Lifestyle and Behavioral Modification: Initial Approaches to Managing Obesity (and stopping the “Yo-Yo” once and for all)

Holly Wyatt, M.D.Associate Professor of MedicineDivision of Endocrinology, Metabolism and Diabetes Anschutz Health and Wellness Center

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Disclosure Slide for Holly Wyatt, M.D.

• Book Author, Royalties , Rodale/ State of Slim

• Ownership, Shakabuku LLC

• Ownership, Dr. Holly LLC

• Patent, Energy Gap

• Consultant, The Beef Checkoff

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I have to eat perfectly to lose weight and keep it off; and when I lose weight, I gain it right back with even the smallest indulgence. It feels really hard if not impossible to live my life at a lower weight.

I alway start off very motivated and lose some weight but within a few weeks or months my motivation wears off and I gain back the weight (and sometimes a little more). It feels frustrating and futile to repeat this cycle over and over and never make any real progress.

I can no longer eat whatever I want and stay lean; until a few years ago, maintaining my healthy weight was something that used to happen without too much effort and now it seems I just can’t get back to my previous weight once and for all.

Game Plan

•Lifestyle and Behavioral Modification •What is it?•Why is it important? Why should we care? •Strategies for stopping the Yo-Yo once and for all

What is lifestyle and behavioral modification?

Lifestyle and behavioral modification involves altering long-term habits, typically of eating or physical activity, and maintaining the new behavior for months or years. Lifestyle modification can be used to treat a range of diseases, including obesity.

Why is it important?

• The cornerstone for long term success

• Your lifestyle and behaviors produces your health AND happiness

• Impacts your quality of life

We need an enemy.

Why we have declared the Yo-Yo is the Enemy

• There is not ONE cause of the obesity epidemic• There is not ONE person, thing, situation, food group, gene, metabolic

pathway, organ system, neurotransmitter, environmental condition, behavior, law, corporation, government, or economic factor to blame.

• The cause is NOT simple therefore effective treatment will NOT be simple

• We ( and our patients) must stop looking for a single etiology, a single fix to ultimately succeed

• The “YoYo” is the unified enemy we ALL can fight against

• It’s an enemy that if we combine our forces we can beat but if we keep seeing the enemy as sugar, or lack of exercise, or genetics or a single industry we believe we are destined to fall short again and again.

Why we have declared the Yo-Yo is the Enemy

• Never living for a sustained period of time at a reduced body weight keeps people from living their very best life.

• Impacts their health and gets in the way of engaging in life the way we were all meant to live. It keeps people on “the sidelines”.

• Promotes a “stuck” mindset. Makes people feel helpless, hopeless, frustrated, angry and takes them down a path to believe they can’t be successful. It stimulates a “victim” mindset and that impacts other areas in their life. It encourages them to settle for less.

Weight loss ≠ Weight Loss Maintenance

Acute Weight Loss

Chronic Weight Loss

Weight Loss Weight Maintenance

4-6 months Years/Forever?

Strategy

Strategy

Strategy 1 Strategy 2

Weight Maintenance

The Bathtub Analogy- Why Most Diets Don’t Work

1. Turn down the faucet

2. The faucet turns back up

1. Turn down the faucet temporarily

2. Unclog the drain and increase its diameter

3. Slowly increase the faucet to MATCH the drains new larger capacity

Begin With The End in Mind

Image By Abraham Sanogo CC BY-NC-SA 3.0

WeightMindsetMetabolismActivity LevelNutrition Environment Routines and RitualsLink to PurposeBIG Why?Your Identity

•Only 2.7% of adults met criteria of

•1) healthy diet

•2) adequate physical activity

•3) healthy weight

•4) non smoking

Behavior Change is Hard

What is Missing?

My weight is fine but I feel like my life is not moving forward. I feel like I am settling and there is so much more I could be accomplishing but I can’t ever move ahead for an extended period of time. I can see where I want to go I just can’t get there. Life feels hard and I feel STUCK and at the mercy of whatever life brings my way.

Transformative Weight LossApplies to any behavioral change or goal people want to achieve

• The process of creating and aligning a new reduced body weight, a positive and emotionally resilient mindset and your bigger purpose/spirit with a new lifestyle and way of living. LIVING LARGE!

• Links the WHAT and the WHY

• Provide the HOW – the Bridge

• If your WHAT is not related to your WHY you will stop doing it

LIFE TRANSFORMATIONMindset Choices and Skills

• What I get to do versus what I am giving up

• Believing I have the power to change versus believing I am a victim to my life/circumstances

• Expecting success versus failure

• Finding and aligning your new life with your purpose and values/your BIG WHY?

• Developing Emotional Resiliency Skills- bending versus breaking in rougher times

• Feeling Fear and Living in the Arena

Become on the outside

who I always knew I was

on the inside

The Importance of Getting Uncomfortable

Growth Mindset

8 Secret Powers to Stop the Yo-Yo

1. Begin With The End in Mind

Image By Abraham Sanogo CC BY-NC-SA 3.0

Get QUIET to get CLEAR

2. Let go of the Noise

• Say no to things that are not helpful or are distracting and do not get you closer to POINT B• Things You Do

• Your Thoughts

• People

• Habits

• Perceptions of who you are or are NOT

The YoYo loves NOISE!

• Gives you more time, ENERGY and lets you see the path to point B

• Easier to see the next step

• Makes room for the important stuff

• Faster path to point B

3. Control what you can control and LET GO of what you do not control

The POWER of Letting GO #letgo

• What you control- INTERNAL• Actions• Attitude• Perspective• Decisions• Thoughts• Feelings• Beliefs • Mindset• Determination• Judgements • Desires

• PERCEPTIONS

• What you do NOT control- EXTERNAL• Life events• Other people

• Actions

• Emotions

• Beliefs

• Weather• Economy• Reputations• Trends• Disasters• Money• Health

• OUTCOMES

Never Give your Power to an OUTCOME

4. See the Obstacles as Barriers versus Beacons

Life Bumps- Mindset Shift

• Life’s experiential homework assignments to grow to transform to not stay stuck?

5. Create a NEW Normal

6. Connect to your BIG Why!

7. Find Your SUPERFRIENDS and YOUR TEAM

8. Have a Safety Net and a Reboot Plan

Secret Powers to Stopping the YO YO

• Begin with the End in Mind

• Let go of the Noise

• Be the HERO- Take control of what you control

• Seeing the Bumps as Beacons

• Create a NEW Normal

• Connect To your BIG WHY- make it BIGGER than weight loss

• Find Your SUPERFRIENDS

• Have a Safety Net and Reboot Plan