Do you believe it? Can you see it?

A person wakes up one day and realizes that s/he is in bad shape, already showing signs of poor fitness and at risk for serious diseases and reduced longevity.

It may be her/his doctor who has made this reality extremely clear, or it may be other events and experiences that lead someone to this realization about their current health and fitness levels.

When this "awakening" happens, and not before, then a door is opened to the potential for greater wellness. Once one has grasped the seriousness of the current state and glimpsed the possibility of improving it, then the motivation to change will be there.

On the other hand, a person who feels that a successful weight control outcome is not likely to start, let alone succeed in the long-run. Where does the self-belief needed to drive and maintain long-term change come from?

Firstly, it is developed through practice - practice makes perfect they say, and practice builds confidence.

A second source of inspiration is the imagination. The power of the imagination is often ignored or dismissed, but it is an important source of motivation. Imagination allows us to mentally play with different decisions, options, goals and plans.

Can the person see herself in a "transformed" state, with large and dramatic improvements in the quality and quantity of eating and exercise, health and fitness?

Up to what point does it all seem feasible? Desirable? Acceptable?

Sometimes there is a lack of self-belief and the ability to even envision success. What is stopping the person from visualizing the change? The obstacle in this case is in their own head.

It is this level of thinking - the core beliefs and mental blocks - that must be explored and worked on in order to allow successful obesity treatment.

Stephen Stotland, Ph.D.


Emotions and success in long-term weight control

It is now widely recognized that emotions are important in weight control.

The more that unhealthy eating and exercise habits are tied to emotions the more that they get strongly reinforced, so become stronger and stronger habits.

This means that "successful weight management" requires a new kind of emotional management.

Simply put, better long-term weight management requires an untangling of the link between emotions and behaviours that result in weight gain (i.e. overeating and underexercising).

How does a person change the strong link between unhealthy eating, exercise and emotions?

It starts with awareness. One has to see and understand one's habits and their consequences. Then comes a determination to change, for whatever reasons and values are important to the individual. Then comes learning new habits...the apprenticeship...and then continuing to practice...gradually gaining mastery.....

And dealing with difficult emotions all along the way without losing focus.

What does it take to really, truly change bad habits and achieve better health and happiness?

It takes a consistent effort of mind and body.

You can do it! We can help.


Canadian Obesity Summit 2013

I enjoyed the 3rd Canadian Obesity Summit, May 2013 in Vancouver. It was a great chance to talk with peers working on obesity. Today there is a great diversity of academic disciplines involved in the study and treatment of obesity. It's impressive how much intellectual talent we have working on this problem in Canada, and this is never more on display than at the annual summit. Congratulations to all the organizers for putting this together year after year and helping it grow both nationally and internationally.

I had the opportunity to present on two topics at the summit. In a Clinical-Focus seminar session, I presented with Caroline Larocque on "the therapeutic relationship in obesity treatment." We tried to open up an important new perspective on obesity treatment research, going beyond the typical consideration of weight loss outcome. While the ultimate goal of research is to improve treatment outcome, in order to accomplish this we need to intensively study the treatment process, in particular the patient-therapist relationship.

In a second presentation, with Maurice Larocque and Laurent Legault, I presented our work on the validation of a new assessment device for adolescent obesity. The new online questionnaire that we developed, which we call the Adolescent Weight and Wellness Inventory (AWWI) may be used as a screening device in the general adolescent population to assess risk of behavioral and emotional problems that may lead to weight problems and eating disorders. The AWWI provides a measure of a large number of variables that are important for weight management, along with information about general emotional and interpersonal adjustment.

Stephen Stotland, Ph.D.


Multidisciplinary Obesity Treatment Program

What is the best treatment for obesity?


A lot of people kind of take this on faith now.

It just makes sense, that more help, more professional perspectives, the more successful the treatment.

Multidisciplinary sounds right.

So why are there so few specialized multidisciplinary teams offering treatment of obesity?

Not many professionals specialize in obesity treatment, and a team of like-minded specialists is therefore even more rare.

The Montreal Comprehensive Weight Management Program is a highly experienced multidisciplinary team of medical, psychological, nutrition and exercise professionals.

We are proud to be able to offer this type of comprehensive care!

Stephen Stotland, Ph.D.


The Right Diet

Is there a 'right diet' for everyone? How much depends on the individual? How much is universal?

Yes. And no.

The simplest question is "energy," or how many calories one needs. Individual energy expenditure is only partially predictable with universal formulas. There are large individual differences in actual energy expenditure.

Beyond calories, there are other questions about optimal nutritional intake - how much protein, fat, carbohydrate, vitamins and other micronutrients do we need?

The optimal diet seems to be low in fat, moderate in protein, and high in carbohydrate and fiber.

The right diet for an individual depends on their physical condition and activity pattern. With increased activity comes additional nutritional needs (more energy!).

Achieving the right diet is an individual process, based on our history, habits and preferences.

In our clinic we help promote an internal self-discovery process that does not depend on a particular diet or overly rigid control of eating and exercise, but a natural way of being that is consistent with one's values and preferences.

The real purpose of obesity treatment is to support the individual in discovering a lifestyle that works for them. That is the "right diet."

Stephen Stotland, Ph.D.


Practice makes perfect in weight control

Let's try to define what we mean by weight control "practice."

Firstly, like any practice, it begins with a desire to improve something, an intention to change, a goal. In other words, we begin by considering the quality of motivation.

Progress comes from turning motivation into action....keeping up a consistent practice.

The more effort that's put into improving eating and exercise, the better the weight control outcome. That's true on both a short- and long-term basis.

In our view regular practice leads to "internalized" change, meaning that the new habits become automatic, natural and desirable, and this leads to better long-term weight loss results.

So practice, practice, practice !!!

Stephen Stotland, Ph.D.


To Optifast or not to Optifast, that is the question.

Why would you want to give up food for a liquid meal replacement? There are actually several reasons why this might be a good idea. In some cases Optifast is used for the purposes of very short term weight loss, for example by patients preparing for a surgery in which losing weight may actually reduce the risk and speed recovery (e.g. weight loss surgery, other gastrointestinal surgeries). This effective weight loss method might also be used by women who want to increase their chances of becoming pregnant in the context of fertility treatment. The most common use of Optifast is as part of a long-term medically-supervised weight management program. In this case, the use of a meal replacement is step one of a multi-phase approach. In the present discussion I will examine the role of Optifast in the program that we offer in our clinic.

Firstly, a quick description of the product. Optifast is a meal replacement that can be used as a total substitute for food, providing all of the basic nutrition that one needs in a very low calorie package. The Canadian version provides 900 calories per day. That does not sound like a lot (it isn't), but the formula includes adequate amounts of protein, fat and carbohydrate for the average person -- medical supervision is necessary, because there are some cases in which this isn't true.

In our program, Optifast is offered as a "choice," one of several treatment options. The main reasons that an individual chooses this route is its simplicity and efficacy. In other words, taking 4 liquid meals ("shakes") at 4 hour intervals during the day is pretty straightforward and, given the small amount of calories consumed, the resulting weight loss can be quite dramatic. So patients select this approach because they are highly motivated to get off to a fast start with a safe and structured solution.

Of course, giving up eating comes with certain costs. This is a practical method, not a gourmet one. The taste of liquid meal replacements is not surprisingly quite bland. Most people adapt fairly quickly, finding ways of preparing it to their own taste, and some people even come to like it. There are social inconveniences as well, such as not being able to join in a meal with others, or having to cook but not eat what one has prepared. Physically, there is also a short term adaptation period, several days in which one may feel tired and hungry. These costs are short-term, however, and easily handled by most people.

Some people are skeptical about the long-term effects of using meal replacements, and for good reason. One is not about to stay on such a product forever, so what happens when one stops? In many cases, people who use such products, lose substantial amounts of weight and then go back to food, quickly regain their weight. They end up feeling disappointed and discouraged and of course question the value to the product. The point is as follows: meal replacements on their own have absolutely no long-term usefulness. Most people need professional support to guide them back to food, and towards the long-term behaviour changes needed to ensure weight loss maintenance.

So why not skip the "artificial" products and go straight to working on the behaviour changes? That certainly works for some people, but for others the intial simple, structured and effective meal replacement phase is a great way to get started. In a well-designed treatment program, the transition back to food will be slow, and will allow the patient to find a way of eating (and exercising!) that fits their preferences and lifestyle.

This is a complex question that should be discussed with the health professionals supporting you in your weight loss efforts. There is no one-size-fits-all approach, so keep looking until you find the one which is right for you.

Stephen Stotland, Ph.D.