Helping Diabetes Management in Teens | Identifying the barriers to achieving desired A1C

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Assisting people with improved diabetes management behaviors has been a specialty of mine in my psychotherapy practice since 2009. My Wife has a been a senior research coordinator at the Barbara Davis Center for Childhood Diabetes in Denver since 2006, and through bonding with her passion to assist in this area, I have developed my own modes of intervention.

There are a number of factors which make managing A1C particularly difficult for teens including: Social pressures and responsibilities, motivation, personality, nutrition, substance use, sleep habits, brain re-structuring, defence mechanisms (such as denial and avoidance), social justice issues (oppresion – racism), diabetes education, individuation, future-oriented culture, access to health services, family structure and dynamic issues, marital conflict between parents, family and friendship conflict with teen, mental health stigma, academic pressure and responsibility, limited mindfulness and somatic awareness, spirituality (especially concerning death), an under-developed ability to conceptualize long-term cause and effect (this is developmentally normal for teens), co-parenting discrepencies, emotional inteligence, individuation, hormonal changes, the tendency for co-morbidity (people with diabetes can be more prone to additional physical and mental health diagnosis), and many other life/environmental stressors (poverty, grief etc.) .

One of the most significant impediments to proper management is the reality that often times the variables which are most disruptive to diabetes management are outside of the control of the teen. 2 examples: (1) If the teen lives in a household with domestic violence the resulting stress can impede their ability to maintain attention on their management routine. In this instance the ‘cycle of abuse’ needs to be intervened upon – assistance to the teen alone may not render significant results. (2) If for financial reasons the teen does not have access to proper nutrition, diabetes education, insulin or testing strips, the ability to manage diabetes will be near impossible (again an intervention on the teen alone would not be particularly helpful – a social intervention is necessary).

Proper diabetes management requires an unbelievably high level of self-discipline, familial and social support, consistency, mindfulness, finances, education, and organizational skills. Imagine dedicating yourself to an exercise and nutrition regiment that was conducted exactly the same way every day of your life … a routine that was never to change despite the relative influences of changing social, emotional, and environmental conditions… yet, paradoxically… the specific intervention was always to change in response to changing social, emotional, and environmental conditions. (ex. you exercised at exactly the same time every day, but the way you exercised was different and in response to a large number of variables). Wow, this is hard…

In order to best assist an individual in achieving their A1C goals, we must first help in identifying the impediments or barriers to proper management. in other words-

“What are the factors or stressors which are most disruptive to proper management?” 

The answer to this question can then dictate the most effective mode of intervention, and to be realistic, there is most often a need for multiple forms of intervention. Social, emotional, cognitive, motivational, familial, and academic interventions have been the most abundant needs in my experience.

From answering this question we can come up with a treatment plan which is holistic and individualized. Of course, this can become a financial issue as it is rare to find an interventionist who is adept at all these different modes of intervention (many of these interventions come from different theoretical orientations and it is not uncommon for a psychotherapist to specialize in one).

To address this financial reality, perhaps it is helpful to subtly change the question so as to identify the one variable which is most disruptive to diabetes management for the given individual.

“What is the one variable or stressor, once removed, that will have the most positive impact on your ability to manage your diabetes?

note: answering this question will often take a minimum of a session or two with a highly trained psychotherapist (ideally other people who know the teen will collaborate) as it is very likely that the teen is not conscious of the answer… additionally, the answer that the teen initially offers is usually what they believe to be the ‘right’ answer or an answer someone already suggested (ex. I need to try harder) as opposed to the answer which would ultimately serve them most effectively (ex. I need my house hold to be a place of respite, which means I need my parents to stop fighting so much).

I will end with a short list of specific intervention types which have been used to address the ‘most significant stressor.’

Existential and Spiritual Intervention – Stressor = fear of death and resulting apathy. The intervention focuses on increasing tolerance of the fear surrounding death so that it can be contemplated with less stress. Reducing this stress can reduce avoidance behaviors to proper management.

Family Structure Intervention – Stressor = overinvolved and under-involved parent creating inconsistent and less useful assistance to teen. In any family system, there is always going to be a parent who is more adept at motivating a teen (this is no one’s fault and mostly has to do with personalities). In many family systems, there is one parent doing all the ‘reminding’ – this reminding often increases avoidance behaviors. The goal of the intervention is to create a family structure and interaction dynamic which motivates the teen towards better management and minimizes stress and avoidance behaviors. This involves getting the parents on ‘the same team’ and intelligently deducing who engages with the teen in what way (ie. who asks about blood sugars and who reminds or collaborates in reminding to give insulin and how they do that).

Motivation and Solution-Focused Intervention – Stressor or factor = lack of willpower, habit, momentum or hope that better management will positively impact a teens life. The collaborative method focuses on identifying what the teen believes that they can realistically accomplish and to ‘cheerlead’ them when successful. The intended result is for the teen to feel empowered to engage in solutions and to be more hopeful about the positive impacts of engaging in solution-oriented behaviors. On an unconscious level this also ‘re-trains’ the mind to focus more on solutions and less on cynicism or ‘problem-focused’ thinking.

Attachment-based Intervention – Stressor = Stress from Family conflict including an inability for the family to offer a supportive and regulating home environment to assist in mediating stress, promoting resiliency, and in offering validation. helping the family in developing the emotional intelligence aptitudes necessary to interact with other family members in a way which supports: bonding, authenticity, vulnerability, and compassionate empathy. Attachment intervention serves to mitigate stress by increasing the family systems ability to offer regulation through connection. In my experience, often it is marital counseling which ends up having the most positive impact on the teen’s stress level = the intervention is with the parents and not necessarily with the teen at all.

Academic Advocacy Intervention – Stressor = Inability to meet the responsibilities of school, which result in intolerable emotions (shame, fear, anger etc) that encourage apathetic behaviors in all areas of the teen’s life – including diabetes management. In my experience, constantly fluctuating blood sugar levels appear to create symptoms similar to ADHD – this makes it extremely difficult for certain teens to use the attention and organization skills necessary to complete tasks on time and independently. Additionally, because of medical leaves of absence, Teens often fall behind in school and find themselves completely overwhelmed by the task of ‘catching up’ (often it is mathematically impossible for them to ‘catch up’). In these instances, the intervention is to advocate for the teen to have an individualized education plan which accommodates their specific needs (ex. certain homework assignment being excused, tutors, un-timed testing etc.)

Education, behavioral and strategic Intervention – Stressor = a lack of understanding of the most effective form of management along with a lacking ability to create an implementation strategy that accommodates all the nuances of the teen. For this intervention, the psychotherapist takes both an expert and a collaborative position to create an individualized behavior plan that the teen can follow to best manage their diabetes. (the plan will include: times to check blood sugar, education about carb counting and taking insulin, and a daily time for the teen to report to his parents about management updates etc. – parents need updates or else they become overwhelmed with fear – often a structural intervention is necessary for the teen to feel comfortable in offering updates.

Cognitive Intervention – Stressor or Factor – thoughts, ruminations, and/or beliefs which negatively influence the teen’s management behaviors. The intention of this intervention is to both dispute unhelpful and possibly irrational beliefs while also allowing new narratives to positively impact the teen’s life. Some examples of an unhelpful belief could be: “if I can’t do it perfectly I shouldn’t do it at all” – or – “If I don’t think about my problems they will go away.”

Mindfulness intervention – Stressor or factor = an inability to observe physiological indicators which could help to inform the teen about current blood sugar levels or an inability to focus attention on the present moment so as to reduce anxiety and increase felt happiness. Mindfulness is the ability to keep your attention in the present moment as opposed to the future or the past. Body awareness mindfulness exercises help a teen to observe the sensations of the body in the present moment. I have found that teens with this ability are far superior at managing their diabetes as they take management action long before they are way ‘too- high’ or ‘too-low” This intervention generally also necessitate one of the above intervention as mindfulness facilitates increased ‘awareness’ and other interventions are often helpful in encouraging responsive action.

 

 

 

 

 

 

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Addiction, Self-determination, Flow, Mindfulness, Culture, Emotional Intelligence, and Human Bonding

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Addiction, Self-determination, Flow, Mindfulness, Culture, Emotional Intelligence, and Human Bonding

What are the components of addiction? why is addiction less desirable? and what aptitudes help us to avoid addiction?

“Let’s Turn the conversation towards Efficiency and Away from Morals”

The Psychobiological and Relational causes of undesired, addictive, and compulsory behavior:

Flow (peak experience) – Humans are most fulfilled when: Goals are clear, there is regular feedback concerning progress towards the goal, and you have the aptitudes necessary to make the challenge at the sweet spot between too hard (anxiety) and too easy (boredom).

  • Implications – Many electronic devices contain software that was developed to create a sense of flow. This creates a radical craving to engage with the software.

 

  • Solution – We need to ensure public access to ‘flow’ promoting activities that increase biological, relational, and existential wellness. Historically this includes extracurricular activities such as the arts and sport. Self-discipline with also be necessary – such as not having your cell phone at dinner or while on hikes etc.

Implicit System Conditioning – Most human emotions, thoughts, and behaviors are controlled by the implicit system. Our implicit system is evolutionarily older and significantly faster (more intelligent) then our intentional and rational explicit system. This system is adaptive – ex. you couldn’t drive a car with you explicit system.

It is very important to note that most interventions in the past have focused entirely on an explicit override of the implicit system – for example, we attempt to ‘rationalize’ away from a person’s automatic emotional response to stimuli. Unfortunately, this is not how the brain works (If I give you a rational explanation for why something ‘isn’t’ disgusting this will have no impact on your automatic disgust response).

  • Implication – Most of us have been primed to have automatic behavioral responses (towards a vice) in response to various emotions or environmental stimuli. example of stimuli that often lead to drinking: anxiety (emotion) or watching a sporting event (environmental).

 

  • Solution – We can set up our environments which allow a mindful reflection on our emotional and somatic realities so that we can our observe our desired impulses, emotions, and sensations with calm attention and without action. We then can learn to feel our feelings without reacting automatically to them. Increasing our ability to tolerate intense emotional experiences will have a positive impact on our ability to avoid the compulsory behavior.

Brain wiring and neurotransmitters – there is some overlap here with the implicit system. “What fires together wires together” Experiences that happen together can wire together – this creates predictable emotional reactions to stimuli and can create associates that are not necessarily rational. 

Neurotransmitters help to control our psychological wellness – deficits and surpluses create issues ranging from depression to mania to attention issues to psychosis etc. Adding substances to a developing mind (or a developed mind) can have unpredictable effects on our neural chemistry. Additionally, substances can impact the brain’s ability to properly uptake, release, and create neurotransmitters – which then leads to deficits or surpluses.

  • Implications – Substances such as ecstasy have been shown to dramatically impact the production of important neurotransmitters.
  • Solutions – Modeling and appropriate structure – We can ensure that we are modeling healthy relationships (including abstinence when necessary) with behaviors that can be unhealthy for our biology. We also should have regular access to nutritional items that promote a healthy biology and a sense of enjoyment.

Human Bonding and Attachment – Many vices (especially substances) impact or interact with the brain area responsible for human bonding and attachment. This means that instead of seeking out a secure relationship with another human – the substance is used (ineffectively) as the relational surrogate. This often leads to isolating behaviors – which leads to dysregulation and depression – which leads to more substance use.

  • Implications – Many people will use pot or alcohol as a means of feeling less lonely and dysregulated – though this can feel helpful in the start – the process can create a feedback loop which leads to exacerbated feelings of loneliness and dysregulation without the substance.
  • Solution – Emotionally significant/vulnerable and authentic connection. It is easier to use electronics or to engage in a substance than it is to be vulnerable enough to share your true self with another person. It is hard to remain open, empathetic and compassionate in front of a person who is suffering or who is offering their authentic self in a way that we don’t yet understand (Our impulse is generally to fix or to categorize). When we grow in our ability to stay present, honest, openminded, and compassionate, we naturally dissipate feeling of loneliness… in turn we gain a felt sense of regulation (and we, therefore, are not in need of the vice to mitigate our fears).

Anthropological Importance of Inclusion – We are a tribal animal. Our cortex developed to its’ current sophisticated state in response to the need to track an ever-increasing amount of social information (currently we max out at about 200 people). Exclusion from the group generally resulted in death for the vast majority of human existence – we tracked information to ensure inclusion (and to track ‘unsafe’ people). This reality has created a substantial fear response related to exclusion – this fear will propel us to make poor decisions to mitigate our fear.

  • Implications – We will often compromise our beliefs, emotional needs, intuition, and ration in order to protect ourselves from the fear associated with exclusion – this can mean that it feels terrifying to be without social media or to ‘just say no’ when the dominant group is engaging in unsafe behavior.

 

  • Solutions – Create emotionally intelligent communities that promote acceptance of differences and encourage open-minded and vulnerable communication. Through a compassionate dialogue, we can create a sense of culture which is best suited to the needs of the individual and the collective. Within this space of openness and acceptance, we reduce judgment and make it safe to express differences (therefore the culture will be inclusive of people who avoid behaviors that are harmful, though ‘normal’.

Faced paced society with ever increasing stimuli, social dynamics, and expectations with a corresponding reduction of health-promoting options – Currently, our society is not set up to be optimal for our psychological health. We are over inundated with stimuli, we lack sleep, we are responsible for monitoring more social dynamics than is possible, we lack access to nature, there is less access to arts and athletics, we are constantly encouraged to think about the future as opposed to the present moment, and we are often held to unrealistic expectations (such as the average workweek for an adult).

  • Implications – Often it can feel like the only way to ‘deal’ with our life is to disassociate from it, avoid it, repress it, or escape from it. Many electronics help us to completely leave (disassociate) from our current reality. Many substances produce a feeling similar to a state of mindfulness – you are absorbed in the present moment and free from the suffering found by attending to the past or the future. Lastly, many substances give us the permission to be who we want to be – inhibition. Both electronics and substances help us to deal with our anxiety resulting from feelings overstimulated, unrested, unfulfilled, and over-extended.
  • Solution – Intentionality and authentic prioritizing our life choices and values. We can enact intentionality and discipline so as to live within a set of values that promote our well-being.  health diet, appropriate boundaries, authentic expression, secure relationships, exercise, and access to nature are vital for our psychological well-being – these should not be compromised if we have the privilege to not be oppressed from accessing them (many, if not most, people in our world are oppressed from access to these variables).

Variables Impacted by Addiction

Freedom and Self-Determination. Reduced Intentionality – Increased automaticity

  • Remember Pavlov and the salivating dog (rang a bell every time the dog was fed – led to the dog salivating by the bell – even when no food was present)? As humans, we are constantly conditioned to have predictable and automatic responses to certain stimuli (this is adaptive). We can, therefore, develop automatic (and often unconscious) emotional, biological, cognitive and behavioral responses to substances, electronics, and other vices.
  • Conditioning Targets the implicit system to create unconscious associations with the vice (drugs, electronics, alcohol, shopping etc).

Experience: you have a huge problem and there is nothing that you can do about it in the moment – what vice do you want?(sibling lost all their money and they are on their way to your house to live with you)

  • Anxiety = conditioned to have a strong desire (sensation and emotion) for vice – often followed by an automatic behavior to engage in vice
  • The teenage brain is already in a state of re-structuring – pre-frontal cortex (executive control center) is less integrated into brain functioning. (this is an important time for the development of intentionality and good habits).
  • Solutions –
    • Mindfulness – focused attention on the present moment. The ability to notice without judgment and without automatic reaction. With mindfulness, we can observe the stimulus and our mind and body’s desired reaction to the stimulus. With practice, the pre-frontal cortex can override the automatic behavior (though the automatic emotion will likely stay mostly the same).
    • Willpower to engage in life intentionally despite a strong impulse to avoid or otherwise retract from discomfort. (without self-determination we are controlled by the external world and our urges)

Emotions and Body Awareness. reduction of sensory and emotional experience along with a reduced ability to tolerate emotions or sensory experiences.

  • What sensations are experienced in an elevator with a stranger (what does it feel like in your body)What emotions do you have as a result? What behaviors are we likely to engage in?
    • Now imagine all the experiences that a teen is going through – Away from home, love interests, making friends, meeting expectations, and figuring out who they are
  • After you have looked at a screen for 5 minutes where is your consciousness?
    •       What effect might this have on emotional aptitudes such as empathy?
    • Electronics and substances often disassociate us from our body (and relationships).
  • We must learn to continually be aware of and to tolerate our emotional and somatic experiences to achieve our ambitions – substances and electronics can rob us of the ability to develop this capacity.

What normal aspects of everyday life require a high level of emotional awareness and tolerance? Public Speaking 😉 Creating an emotionally intimate relationship.

Attachment and inter-regulation through Human bonding

  • New research is finding that substances and electronics target the same area of our brain used for human attachment and bonding (bonding is a primary need like water (orphanage example & cast away example)— the pull is extreme)
  • We are a social animal, and through millions of years of evolution we have developed a very sophisticated system of bonding with other humans that radically improves our ability to survive – Human connection is the #1 predictor of happiness (slope of a hill appears less steep, reduced amygdala activation in FMRIs when shocked)
  • We need to help our teens to bond with each other, with us, with the community
  • Electronics and substances mimic the feeling we get from positive human connection BUT they do not lead to lasting happiness and they do no facilitate regulation (human bonding is the cure for stress).

Conclusion – Our goal is to mentor our community towards becoming Self-determined, Emotionally intelligent, and Relationally able people. This doesn’t need to be a moral argument – Drugs and Electronics are not intrinsically bad or good… Instead, let’s change the discussion to efficiency – what are the most efficient means of developing the above Aptitudes?

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Choice is Oppression

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Wow that is a provocative way to start! of course Choice is also liberation and a billion of other things, but in the post I want to shine some light on how individualism has created a blind infatuation with choice – and how ‘choice’ is actually the very source of our oppression.

perhaps the single most pervasive and uniting variable in the US is our individualism – Our desire to emancipate the self from any barriers to self-fulfillment. It can be so hard for us to see that fulfillment is both in maintaining and emancipating from barriers. both in having choice and in allowing ourselves (irony noted) to not have a choice.

The other Day my 5 year old was balancing on a kitchen chair and was distracted by some other stimuli that stole his attention. He lost his balance and fell pretty hard, only kind-of catching himself on the chair before hitting the wood floor. he’s fine.

Of course he had been told many time not to do this… but even at 5 his strong desire to have a choice in all matters was stronger than his desire to avoid bodily injury in cases were injury was most probable and where there wasn’t really any benefit associated with the risk other then in validating that ‘he had a choice’ (meaning it wasn’t particularly rewarding- fun – for him to be standing on the chair = he just wanted to do it because he wasn’t supposed to).

As adults we have countless examples of such experiences with children and teens – its maddening! “Why can’t they just follow the rules!”

but we tend to avoid looking at the metaphorical mirror to see how often we are doing the same thing. “What don’t we have any rules to follow!” 😉

the defensive sides of us want’s to quickly retort, “wait a minute – I have rules! I would never kill someone… I don’t steal people’s cars! I don’t pee in public places… well wait .. I don’t unless…I don’t drink and drive… well actually I don’t get drunk and drive….well”

I’m not trying to focus us in on the big examples – this isn’t just a conversation about strict adherence to morals.

Ask yourself this question – What choices would be good for me to remove if I had the goal of being a physically, relationally and psychologically healthy person?

If exercise is a choice how often are you going to choose it? How many variables would you have to realistically quantify in order to make that choice? ex. I drank too much last night, I have a minor headache, its windy, my class has a sub teacher, I’ll work out tomorrow etc.”

If intentionally engaging in the health of your relationship is a choice how often would you choose something more suited to the self? How often would you go somewhere you didn’t want to – have sex when your partner was hot and bothered and you were tired- clean up when the mess wasn’t yours – be emotionally available when the ball game is on – play with your kids when you are always exhausted from work?

What if your passion and spirituality surrounds doing something uncomfortable such as camping in the fall, surfing at sunrise, getting first tracks on a ski mountain, practicing your musical instrument, traveling to connect with important relationships etc?

How are our choices oppressing us?

Perhaps if another drink after midnight wasn’t a choice we would have enjoyed the first lift, perhaps if staying in bed wasn’t a choice we would have caught a sunrise set of waves, perhaps if TV was not an option we would know how to play our instruments. Perhaps if waiting for perfectly comfortable weather wasn’t a choice we would have gone camping. Perhaps if choice wasn’t an option I would blog more…

Authenticity and congruence are difficult variables to describe in a spiritual sense… yet we all feel what they mean.

we have offered ourselves the choice to be incongruent… to be inauthentic… to avoid our passions… to live without fulfillment… and to engage in activities that hurt the body and relationships we live in

and this is why choice is our oppressor… we have attached to choice with religious rigidity and in doing so we fell from our authentic path… we chose to avoid our destiny to satisfy our addiction to comfort and individualism.

It feels really wonderful for me to think about freeing myself of this burden… to allow myself the freedom to have no choice in the area of congruence. To be congruent – especially when it is the less comfortable choice.

 

 

 

 

 

 

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Weight loss – what does that food mean to you? Insight, reflection, and replacement in achieving weight loss goals.

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Quick summary: I will discuss why certain foods seem or feel impossible to give up and offer a brief suggestion as to what you can do to overcome such an obstacle. Food (as with many other things in life) often has a symbolic importance which is more influential or otherwise important that the simple tangible object that it seems to be.

 

The theory is that insight into the unconscious drives related to a food can liberate a person to address those drives and the person therefore gains a degree of power over the automatic impulses related to that food.

 

Insight by itself in no way solves a problem related to eating unhealthy foods… in fact some research is suggesting that certain people are less likely to make a healthy food decision when nutritional information is offered to them in an attempt to encourage a more healthy choice.

 

  • the researches who found such evidence have suggested that our drive towards freewill trumps our desire to make the most intelligent or healthy decision… in short, when we are told to eat something because it is healthy, we often don’t want to comply simply because we perceive someone else as telling us what to do… we are more concerned with choosing our behavior than in taking suggestions which are in our best interest.

 

Insight into unconscious drives frees a person from a degree of automaticity.

  • An ability to reflect on an impulse is created thereby giving a person an opportunity to choose what behavior they will engage in. For many people insight into an impulse does not dissuade them from succumbing to the impulse.

 

What if you could find a more healthy replacement behavior to satiate the burning drive of that impulse?

 

Exercise to find insight about the hidden drives of the ‘impossible to give up’ food

 

Firstly I want you to list a food that you can hardly imagine not eating.

 

Symbolism – What does this food mean to you?

 

History – what is your history with this food?

 

Feeling – what is the desired feeling that you want to experience while eating this food?

 

Cognitive – what are some of the reasons that you tell yourself that encourage you to eat this food?

 

Importance – what are all the reason why you do not want to give up this food?

To reduce the amount of willpower that it will take to restrain yourself from this food it would be in your best interest to find a replacement means of attaining the above variables.

 

  • Example, if you are trying to feel that lazy, satiated, completely satisfied feeling is there another way of accomplishing this?
  • – for many people eating comfort foods is a way of attaining feeling similar to those acquired in a healthy adult sexual relationship.

 

With insight about the above variables you can free yourself to make appropriate decisions on a moment-by-moment basis.

 

  • Example, if your cognitive reason for eating the food is “that it doesn’t taste good without out it” ask yourself if this is always true or if it is more true in certain situations than in others.
  • – if you absolutely love cheese on your burger ask yourself if you would even taste the cheese if you already are getting three other toppings.

 

Make a decision before the impulse is present to avoid having to make a difficult choice when the food is begging for you to comply with its demands to be eaten.

 

  • Example, if there is a certain food that has a lot of meaning to you and your family then choose the best times to indulge and choose times where it is not necessary to indulge.
  • If you and your family love a huge greasy slice of lasagna have it when someone that knows how to make it is going to be serving it and make the decision to avoid it at cheep chain American restaurants.

 

“Do I really want this food or do I actually want something that this food is symbolic of?”

 

  • Example, sometimes it is best to find the symbolic importance of the food and meet your needs another way.
  • – if you associate eating BBQ with your father who you have not seen in a while perhaps sometimes it would be better to call your father than to over-indulge in BBQ.
  • – If you are longing to feel young again and eating pizza makes your feel young perhaps there is another way for you to achieve such a feeling.

 

 

The Best plan is moderation and not abstinence… giving up your favorite ‘not so healthy’ food is unnecessary and incredibly difficult…

 

How can you enjoy the food with more moderation and still meet the above needs adequately?

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.

Realistic Weight Loss Work Sheet – Keep what you love, substitute and add where you can, and remove the unimportant

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Quick summary: When it comes to weight loss the tortoise wins and the rabbit ends up going the wrong way. Unrealistic eating plans get in the way of your weight loss goals (some even make things worse). If you are using too much personal restraint you may be setting yourself up to fail. This questionnaire will help you to create a reasonable plan to achieve an eating pattern that can be maintained for a lifetime. Moderation, Balance, and realistic expectations will help you find hope and wellness.

 

Complete these questions and bring them to a Nutritionist. (Complete the questions 10 times for each of the two categories = twenty total food dishes with all relevant components and sides.)

Favorite Food – Highly desired immensely Satisfying food (name the food that would require all of your will power to restrain yourself from eating). __________________.

  • Name all the individual components of the dish (ex. mayonnaise, cheddar, sourdough role, pepperoni, bacon etc.) ______________, ________________, ____________________, _______________, _________________, _______________,
  • Name all the sides that must accompany the dish to satisfy your desire (ex. Cole slaw, French fries, Ice tea, Pepsi etc.)_________________, ______________, _______________, ______________,
  • What is the benefit of eating this food to you? (delicious, family memories, emotional comfort, makes me feel good, cultural, tradition etc)

 

Moderate to low desire/satisfaction Food – The food that is not particularly good for you that you don’t have an unyielding desire for. (Name the unhealthy food that you eat which would not take much restraint to avoid.)

  • Name all the individual components of the dish (ex. mayonnaise, cheddar, sourdough role, pepperoni, bacon etc.) ______________, ________________, ____________________, _______________, _________________, _______________,
  • Name all the sides that generally accompany the dish (ex. Cole slaw, French fries, Ice tea, Pepsi etc.)
  • What is the benefit of eating this food to you? (convenient, quick, cultural, all there is, easy to make etc)

 

Fill this form out 10 times for Favorite Foods and 10 times for Moderate to low desire/satisfaction Foods.

 

Rank all of your Sides and components on a scale of 1 – 10 (10 being very important = no substitution is a reasonable option, and 1 being not important = you could use a healthy alternative or remove it all together).

 

Name all the healthy foods that you already enjoy.

 

Take your answers to a nutritionist and ask for guidance on how to create a reasonable eating plan. (Meaning the plan will be sustainable without requiring excessive personal restraint.)

 

  • You now have a list of important and not so important foods. It is reasonable to assume that your degree of self-control surrounding food will be related to this list.

 

  • Foods that have significant emotional importance to a person can be looked at with a therapist. This topic will be in a future blog.

 

  • Have your nutritionist suggest healthier alternatives or replacements to every component and side of the food that you listed above (ex. beef burger to turkey burger, White bread to wheat bread, pepperoni to Canadian bacon, three slices of cheese to one slice of cheese etc).

 

  • Go through the list with your nutritionist and mark down the replacements that you know will work for you, you know will not work for you, and those that you are willing to try.

 

  • Set yourself up for success… Success is based on being realistic with yourself often when a person fails at one part of their diet they will give up all together… if substituting ground beef with ground turkey will require immense restraint then avoid setting yourself up for failure.

 

  • For your favorite foods your number one goal is portion size control… if changing an ingredient dramatically impacts your satisfaction then do not change that ingredient.

 

  • Ask you nutritionist to help you create a reasonable eating schedule that will encourage a healthy metabolism.

 

  • Ask your nutritionist for tips on how to avoid overeating unhealthy favorite foods (ex. waiting ten minutes after you have finished half of your meal, drinking a pint of water before you begin eating, eating your salad or a fruit before you have your meal etc)

 

  • Finally have your nutritionist offer ways of including necessary healthy foods into your daily diet. Talk openly about which suggestion feel realistic to you. Encourage her to use as many of the foods that you already enjoy as possible.

 

  • Important – you must be honest with your nutritionist… if you think that a suggestion is too difficult consult with her on other options.

 

  • Allow yourself to be continually supported by the nutritionist… success often necessitates continuous involvement from a supportive professional in most situation in which the goal is fundamental change.

 

Note – Eating smaller portion more often is generally ideal and some research is suggesting that eating your ‘vice’ favorite food earlier in the day will help you to avoid overeating that food later in the day.

  • This is based on restraint theory research which suggests that the more you restrain yourself from something the more you desire that something and therefore the more likely you are to overindulge when your self-restraint eventually fails.

 

For realistic nutrition tips visit www.justalittlechocolate.com

 

You can do this in a way that doesn’t feel constantly painful.

 

Live and be healthy – these were never mutually exclusive

 

Click the Weight Loss button under Categories on the sidebar for more support in reaching your weight loss goals.

William Hambleton Bishop is a practicing therapist in Steamboat Springs Colorado.