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I hear this nearly every day in my primary care clinic. Many of my patients are overweight or obese, which mirrors the national trend: two out of three adults in the US are overweight or obese. Many of these folks suffer from medical issues such as low back, hip, knee, and foot pain; asthma; obstructive sleep apnea; fatty liver; type 2 diabetes; high blood pressure; high cholesterol; or depression. We know that these conditions often improve with weight loss. So, I often recommend weight loss as a first step in treatment, and the usual approach is through lifestyle change.

Lifestyle change programs for weight loss have been extensively studied, and across the board, those that incorporate diet and exercise are very effective 鈥� if people can stick to the program.

And that is exactly my patients鈥� lament. They know they鈥檙e suffering, they know that weight loss can help, and they know all about diet and exercise, but many have trouble sticking to the program. Why is this, and what can I do to help?

A recent examined what things hinder or help people to stick to a lifestyle change program. The authors scoured the research literature for high-quality studies. What鈥檚 really important about the studies included is that they did not look at actual weight loss, only at lifestyle change success or failure.

Research found that these steps can help you live more healthfully

• Set realistic expectations and focus on health, not the scale. When you have a lot of weight to lose and the pounds are coming off slowly, it鈥檚 hard to stay motivated. At the same time, people who weren鈥檛 expecting to lose a lot of weight tended to be more successful. In addition, harboring negative attitudes and assumptions about obesity, and feeling embarrassed about one鈥檚 weight, were associated with quitting. We can benefit when we let go of self-judgment and focus on our overall health, as well as develop smaller, more realistic goals.
• Study your mood and food. Stress, depression, anger, poor coping skills, using food as a reward, and seeking comfort in food can derail a person鈥檚 commitment to eating more healthfully. Treating underlying psychological problems and learning how to better manage stress can be essential to our success. Doctors who don鈥檛 address these issues are doing their patients a disservice. There are many approaches to improving behavioral health barriers, and a plan should be tailored to the individual.
• Put the oxygen mask on yourself first. Attention to the needs of family above self and pressures from home or work were also associated with quitting a program. I鈥檓 highlighting this because it鈥檚 the number one thing I hear from my patients: they have responsibilities at home and/or at work, and they have 鈥渘o time for me.鈥� Listen: when you鈥檙e on an airplane, the flight attendant gives that spiel, 鈥淚f you鈥檙e traveling with children, and the oxygen masks come down, put the mask on yourself first.鈥� Why? Because if you鈥檙e going unconscious, you can鈥檛 help anyone. It can sound like a clich茅 but it鈥檚 a fact. If you鈥檙e not taking good care of yourself, you can鈥檛 take good care of others. When we鈥檙e taking the time to prepare healthier meals or get some exercise, it doesn鈥檛 just benefit you, it benefits every person you care about and your ability to do your job, whatever it is.
• Even though you ain鈥檛 got money. Economic issues were cited as a barrier, as was lack of knowledge about nutrition and physical activity. Many of us believe that eating healthy costs a lot of money, or that we need expensive equipment or a gym membership in order to exercise. Education and experimentation with cheaper fresh, frozen, and canned produce, as well as a home exercise plan, can help dispel those myths. Produce in the refrigerator aisle is often flash-frozen at the peak of freshness, and a lot less expensive. At our house, we buy pounds of frozen mixed berries, chopped greens, and cubed squash at the local bulk grocery chain. Workouts like running, walking, hiking, or Rocky-style calisthenics can be enjoyed for free. Or, you can exercise at home using a mat, or a simple manual exercise bike.

Willpower isn鈥檛 the problem

While lifestyle changes including diet and exercise can work, many people struggle to stick to a program, and it鈥檚 not for lack of willpower. Many factors can get in the way, but with a little work you can figure out what those are. Your doctor can help you figure out ways to overcome the barriers to healthy living. Tell your doctor what鈥檚 working or not working for you. Ask about resources, possibly including life coaches, therapists, and/or nutritionists, who can help you be successful with your lifestyle change program.

Sources

National Institute of Diabetes and Digestive and Kidney Diseases, .

. The Lancet, August 2014.

. Clinical Obesity, October 2016.

. The Lancet, February 2016.

. Clinical Spine Surgery, November 2016.

. British Journal of Sports Medicine, May 2017.

. Surgery for Obesity and Related Diseases, January 2017.

. Rheumatology International, May 2017.

. Respirology, March 2017.

. Obesity Surgery, July 2015.

. Clinics in Liver Disease, May 2016.

. Expert Review of Cardiovascular Therapy, March 2004.

. Journal of the American College of Nutrition, April 2017.

. Clinical Obesity, March 2017.