting at the crowds –  “Hey, let’s give it up for Beth. She’s 75!” This was met with deafening cheers and young women screaming: “You’re my inspiration!” Beth jabbed me in the ribs and shouted: “I can’t believe you told them my age!” Laughing, I noted her pace had quickened and she was proudly thrusting her chest out, assuming the posture of a winning running warrior princess. I resorted to this three more times, each time as successful as the last in prompting a second wind. As we passed Boston College, Cameron, a handsome 19-year-old student, popped out of the spectators and ran out beside Beth shouting “I’m going to get you through the next mile!” Smiling, with a twinkle in her eye, she looked at me and said, “He’s definitely my type, so hands off!” He kept her occupied with adolescent banter for the next mile, then graciously bowed out, waving and wishing us good luck. Beth jabbed me again and said, “Do that shout out thing again and let’s get another one!”

When we reached mile 16, the famous four hills loomed ahead of us. Funny thing, neither of us cared. We actually love hills, preferably in cooler weather, of course. What we didn’t know was that earlier in the race at mile 18, last year’s world record breaker in the men’s Boston division, Geoffrey Mutai (2:03:05), had bailed out of the race due to cramps. Other elites were dropping out as well. Neon signs warned runners to take walk breaks, unheard of at this marathon. As it turns out, our marathon was making history as one of the hottest.

Meanwhile, Beth and I were gradually making our way up the hills. What helped us survive was not only the welcome sport drinks and water provided by the Boston Athletic Association, but the thousands of spectators. God bless every one of them for these four gifts:

1) A boisterous and heartfelt chorus of “you can do it” cheers;

2) Ice from their freezers as well as store-bought, which Beth and I happily dumped into our hats and down our fronts;

3) A run for the hoses, as the 26.2 miles was strewn with tall ladders and atop each one was some kind and wonderful person with a garden hose spraying us as we ran by;

4) Every flavor of popsicle, which began about mile 16 and was so wonderful that, to this day, and probably for the rest of my life, I can still taste the strawberry and mango melting in my 100-degree mouth.
By mile 22, we’d reached the top of Heartbreak Hill. Four point two miles of running on the flat to go. I looked at my watch and realized we were doing fine for time. Two more miles and then we finally entered downtown Boston, where the crowd’s clapping and cheering magically buoyed us through more pavement pounding. Viewing the large CITCO sign, I knew we had one mile to go. I felt terrific and sprinted ahead to fulfill my dream of running down Boylston Street Rocky style, pumping the air, mile-wide smile, a few tears of joy, and a dash across the finish line. Beth and I were greeted by gleeful friends and a welcome seat to finally rest after finishing our quest. Twenty-one thousand men and women completed this 116th running of the Boston marathon that sweaty day.

So, why is the marathon a metaphor for life? Because it’s an exercise in life mastery. Here are some tools to help guide you:

1) Set and Achieve Goals: It’s so important to have a goal you can visualize and can help give you a context within which your other life decisions can be made. Set your mind on a goal, work hard to prepare, learn to stay focused, and push through to achieve.

2) Practice Mindfulness: By being present and concentrating on every step taken in any journey in your life, you’ll realize that life is lived while you’re striving to achieve your goals, not just by achieving them. Live and breathe in the moment, embracing the sights and smells and beauty of your life.

3) Learn to Adapt and Adjust: You never know what life throws you on your quest to achieve any goal in your life. Instead of quitting and running away when things get rough, stay focused and determined and learn how to adapt and adjust.

4) Expand Your Tribe: When you get out there and participate in anything from a book club to a hiking group, you’ll meet amazing people along the way. Some may become lifelong friends. You can’t make new friends unless you show up. Create your own support system and cheerleading squads. We all need them.

5) When You’re Giving to Others, the Journey Gets Easier: Buddying up with Beth most definitely added the spice and fun I needed to have the best experience ever. When you’re sharing with someone else, the miles go by pretty quickly.

6)No Regrets: Throughout your life, make certain to live it richly and fully. Take risks and don’t be afraid to experiment and do new things. Be courageous and adventurous. As Helen Keller once said, “Life is either a daring adventure, or nothing at all.” Err on the side of the adventure!

Speaking of which, I’m already exploring fun new exploits. What about you? Stop deferring and start living. Your adventure awaits you.

Photo: Dexter Emoto

Posted by: Pamela Peeke, MD at 11:16 am

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