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TAKE CONTROL – USING BEHAVIOR MODIFICATION TO GAIN OR LOSE WEIGHT One method that you might want to consider the next time you set sail on a weight loss endeavor is behavior modification. Behavior modification offers an excellent method for controlling your weight. There is considerable research that indicates that the behavioral approach yields the best long term results as far as weight loss is concerned. Basically, the method involves establishing a baseline of food consumption, setting goals, increasing exercise, keeping precise records of your eating behavior and developing a reward system. In case you are interested, what follows is a brief behavioral guide to weight control.

Weight Control: A Behavioral Approach I. Preparation _____________________________________________________

- 1. Get a medical check-up If there is any doubt about your physical condition, get a thorough physical examination in order to determine if there are any medical problems that might result from dieting or reducing caloric intake. Determine if increased exercise will pose a health risk. Also, remember that you might be one of the 5% of Americans who has a glandular disorder that is responsible for your weight problem. If that is the case, rest assured that the medical profession could be of considerable help.

- 2. Establish goals and expectations With respect to weight loss, the goal of your program should be a slow and steady weight loss until you get down to the desired level. Remember, you gained your weight over a long time. Don’t expect to lose it overnight. Generally, the more overweight you are, the faster your initial weight loss will be. Be aware, however, that as you continue to lose weight, the less rapidly your subsequent loss will be because there is less and less weight to lose. Don’t become discouraged when this occurs. Focus on the fact that you are getting closer to your desired weight. The most effective programs for long range weight control usually achieve weight losses of between one and two pounds per week. If you are on a livable program and your initial weight loss is much more, that is okay, but don’t expect it to continue. A sense of failure is related to your goals. Don’t set your goals so impossibly high that you ensure failure. Avoid perfectionist standards. Perfectionists are more likely to go on an eating binge when they don’t live up to extremely high standards because, for them, a slight transgression is viewed as a complete failure. For example, after “slipping a little” a perfectionist may say, “Well, I’ve blown it,” and go on to eat until he or she feels sick. So, beware of unrealistic and rigid goals. Don’t be impatient with slow rates of progress and negative evaluations about your capacity to loss weight. Look for the positive in each situation. Remember, that success breeds success. The more success you have, the easier things will become. Activity # 1: List Goals. Write down all of the goals that you want to accomplish through your weight control program. Your goals should emphasize improved eating habits and not just weight loss. Establish primary, secondary and long range goals. Long range goals are goals to be accomplished in a long time span, say three months or longer. Secondary goals are of shorter duration, such as a week. Primary goals are daily goals. Primary goals should lead to secondary goals and in turn, lead to long range goals. For instance, let’s say that your long range goal is to lose 12 pounds in three months. Your primary goals would be to decrease your daily caloric requirement (DCR) by 500 calories. This will lead to your secondary goal of

losing one pound a week, which in turn, will lead to your long range goal of losing 12 pounds in three months. Once you establish your goals, focus only on your primary goals. Let everything else just fall into place. You must be systematic about these goals. Write them down each day and check them off as you accomplish them. This will not only serve as a reminder of your daily routine, but will also shape your behavior by reinforcing small bits of behavior to get an overall desired response. Again, be aware that goals are the essential element of any successful formula. Without something to shoot for or without a sense of direction, your potential for failure is significantly increased. With direction, your potential for success is almost assured.

II. Self-Monitoring _______________________________________________________________

Activity # 2: Record Your Weight. Get a sheet of graph paper and construct a graph of your weight loss by plotting your weight every day (see figure 1). Try to weigh yourself at about the same time each day. Display the chart in a prominent place so that you and others who may be helping you will see it every day. It’s a good idea to tape the graph to the door of your refrigerator. Usually, just recording your weight each day will help produce a weight loss.

151 150 body weight

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Figure 1: Charting Body Weight Activity # 3: Determine Your Daily Caloric Allotment. Each morning, right before breakfast, calculate your DCR for that day. Then subtract the number of calories you want to cut back on from your DCR and record that total in your reduction diary. This will give you a written record of exactly how many calories you are allowed to consume during that day. Activity # 4: Record Calories. Record the caloric content of everything you eat and drink. In order to perform this procedure accurately, you must know the ingredients of the food you eat, the quantity of the food you eat and the number of calories contained in the food you eat. Note that most foods contain a caloric index on the package. The caloric value of other foods can most likely be found in diet books. When you eat, it’s a good idea to immediately record the number of calories consumed. By doing so, there will be less chance of your forgetting to record what you eat. You may also want to graph the number of calories consumed each day (See Figure 2). This type of self-monitoring will increase your eating awareness and make the response sequence of eating less automatic. It will also help you gain a better

understanding of the type and quantity of food you are eating. Many behavioral therapists believe that selfmonitoring of caloric intake is one of the most effective techniques for controlling eating behavior.

Calories Consumed

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1550 1500 1450 1400 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Days

Figure 2: Charting Caloric Consumption

Activity # 5: Record Events. Record events associated with your eating behavior. Record the time you eat, where you eat and the circumstances that occur before, during and after you eat. Also, note who is around when you eat and what their response is to your food intake. In short, record the psychological and social consequences of your eating behavior. By monitoring your behavior, you will probably find that you eat more often around certain people and in particular environments. If that’s the case, avoid these people and places when you don’t want to eat.

III. Cognitive Factors _________________________________________________________________

Activity # 6: Study Nutrition - Intellectual Training. Engage in an extensive program of intellectual training. Learn about the nutritional and caloric value of different foods along with the nutritional requirements of your body. Also, develop a thorough understanding of human behavior. Be aware that we have biological motives, intra-psychic motives and social/behavioral motives. Understand that these three separate systems of emotional processes interact with and influence each other. To overemphasize the importance of any of these processes or to try to explain in all human behaviors by one process is a significant error. Learn about all three systems and how they interact. Try to spend at least one-half hour each day engaging in some type of intellectual training. Attend lectures, view films, read and perhaps learn from other dieters. Intelligence is a source of power that can elicit superior performance. The more you know about your body, your psychological state and the dynamics of your environment, the easier it will be to control your own behavior. Research has consistently revealed those individuals who are afforded information about the physiological, psychological and environmental factor of behavior exhibit significantly greater control of themselves and the people with which they come in contact. Activity # 7: Plan Meals. Plan nutritionally balanced meals instead of simply trying to decrease the amount of food eaten. Use a minimal amount of sugar, fat, cholesterol and salt in your diet. Although these elements have important nutritional value, they can cause serious cardiovascular problems when used in excess.

Try to eat high bulk foods such as bran, which are low in calories. By doing this, you can eat a larger quantity of food. Of course, these foods in large quantity will take longer to eat and will contribute to an earlier sensation of fullness. Make a special effort to experiment with your foods. Many individuals successfully cut down on the number of calories consumed by gradually changing the ingredients in their foods. For example, you could gradually reduce the amount of sugar or cream in your coffee until you get used to drinking it black. Note that any diet that is nutritionally sound and sufficient in calories can be used. Experts recommend that you use flexible diets rather than rigid diets that have little variety in the foods that are to be consumed. Remember, your goal is not only to lose weight, but also to develop a lifetime plan for eating. Activity # 8: Construct Cue Cards. Make a set of cue cards that focus on your established goals and the desired rewards of normal weight. Read these statements each day. Focusing on the rewards and pleasures of accomplishing your goals is more effective than thinking about the negative aspect of being overweight. Activity # 9: Focus on Internal Cues. Focus on internal hunger cues. Most importantly, stop eating when you no longer feel hungry. Before you eat, ask yourself, “Am I really hungry?� Give the little man in your brain a fighting chance. Try to put small amounts of food on your plate. If you feel that you need more food after eating that portion, go back and get a little more. It is better to have a little food on your plate and go back for seconds than having a lot of food on your plate. Practice leaving a small amount of food on your plate to overcome the habit of automatically eating whatever is in front of you.

IV. Response Control ________________________________________________________________

Activity # 10: Slow Down Your Eating. Slow down the pace at which you eat. The extra time will allow you to feel full and to stop eating before eating too much. Also, if you eat fast, there is a strong possibility that you will feel compelled to continue eating while waiting for those dining with you to finish. Put your fork down between each bite. This will help slow down the pace of your eating. The simple experience of eating more slowly is, in itself, important. Chew your food well. Take small portions of food into your mouth and chew these portions thoroughly before swallowing. This will activate the trigeminal nerve, which will activate the satiation center in the hypothalamus, thus decreasing your hunger. Activity # 11: Engage in Incompatible Behavior. Write down a number of activities that you enjoy as much or more than eating. When you get hungry, substitute one of these activities for eating. The activities you select should in no way be associated with the response of eating. Use these activities as an incompatible behavior for eating. Every time you get an urge to eat at an inappropriate time, engage in one of these activities instead. Since eating is not ordinarily associated with these activities, there will be less of a temptation to eat while performing them. Examples of these methods might include a walk in the park instead of eating a snack, engaging in absorbing hobbies to take your mind off food, or swimming instead of eating.

V. Motivational Aids _______________________________________________________________

Activity # 12: Alter the Consequences of Eating.

Set up a system of rewards and punishments to provide additional incentives for reaching your goals. These incentives can be self-controlled or enforced by others. Generally, individuals who have relied on self-reinforcement have been more successful in maintaining their weight loss. Write down a number of things that you would like to have. Be realistic. For instance, a new car might be a little out of your range. Use items you desire to reward yourself with for accomplishing a specific goal. Some rewards should be relatively easy to obtain whereas others, perhaps more valuable, should require sustained success. You could assign a certain number of points for achieving various objectives and points could then be exchanged for rewards. In general, you should reward desirable changes in eating habits rather than just focusing on the amount of weight that you’re losing. Punishment techniques can also be employed to control behavior. Set up a situation in which undesirable responses result in the forfeiture of something valuable. Controlling the consequence of eating behavior is perhaps the most important part of any diet program. Learning to eat correctly is a matter of establishing voluntary selfcontrol over your actions. Without reinforcement, you will find it is extremely difficult to acquire the self-discipline you will need to get your weight down and keep it down. Activity # 13: Power Talking and Positive Thinking. Utilize scripting and/or power talking as often as possible. Write out and tape record scripts that you will use in your power talking. Select words and statements that will elicit positive mental imagery. It’s also a good idea to use “trigger words” that will elicit the emotional response that you want at that particular time. If possible, tape record your scripts and use them on a daily basis. Bombard your brain with positive affirmations. Keep in mind, there is a powerful magic in believing. If you believe in yourself, there is nothing you can’t accomplish. Make a conscious effort to ensure that every word, thought and action is of a positive nature. Practice expressing these positive affirmations every chance you get. Understand that the mind, like a muscle, increases in power the more you train and exercise it. Activity # 14: Social Support - Encourage Support of Friends. Family members, friends and co-workers can play an important part in helping (or hurting) your efforts to lose weight. Enlist their support. Tell these people never to offer you food. Ask them not to tease or criticize you for your efforts. Invite other overweight individuals to go on a weight loss program with you. If they seem willing to help, call other people’s attention to what you are trying to do. Activity # 15: Use Covert Sensitization. Use covert sensitization to make certain foods undesirable. Find a quiet place, lie down and relax yourself. Then simply imagine as vividly as possible something disgusting about the particular food you are trying to avoid. For example, if doughnuts are tempting, you could imagine that flies from a dirty bathroom have crawled all over them, making them totally undesirable to consume.

VI. Environmental (Stimulus) Control __________________________________________________________________________________________________

Activity # 16: Reduce visual cues. Keep food out of sight. Store food in opaque containers. Do not leave extra food on the table at mealtime. Put it away before starting to eat. Serve smaller portions of food and use smaller dishes to make the food look like more. Tempting and high calorie foods should be made unavailable. Reduce your contact with food. Don’t develop a hobby of cooking or baking. At the same time, if you are the kind of person who frequents fast food restaurants, you may have to start preparing some healthy meals for yourself so that you can avoid convenient but unhealthy eating habits. Choosing and preparing healthy foods can become very rewarding. Avoid areas in the market where undesirable foods such as desserts are displayed. Activity # 17: Reduce Cues for Eating.

Eat only in a limited number of places such as in the kitchen or dining room. This way you’ll be less likely to feel hungry or eat when you’re in the den, bedroom, or other places. If you eat only in certain places, you will be better able to control eating by avoiding these places from time to time. Separate eating from other activities…do not associate eating with watching TV, reading, studying and etc. Otherwise, it will become difficult to engage in these activities without eating. Activity # 18: Control Environmental Stimuli. Make eating a pure experience. When you eat, do not engage in any other activity that might inadvertently reinforce eating, For instance, don’t read, listen to music, talk, watch television or daydream. When it’s time to eat, just eat and don’t do anything else at the same time. It’s a good idea to eat alone in a secluded area away from other activities. By doing this, you can significantly decrease the number of stimuli that might be paired with eating. By eliminating distracting discriminative stimuli that may be paired with eating, you can more effectively control your eating behavior. For example, if you both eat and study at your kitchen table, the kitchen table will become a discriminative stimulus for both activities, even if they are engaged in separately. In this case, you may find yourself going into the kitchen to study and end up eating. This will be a particular problem if you procrastinate studying and you seek ways to get out of doing your work. The solution to this problem is to keep the stimuli for eating separate from the stimuli for studying. As suggested, eating should occur in a place in your house away from other routine activities. This way, you’ll be less likely to feel hungry or eat when you’re in an inappropriate environment. The fewer times you find yourself where you ordinarily eat, the less you will eat. It’s also a good idea to make the eating occasion as unique as possible. Use your imagination to make an unusual eating ritual. For example, you might eat only when there is a red tablecloth on the table or when you’re wearing a particular item of clothing. By doing this you are not only reducing the number of discriminative stimuli for eating, but you also pairing eating with specific stimuli for eating.

VII. Exercise __________________________________________________

Activity # 19: Increase Your Physical Activity. Individuals who combine exercise with dieting are more likely to lose and maintain weight loss. Exercise will burn off calories, dampen your appetite, speed up your metabolism and ward off stress and anxiety. For this reason, exercise should be one of the most important factors in your weight control program. Pursue physical activities that you find enjoyable. If you are in poor shape, start out slowly. Write down a number of exercises that you enjoy and engage in those activities. Exercise should be fun, not pain staking. Also, take advantage of natural opportunities to exercise. Become more active in everyday life. For example, walk up a flight of stairs instead of taking an escalator. Don’t circle around a crowded parking lot to find a closer space. Instead, park your car a little distance from the place you want to go. Walk more. Remember, the more work you do, the more calories you burn.

VIII. Assertiveness ____________________________________________________________

Activity # 20: Practice assertiveness. Practice expressing your true feelings in a reasonable but firm manner. Be assertive in refusing offers of food that you don’t want or feel that you shouldn’t eat. Again, focus on internal cues and don’t let the situation or other people dictate what you eat. By following the suggestions outlined above, you will not only gain control of your eating behavior, but you will also learn a great deal about yourself and your environment. Do not expect too much too fast. Think positive! And remember, the journey of a thousand miles begins with the first step.