Awhile back, a Beyond Blue reader asked me to address the problem of weight gain and medication. “How do you deal with this yourself?” she asked me.
I’ll be perfectly honest — it’s a battle. As someone with a history of an eating disorder, I’ve had to work very hard on getting to a place where I eat when I’m hungry. For that reason, I won’t go near drugs like Zyprexa, because the 20 pounds that I gained in one month made me feel almost as bad as my depression.
I totally understand that body image is important to your self-esteem. I wish I wasn’t so shallow, but look at the ads around us. What’s the message that they’re screaming?
“Thin people are beautiful. Overweight people aren’t.” I hate that.
So, since this is Friday’s question that is usually answered by an expert, I read through my Johns Hopkins’s literature and found some helpful modification guidelines by Karen Swartz, M.D., Director of the Clinical Programs and one of the physicians who evaluated me in March of 2006 (and then sent me directly into the inpatient unit!). I hope her guidelines help. In the “Fall 2008 Depression and Anxiety Bulletin,” she writes:
In 2006 a study funded by the National Institute of Mental Health and published in the Archives of General Psychiatry reported that nearly one in four cases of obesity is associated with a mood or anxiety disorder. Among newly diagnosed patients with a mood disorder or anxiety complaint, weight gain is often a serious concern. Many fear that they’ll become fat–or get fatter–if they start medical treatment. A rapidly expanding waistline is also one of the major reasons why patients prematurely discontinue an otherwise effective treatment, fall back into depression and experience a poor outcome. Building a strong doctor-patient relationship and proactively discussing concerns such as weight gain are essential to a positive outcome.
In addition to discussing your weight with your physician, I hope you’ll find the following behavior modification guidelines helpful.
1. Set realistic goals.
Instead of attempting to lose a specific number of pounds, make it your goal to adopt healthier eating and exercise habits. If you feel compelled to set a weight goal, losing 10 to 15 percent of your current body weight is a realistic objective. The good news is that weight loss of as little as 5 to 10 percent of body weight can significantly improve heart disease risk factors such as blood pressure, blood glucose, and triglyceride and cholesterol levels. The safest rate of weight loss is 0.5 to 2 pounds a week. And added bonus: If you lose weight at this rate, you are more likely to keep it off.
2. Seek support from family and friends.
People who receive social support are more successful in changing their behaviors. Request help from family and friends, whether this means asking them to keep high-fat foods out of the house, relieving you of some chore so that you have time to exercise, or even exercising with you to keep you motivated. It will be easier to stick to your new eating plan if everyone in your home eats the same types of foods. You might also want to consider joining an online or local weight support group to talk with others about dieting and exercise challenges.
3. Make changes gradually.
Trying to make many changes too quickly can leave you feeling overwhelmed and frustrated. Instead, ease into exercise; do not overdo it. If you can only walk on the treadmill for 10 minutes, that’s fine. However, in a week or two try to increase the time to 15 minutes. In addition, adopt a healthy diet in stages. For example, if you typically drink whole milk, switch to reduced-fat (2 percent) milk, then to low-fat (1 percent), and then to fat-free.
4. Eat slowly.
Many people consume more calories than needed to satisfy their hunger because they eat too quickly. It takes about 20 minutes for the brain to recognize that the stomach is full, so slowing down helps you feel satisfied on less food. In addition, eating slowly allows you to better appreciate the flavors and textures of your food.
5. Eat three meals a day, plus snacks.
Skipping meals or severely reducing your food intake is counterproductive, since such strict changes are impossible to maintain over the long terms and are ultimately unhealthy. In addition, eating the bulk of your calories at one sitting may slow down your metabolism. You will be more successful in the long run if you allow yourself to eat when you are hungry, eat enough nutritious low-fat food to satisfy that hunger, and spread your calorie intake over the course of the day.
6. Plan for exercise.
Choose activities that are convenient and enjoyable for you to do on a regular basis, and then treat exercise like any other appointment: Set a time and jot it down in your date book. Many people find it easier to exercise first thing in the morning, before the demands of the day interfere.
7. Record your progress.
Start a food diary and exercise log to keep track of your accomplishments. This may seem cumbersome, but it can help you stay motivated, and reviewing your entries can help reveal problem areas. The information can also help your nutritionist or doctor treat your eight problem more effectively.
8. Evaluate your relationship with food.
Behavioral and emotional cues all to often trigger an inappropriate desire to eat. The most common cues are stress, boredom, sadness, anxiety, loneliness, and the use of food as a source of comfort or as a reward. Eating may appear to soothe uncomfortable feelings, but its effect is temporary at best and ultimately does not solve any problems. In fact, eating may distract you from focusing on the real issues.
9. Recall your accomplishments.
Over your lifetime, you have probably been successful in tackling many challenges, including coping with your mood or anxiety disorder. Reminding yourself of your own strength can help you feel more confident about making the changes that will lead to weight loss.
10. Don’t try to be perfect.
While losing weight requires significant changes in eating and exercise habits, not every high-calorie food must be banished forever, and you do not need to exercise vigorously every day. On some days, you will go off your weight-loss plan. This is normal, so don’t let these “bad” days deter you from returning to your healthier eating and exercise habits as soon as you can.