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.
Tuesday, February 22, 2011
Thursday, February 17, 2011
Lying
This is a tough topic, but maybe it’s time to “face the music”…
All “compulsives” blame their behaviour on something ... something they keep saying is only temporary... there's always tomorrow... so they’re lying to themselves... Ultimately, there is a lot of lying to other people too...it's inevitable as the shame creeps in, and the cognitive dissonance increases that the behaviour becomes more and more secret...and therefore lies and deceptions are needed to keep it secret...and that does not add to self-esteem, or to the strength of will needed to overcome the compulsion.
Yet the compulsive is different than the true addict...the addict is beyond questioning the habit, mostly or all the way past guilt...it is just need...the addict lies in a myriad of ways...
The gourmand is a person with a professed love of food, believing that she/he is more in love with food than other people, able to experience more pleasure through eating, etc. There is an elevation of eating to a central place in the personality, even to a spiritual level. The gourmand is thus an addict who dresses up the fact in socially acceptable ways; in other words, it's ok to eat, even necessary...The gourmand is lying about the importance of eating, creating and defending a rather unbalanced lifestyle, closer to gluttony than to a gourmet's discerning palate.
The couch potato is another type of compulsive...this is compulsive inactivity, sloth if you will...to this person the most attractive option is the least physically effortful...this person lies too, saying it is too hard to move, too painful, lacking all pleasure...this is a lie because there is always the possibility of enjoyment and improvement, and really no need to progress any faster than is comfortable...people come back from all sorts of physical disabilities and injuries by applying intention, determination and persistent practice...so it's a lie to believe there is no hope and that the only option is the habitual one...
Each of us may be a bit of the compulsive, addict, gourmand and couch potato, engaging in a variety of self-deceptions and different kinds of lies.
How does one stop lying? Generally speaking, it takes support of some kind...because the liar has to trust at least one person, has to be honest with one person...that's what it takes.
Stephen Stotland, Ph.D.
All “compulsives” blame their behaviour on something ... something they keep saying is only temporary... there's always tomorrow... so they’re lying to themselves... Ultimately, there is a lot of lying to other people too...it's inevitable as the shame creeps in, and the cognitive dissonance increases that the behaviour becomes more and more secret...and therefore lies and deceptions are needed to keep it secret...and that does not add to self-esteem, or to the strength of will needed to overcome the compulsion.
Yet the compulsive is different than the true addict...the addict is beyond questioning the habit, mostly or all the way past guilt...it is just need...the addict lies in a myriad of ways...
The gourmand is a person with a professed love of food, believing that she/he is more in love with food than other people, able to experience more pleasure through eating, etc. There is an elevation of eating to a central place in the personality, even to a spiritual level. The gourmand is thus an addict who dresses up the fact in socially acceptable ways; in other words, it's ok to eat, even necessary...The gourmand is lying about the importance of eating, creating and defending a rather unbalanced lifestyle, closer to gluttony than to a gourmet's discerning palate.
The couch potato is another type of compulsive...this is compulsive inactivity, sloth if you will...to this person the most attractive option is the least physically effortful...this person lies too, saying it is too hard to move, too painful, lacking all pleasure...this is a lie because there is always the possibility of enjoyment and improvement, and really no need to progress any faster than is comfortable...people come back from all sorts of physical disabilities and injuries by applying intention, determination and persistent practice...so it's a lie to believe there is no hope and that the only option is the habitual one...
Each of us may be a bit of the compulsive, addict, gourmand and couch potato, engaging in a variety of self-deceptions and different kinds of lies.
How does one stop lying? Generally speaking, it takes support of some kind...because the liar has to trust at least one person, has to be honest with one person...that's what it takes.
Stephen Stotland, Ph.D.
Friday, February 11, 2011
Philosophical musings: Philosophy and weight
The basic philosophical issues apply to the question of weight -- mechanism and determinism vs. free will, mind vs. body...but then again, perhaps these philosophical riddles are not truly soluble...
Man as machine, robot, computer, biological process is man without self-direction, except as self-direction is built-in as a physical process, the physical mechanics of thought, perception and goal pursuit, thus even self-direction is mechanistic and therefore not free...
Such a view in relation to weight would suggest that the explanation and control of weight problems is in physical processes - hunger, satiety, desire, preference, pleasure, impulse, need - all of these are regarded as physical processes and the direction of research is to find the brain and peripheral anatomy and chemistry underlying them...
Thus, the hoped for gain of control over weight is in the form of a physical intervention, such as a drug to alter any of the above-named processes, or surgery to block or limit them, or environmental control (changing the food and activity environment/settings) to reduce the opportunity for unhealthy behaviour and increase the opportunity for healthy behaviour.
Man as a free agent, is man that is autonomous, self-directed through consciousness/self-awareness, and therefore at least partly free (autonomous man does not deny the reality of the physical, thus, for example, does not believe that if he flaps his arms he will fly, since there is an intuitive understanding of the difference between a human being and a bird)...
Such a view in relation to weight control suggests that an important part of the explanation and control of weight is in conscious thought and self-directed behaviour, and that processes like hunger, satiety, etc. are influenced by such self-regulation activities. Treatment thus focuses on training more effective self-regulation skills. This begins with the individual overcoming the “mechanistic mind-set”...one has to stop thinking he’s the victim of physical processes outside of his control, and begin believing that satisfaction is very much related to how we look at things...
If we come to eating in a relaxed state, take our time to prepare a tasty and well-balanced meal, eat mindfully, savouring the taste of the food, while continuing to relax, and being satisfied with a relatively small portion, knowing that we will eat again, and probably soon (!) then we will almost certainly eat better, eat less, and ultimately weigh less...same thinking applies to exercise, as we focus on the mindful enjoyment of physical activity, we naturally shift to a more balanced, healthier lifestyle.
So philosophy has a lot to do with weight, in fact is central to all efforts to understand and control it. We see that the philosophical stance pervades research on weight. We also see it at the level of the individual, where there must be an attitude shift based on a reduction of mechanistic thinking and an increase in autonomous self-direction...
But on another level, in a synthesis of the two philosophical stances/mind-sets, successful weight control involves using one’s conscious awareness to gradually alter the machinery, so that eventually habit and intention are perfectly aligned with healthy behaviour. Practice and learning lead to mastery and expertise, as in all things. expertise means the application of knowledge and skill without effort, allowing the possibility of creativity.
Stephen Stotland, Ph.D.
Man as machine, robot, computer, biological process is man without self-direction, except as self-direction is built-in as a physical process, the physical mechanics of thought, perception and goal pursuit, thus even self-direction is mechanistic and therefore not free...
Such a view in relation to weight would suggest that the explanation and control of weight problems is in physical processes - hunger, satiety, desire, preference, pleasure, impulse, need - all of these are regarded as physical processes and the direction of research is to find the brain and peripheral anatomy and chemistry underlying them...
Thus, the hoped for gain of control over weight is in the form of a physical intervention, such as a drug to alter any of the above-named processes, or surgery to block or limit them, or environmental control (changing the food and activity environment/settings) to reduce the opportunity for unhealthy behaviour and increase the opportunity for healthy behaviour.
Man as a free agent, is man that is autonomous, self-directed through consciousness/self-awareness, and therefore at least partly free (autonomous man does not deny the reality of the physical, thus, for example, does not believe that if he flaps his arms he will fly, since there is an intuitive understanding of the difference between a human being and a bird)...
Such a view in relation to weight control suggests that an important part of the explanation and control of weight is in conscious thought and self-directed behaviour, and that processes like hunger, satiety, etc. are influenced by such self-regulation activities. Treatment thus focuses on training more effective self-regulation skills. This begins with the individual overcoming the “mechanistic mind-set”...one has to stop thinking he’s the victim of physical processes outside of his control, and begin believing that satisfaction is very much related to how we look at things...
If we come to eating in a relaxed state, take our time to prepare a tasty and well-balanced meal, eat mindfully, savouring the taste of the food, while continuing to relax, and being satisfied with a relatively small portion, knowing that we will eat again, and probably soon (!) then we will almost certainly eat better, eat less, and ultimately weigh less...same thinking applies to exercise, as we focus on the mindful enjoyment of physical activity, we naturally shift to a more balanced, healthier lifestyle.
So philosophy has a lot to do with weight, in fact is central to all efforts to understand and control it. We see that the philosophical stance pervades research on weight. We also see it at the level of the individual, where there must be an attitude shift based on a reduction of mechanistic thinking and an increase in autonomous self-direction...
But on another level, in a synthesis of the two philosophical stances/mind-sets, successful weight control involves using one’s conscious awareness to gradually alter the machinery, so that eventually habit and intention are perfectly aligned with healthy behaviour. Practice and learning lead to mastery and expertise, as in all things. expertise means the application of knowledge and skill without effort, allowing the possibility of creativity.
Stephen Stotland, Ph.D.
Friday, January 28, 2011
On process and outcome
Always focused on the outcome...how many pounds have I lost?
Forgetting that the outcome is merely the result of the process.
Easy to forget this at the beginning when weight loss is so fast and so gratifying.
But the real trick is getting through the early weight loss phase,
and through the later weight loss phase,
and learning
the kinds of behaviour-lifestyle-habits,
that will make it easy to keep the weight off.
Ironically, the way to achieve better long-term weight loss
is to focus more on the process
and less on the outcome.
If we look at the numbers,
and determine how many calories are needed
to maintain
our current weight
vs. our desired weight,
considering the likely activity patterns
associated with each state,
this gives us a good idea
of what needs to be accomplished.
For example,
we might need to learn to eat
400 calories per day less.
Not forgetting that an additional,
and more important
question is
how
to reach the point where doing so is
easy?
When we look at it from the
numbers
perspective
it's less scary,
more of a practical problem.
And practical problems always have practical solutions...
Although finding them may take time
as well as an open mind
courage
self-esteem
and, of course, persistence.
Stephen Stotland, Ph.D.
Forgetting that the outcome is merely the result of the process.
Easy to forget this at the beginning when weight loss is so fast and so gratifying.
But the real trick is getting through the early weight loss phase,
and through the later weight loss phase,
and learning
the kinds of behaviour-lifestyle-habits,
that will make it easy to keep the weight off.
Ironically, the way to achieve better long-term weight loss
is to focus more on the process
and less on the outcome.
If we look at the numbers,
and determine how many calories are needed
to maintain
our current weight
vs. our desired weight,
considering the likely activity patterns
associated with each state,
this gives us a good idea
of what needs to be accomplished.
For example,
we might need to learn to eat
400 calories per day less.
Not forgetting that an additional,
and more important
question is
how
to reach the point where doing so is
easy?
When we look at it from the
numbers
perspective
it's less scary,
more of a practical problem.
And practical problems always have practical solutions...
Although finding them may take time
as well as an open mind
courage
self-esteem
and, of course, persistence.
Stephen Stotland, Ph.D.
Friday, March 12, 2010
Let's talk about eating disorders
Disorders of eating are self-destructive habits, ways of eating that take on greater and greater centrality and importance in the mind and life of the sufferer.
Thus, as one progresses into a more active and severe eating disorder, one becomes more "restrictive" and/or "impulsive" in eating and exercise behaviour, and the more one's general emotional state is negatively affected.
The weight control attitude associated with an active eating disorder is characterized by varying degrees of restraint and disinhibition/binging, and more or less extreme weight loss goals. Different combinations of anorexic and bulimic behaviour patterns are possible.
As people recover from eating disorders they become more flexible and moderate in their eating intentions and behaviour. The recovered patient remains more concerned about her weight and more restrained in her eating compared to the non-eating disordered population, but there is significant increase in the level of moderation and in the integration of this behaviour change.
The changes in weight and eating attitudes with recovery are correlated with equally significant changes in mood, life satisfaction, coping and body esteem.
The amazing thing about someone with an eating disorder is that she pursues a course of action which she knows has negative consequences, and yet sticks to the disorder, much like an addict. That's why you can't treat eating disorders by prescribing diets, or even by hospitalization, without dealing with the essential irony of the problem. You help someone gain self-awareness and deal with emotional coping, and she finds her own motivation to change.
As Bruch and later Garner and Garfinkle point out, there is an overriding importance in the overall causality and maintenance of the disorder of a feeling of ineffectiveness, even defectiveness, and a desperate means of organizing oneself in the service of a goal, even if that goal has negative side effects. Unless a person can overcome the general negative feelings about herself, she will not be capable of motivating herself to recover from the eating disorder. The goal of recovery must become stronger than the attraction to the habit.
As the motivation for recovery grows and the change process proceeds, the restrictiveness and impulsiveness of eating thoughts and behaviours are normalized.
Finally, it's important to remember the recovery from eating disorders is a long-term process. Recovery should be measured over several years.
Stephen Stotland, Ph.D.
Thus, as one progresses into a more active and severe eating disorder, one becomes more "restrictive" and/or "impulsive" in eating and exercise behaviour, and the more one's general emotional state is negatively affected.
The weight control attitude associated with an active eating disorder is characterized by varying degrees of restraint and disinhibition/binging, and more or less extreme weight loss goals. Different combinations of anorexic and bulimic behaviour patterns are possible.
As people recover from eating disorders they become more flexible and moderate in their eating intentions and behaviour. The recovered patient remains more concerned about her weight and more restrained in her eating compared to the non-eating disordered population, but there is significant increase in the level of moderation and in the integration of this behaviour change.
The changes in weight and eating attitudes with recovery are correlated with equally significant changes in mood, life satisfaction, coping and body esteem.
The amazing thing about someone with an eating disorder is that she pursues a course of action which she knows has negative consequences, and yet sticks to the disorder, much like an addict. That's why you can't treat eating disorders by prescribing diets, or even by hospitalization, without dealing with the essential irony of the problem. You help someone gain self-awareness and deal with emotional coping, and she finds her own motivation to change.
As Bruch and later Garner and Garfinkle point out, there is an overriding importance in the overall causality and maintenance of the disorder of a feeling of ineffectiveness, even defectiveness, and a desperate means of organizing oneself in the service of a goal, even if that goal has negative side effects. Unless a person can overcome the general negative feelings about herself, she will not be capable of motivating herself to recover from the eating disorder. The goal of recovery must become stronger than the attraction to the habit.
As the motivation for recovery grows and the change process proceeds, the restrictiveness and impulsiveness of eating thoughts and behaviours are normalized.
Finally, it's important to remember the recovery from eating disorders is a long-term process. Recovery should be measured over several years.
Stephen Stotland, Ph.D.
Understanding the stages of weight control
The stages of weight control is an idea that looks at the process of behaviour change as both continuous and discontinuous. In other words there is change within each stage and between stages.
For example, in the contemplation stage, a person will gradually become more sure of their intention and closer to implementing an action plan, the more reasons they find to make the effort, vs. the reasons not to.
As one progresses with the analysis of the pros and cons and likelihood of success of the behaviour change, the more sure one becomes of making the change, until such point as the decision is firmly made and an implementation plan has been created, at which point the person moves from contemplation into action.
Once beginning the action stage there is a long period of "apprenticeship" in which the person acquires the basic skills and knowledge - of course, there are some kinds of behaviour change (e.g. becoming a medical doctor or an architect) in which the action/learning stage is very long; the same can be said for "recovery from obesity" (otherwise known as "weight management").
In the early "novice stage", the person benefits from a clear structure and feedback. As new eating and exercise habits are established, resulting in the desired weight and body changes, the structure can be modified, allowing more flexibility, in the intermediate stage.
After 3 - 6 months of consistent eating and exercise behaviour changes the individual should have reached the "intermediate stage", with stable habits and adequate flexibility. At this stage the person is quite confident about weight control and not disturbed by situational variations in behaviour. Thus, if one eats more or less "nutritious" food on some occasion, there is still a degree of moderation and therefore no fear, frustration or guilt, but rather satisfaction and resilient confidence.
Eventually, with sufficient practice and experience one may attain the "mastery stage,"where the new habits are fully automatic and second-nature. Within this stage there is still room for development, to the "expert stage." The expert can develop new ideas and can teach others. Thus, the expert of weight control has both mastered his or her own weight, and can help others do the same. Many experts in weight control have overcome their own weight issue.
The stages of weight control include the unmotivated stage, the contemplation stage, the concerned but disengaged, the novice, intermediate, mastery and expert stages.
Treatment require a knowledge and understanding of the stages. Different treatment stategies are appropriate for different stages, but what is always required is regard for the degree that the individual has progressed in his or her "apprenticeship."
If the goal of treatment is to create "experts" then the treatment must go far beyond diets and exercise plans, as there is need for a deeper analysis of motivation, skills, attitudes and self-regulation processes.
Of course, one cannot become an expert without first being a novice, then intermediate and master. It's a process, even a journey.
The 7 stages of weight control are a guide for individual development.
To learn more about my research on the stages check out our webpage: Stage Survey Results
Stephen Stotland, Ph.D.
For example, in the contemplation stage, a person will gradually become more sure of their intention and closer to implementing an action plan, the more reasons they find to make the effort, vs. the reasons not to.
As one progresses with the analysis of the pros and cons and likelihood of success of the behaviour change, the more sure one becomes of making the change, until such point as the decision is firmly made and an implementation plan has been created, at which point the person moves from contemplation into action.
Once beginning the action stage there is a long period of "apprenticeship" in which the person acquires the basic skills and knowledge - of course, there are some kinds of behaviour change (e.g. becoming a medical doctor or an architect) in which the action/learning stage is very long; the same can be said for "recovery from obesity" (otherwise known as "weight management").
In the early "novice stage", the person benefits from a clear structure and feedback. As new eating and exercise habits are established, resulting in the desired weight and body changes, the structure can be modified, allowing more flexibility, in the intermediate stage.
After 3 - 6 months of consistent eating and exercise behaviour changes the individual should have reached the "intermediate stage", with stable habits and adequate flexibility. At this stage the person is quite confident about weight control and not disturbed by situational variations in behaviour. Thus, if one eats more or less "nutritious" food on some occasion, there is still a degree of moderation and therefore no fear, frustration or guilt, but rather satisfaction and resilient confidence.
Eventually, with sufficient practice and experience one may attain the "mastery stage,"where the new habits are fully automatic and second-nature. Within this stage there is still room for development, to the "expert stage." The expert can develop new ideas and can teach others. Thus, the expert of weight control has both mastered his or her own weight, and can help others do the same. Many experts in weight control have overcome their own weight issue.
The stages of weight control include the unmotivated stage, the contemplation stage, the concerned but disengaged, the novice, intermediate, mastery and expert stages.
Treatment require a knowledge and understanding of the stages. Different treatment stategies are appropriate for different stages, but what is always required is regard for the degree that the individual has progressed in his or her "apprenticeship."
If the goal of treatment is to create "experts" then the treatment must go far beyond diets and exercise plans, as there is need for a deeper analysis of motivation, skills, attitudes and self-regulation processes.
Of course, one cannot become an expert without first being a novice, then intermediate and master. It's a process, even a journey.
The 7 stages of weight control are a guide for individual development.
To learn more about my research on the stages check out our webpage: Stage Survey Results
Stephen Stotland, Ph.D.
Weight of the world
We all must learn to "carry our own weight" they say, which means to take responsibility for ourselves and not to expect others to "carry us". Some people have more to carry, as they have had the misfortune to come from difficult family circumstances, unhelpful environments and little opportunity for education or personal growth. And yet some who began in the most disadvantaged of situations have emerged, found ways to thrive and find happiness -- we say that such individuals have "resilience." These individuals have discovered how to unburden themselves of unnecessary weight, to keep only what is essential and valuable.
Why do so many of us appear "weighed down" by our emotions and problems, as if we are carrying the "weight of the world" on our shoulders? Why not just set down the heavy load, and allow ourselves to feel light and free? This is not merely a rhetorical question, but a central philosophical and psychological problem. Each of us must look deeply into our own eyes, into our soul, to our past, present and imagined future, to make sense of existence, to see ourself clearly, to finally say, "I understand why I do this," before we will be able to let go...
To understand ourselves we look within, but we can also learn by looking at the outside, seeing ourselves as another would, as an observer. In this sense, look at your physicality, at your body, your posture, your facial expression, your movements. Look at how you do things, your attitude. To take a simple but relevant example, look at how you eat. What is your attitude towards the food? Do you value the food? Respect it? Give it the proper attention? Use it sparingly, rather than greedily? Do you consume it slowly with mindful pleasure, or aggressively and quickly? Look at your attitude towards food and the act of eating as a reflection of your attitude towards yourself, other people and life itself. Perhaps this is a radical idea, but give it a chance...
When we carry too heavy an emotional burden it is bound to come out in many small but ultimately significant ways - in our eating, sleeping, moving, breathing. The central human dilemma is to gain self-awareness and to find philosophical meaning in our lives. This is not merely an intellectual, academic exercise, but the key to health and happiness!
Stephen Stotland, Ph.D.
Why do so many of us appear "weighed down" by our emotions and problems, as if we are carrying the "weight of the world" on our shoulders? Why not just set down the heavy load, and allow ourselves to feel light and free? This is not merely a rhetorical question, but a central philosophical and psychological problem. Each of us must look deeply into our own eyes, into our soul, to our past, present and imagined future, to make sense of existence, to see ourself clearly, to finally say, "I understand why I do this," before we will be able to let go...
To understand ourselves we look within, but we can also learn by looking at the outside, seeing ourselves as another would, as an observer. In this sense, look at your physicality, at your body, your posture, your facial expression, your movements. Look at how you do things, your attitude. To take a simple but relevant example, look at how you eat. What is your attitude towards the food? Do you value the food? Respect it? Give it the proper attention? Use it sparingly, rather than greedily? Do you consume it slowly with mindful pleasure, or aggressively and quickly? Look at your attitude towards food and the act of eating as a reflection of your attitude towards yourself, other people and life itself. Perhaps this is a radical idea, but give it a chance...
When we carry too heavy an emotional burden it is bound to come out in many small but ultimately significant ways - in our eating, sleeping, moving, breathing. The central human dilemma is to gain self-awareness and to find philosophical meaning in our lives. This is not merely an intellectual, academic exercise, but the key to health and happiness!
Stephen Stotland, Ph.D.
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