1. Jump to it!

It takes half a second, or less, to make that decision to get out of bed and be active. So when you have the thought – jump to it! Don’t spend time weighing up the pros and cons (weather, mood, physical state, etc.); by the time you’ve talked yourself into rolling back over to sleep you could have taken a brisk 20min walk! Bear in mind that planning in advance and exercising regularly increase the likelihood that you’ll stay motivated. ³⁰

2. Run, jog, walk

Run, or just walk, out of your front door and into the new day. Practice reframing your reasons for taking exercise – self-determination again… i.e. because you want to, not because you have to. Do this by focusing on how lucky you are to be alive, experiencing this new day, and to be healthy enough to be able to move your body, see the sun, feel the rain and wind. If you’re depressed, ill or in pain this will be difficult. But try to get up and move in whatever way you can. Get help. Resolve to keep trying, however tiny the steps. Positive habits can transform destructive cycles of mental energy into constructive ones – but it will take time, effort and support if you’re not used to thinking that way.

3. Good, Better, Best

Change the way you make your decision to exercise by re-imagining the activity with focused visualisation. Instead of concentrating on the blast of icy air that hits you when you open the door, focus instead on the warm glow you’ll feel when you get back indoors, the wonderful invigorating shower or the delicious breakfast. And if you don’t manage it – don’t feel guilty. Just be kind to yourself and resolve to do it the following day. Self-compassion rather than guilt is more likely to improve your motivation. ³¹

References

(30) Schmeichel, B. J., Harmon-Jones, C., & Harmon-Jones, E. (2010). Exercising self-control increases approach motivation. Journal of personality and social psychology, 99(1), 162.

(31) Breines, J. G., & Chen, S. (2012). Self-compassion increases self-improvement motivation. Personality and Social Psychology Bulletin, 38(9), 1133-1143.

1. Re-adjust Your Goals

It’s believed that two thirds of us in the UK will be overweight by 2025, so we need to get serious about shedding excess weight. But if you focus on looking slim – rather than being healthy – it might actually work against you.^1,2 Losing weight to look good, rather than optimising health, just doesn’t seem to be as effective long-term.³ This is borne out by what we know about parents unwittingly putting their child at an increased risk for eating disorders later in life by focusing on their child’s weight, rather than giving positive messages about healthy eating in general. Might this also explain why some adults have struggled with weight issues since adolescence?⁴ The self-determination theory suggests that having full autonomy in the choices we make, rather than feeling controlled, can make all the difference when it comes to weight loss. ^5,6,7 This means that wanting to lose weight because of how you think others perceive you is less effective than deciding to lose weight because you yourself want to be healthy. So, although it sounds counter intuitive, lightening up about your size, and genuinely embracing improved health might be the first step you need to take.

2. Forget Fad Diets

Fad diets abound. A library’s worth of new dieting books will be hitting the bookshelves for 2016! The titles are designed to entice all types of dieters – promising the world, but for most, failing to deliver in the long term. In fact this kind of  approach often leading to increased weight gain. ^8,9,10 So save your money, forget the “miracle diet” and spend your time doing something more fun, interesting and worthwhile….

3. …Create, don’t Vegetate

“Veggin’ out” in front of a screen encourages increased food intake, poorer food choices and increased weight. ^11-16 Regular junk food / TV binges can become a bad habit, eating up hours, adding pounds to the waistline and increasing your chances of chronic disease, binge eating and depression.^17-22 Action TV in particular is associated with a greater intake of poor quality food, ²³ a fact that will come as no surprise to the “popcorn inhalers” at the movies. The average Brit spends 3 hours and 40mins per day watching TV, and it’s thought that longer viewing binges (back-to-back Nordic Noir box sets, anyone?) may be taking its toll on the nation’s cognitive health.²⁴ Maybe you are just chilling for a few hours, in which case, enjoy! But if you find yourself habitually using screen time to distract yourself from stress or problems – tuning in, to tune out – you might be creating more problems in the long run. On the flip side, being creative can improve brain function and quality of life as we age. ^25-29 Start swapping screen time for something new a few hours a week, it could be the start of better health, and a more interesting, creative and happier life.

References

(1) Cheskin, L. J., & Donze, L. F. (2001). Appearance vs health as motivators for weight loss. JAMA, 286(17), 2160-2160.

(2) Calder, R. K., & Mussap, A. J. (2015). Factors influencing women’s choice of weight-loss diet. Journal of health psychology, 20(5), 612-624.

(3) Putterman, E., & Linden, W. (2004). Appearance versus health: does the reason for dieting affect dieting behavior?. Journal of Behavioral Medicine, 27(2), 185-204.

(4) Berge, J. M., MacLehose, R., Loth, K. A., Eisenberg, M., Bucchianeri, M. M., & Neumark-Sztainer, D. (2013). Parent conversations about healthful eating and weight: associations with adolescent disordered eating behaviors. JAMA pediatrics, 167(8), 746-753.

(5) Teixeira, P. J., Silva, M. N., Mata, J., Palmeira, A. L., & Markland, D. (2012). Motivation, self-determination, and long-term weight control. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 22.

(6) Georgiadis, M. M., Biddle, S. J., & Stavrou, N. A. (2006). Motivation for weight-loss diets: A clustering, longitudinal field study using self-esteem and self-determination theory perspectives. Health Education Journal, 65(1), 53-72.

(7) Theory of Motivation Guides Our Approach To Helping People. University of Rochester Medical Centre https://www.urmc.rochester.edu/community-health/programs-services/healthy-living-center/self-determination-theory.aspx

(8) Pietiläinen, K. H., Saarni, S. E., Kaprio, J., & Rissanen, A. (2012). Does dieting make you fat? A twin study. International Journal of Obesity, 36(3), 456-464.

(9) Siahpush, M., Tibbits, M., Shaikh, R. A., Singh, G. K., Kessler, A. S., & Huang, T. T. K. (2015). Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample. International journal of behavioral medicine, 22(5), 662-671.

(10) Dulloo, A. G., Jacquet, J., Montani, J. P., & Schutz, Y. (2015). How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity Reviews, 16(S1), 25-35.

(11) Börnhorst, C., Wijnhoven, T. M., Kunešová, M., Yngve, A., Rito, A. I., Lissner, L., … & Breda, J. (2015). WHO European Childhood Obesity Surveillance Initiative: associations between sleep duration, screen time and food consumption frequencies. BMC public health, 15(1), 1.

(12) Boulos, R., Vikre, E. K., Oppenheimer, S., Chang, H., & Kanarek, R. B. (2012). ObesiTV: how television is influencing the obesity epidemic. Physiology & behavior, 107(1), 146-153.

(13) Ciccone, J., Woodruff, S. J., Fryer, K., Campbell, T., & Cole, M. (2013). Associations among evening snacking, screen time, weight status, and overall diet quality in young adolescents. Applied Physiology, Nutrition, and Metabolism, 38(7), 789-794.

(14) Tucker, L. A., & Bagwell, M. (1991). Television viewing and obesity in adult females. American Journal of Public Health, 81(7), 908-911.

(15) Tucker, L. A., & Friedman, G. M. (1989). Television viewing and obesity in adult males. American Journal of Public Health, 79(4), 516-518.

(16) Braude, L., & Stevenson, R. J. (2014). Watching television while eating increases energy intake. Examining the mechanisms in female participants. Appetite, 76, 9-16.

(17) Zhai, L., Zhang, Y., & Zhang, D. (2014). Sedentary behaviour and the risk of depression: a meta-analysis. British journal of sports medicine, bjsports-2014.

(18) Kremer, P., Elshaug, C., Leslie, E., Toumbourou, J. W., Patton, G. C., & Williams, J. (2014). Physical activity, leisure-time screen use and depression among children and young adolescents. Journal of Science and Medicine in Sport, 17(2), 183-187.

 (19) Breland, J. Y., Fox, A. M., & Horowitz, C. R. (2013). Screen time, physical activity and depression risk in minority women. Mental health and physical activity, 6(1), 10-15.

(20) Davies, C. A., Vandelanotte, C., Duncan, M. J., & van Uffelen, J. G. (2012). Associations of physical activity and screen-time on health related quality of life in adults. Preventive medicine, 55(1), 46-49.

(21) Hamer, M., Poole, L., & Messerli-Bürgy, N. (2013). Television viewing, C-reactive protein, and depressive symptoms in older adults. Brain, behavior, and immunity, 33, 29-32.

(22) Burmeister, J. M., & Carels, R. A. (2014). Television use and binge eating in adults seeking weight loss treatment. Eating behaviors, 15(1), 83-86.

 (23) Tal, A., Zuckerman, S., & Wansink, B. (2014). Watch what you eat: action-related television content increases food intake. JAMA Internal Medicine, 174(11), 1842-1843.

(23) Hoang, T. D., Reis, J., Zhu, N., Jacobs, D. R., Launer, L. J., Whitmer, R. A., … & Yaffe, K. (2016). Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function. JAMA psychiatry, 73(1), 73-79.

(24) Fisher, N., Lattimore, P., & Malinowski, P. (2016). Attention with a mindful attitude attenuates subjective appetitive reactions and food intake following food-cue exposure. Appetite, 99, 10-16.

(25) Greaves, C. J., & Farbus, L. (2006). Effects of creative and social activity on the health and well-being of socially isolated older people: outcomes from a multi-method observational study. The Journal of the Royal Society for the Promotion of Health, 126(3), 134-142.

(26) Leckey, J. (2011). The therapeutic effectiveness of creative activities on mental well‐being: a systematic review of the literature. Journal of psychiatric and mental health nursing, 18(6), 501-509.

(27) Ueno, K., Takahashi, T., Takahashi, K., Mizukami, K., Tanaka, Y., & Wada, Y. (2015). Neurophysiological basis of creativity in healthy elderly people: A multiscale entropy approach. Clinical Neurophysiology, 126(3), 524-531.

(28) Kongkasuwan, R., Voraakhom, K., Pisolayabutra, P., Maneechai, P., Boonin, J., & Kuptniratsaikul, V. (2015). Creative art therapy to enhance rehabilitation for stroke patients: A randomized controlled trial. Clinical rehabilitation, 0269215515607072.

(29) Uttley, L., Scope, A., Stevenson, M., Rawdin, A., Buck, E. T., Sutton, A., … & Wood, C. (2015). Clinical effectiveness of art therapy: quantitative systematic review.

If you began 2016 with great and noble plans to lose weight, eat less junk/carbs, more veg, detox, take part in “Dry January” etc. … or just a vague idea of improving your health – now, as February begins, might be the time your resolve starts flagging. Fading memories of December’s excesses and a month of dietary penance, can wither your willpower, sabotaging the best-laid plans and kick starting another year of yo-yo dieting or erratic eating – feast or famine, depending on mood, upcoming event or the need to “reward” yourself.

So, how can you stay motivated to make changes not just for the rest of the year, but the rest of your life?

The next three blog posts will offer up some mind/body ideas to chew on –

Taste is rarely discussed when people talk to me about nutrition, as if it wasn’t a fundamental factor in what we choose to eat. But let’s face facts – if cabbage tasted like chocolate would we be facing an obesity crisis? Or, if Bitter Gourd tasted like those warm sugary doughnuts on Brighton Pier might we be more successful in stemming the rising tide of Diabetes Type 2?

A few months ago while pondering the importance of taste in making food choices, I faced my latest taste hump. I was discussing various medicinal foods with a Sri Lankan friend while waiting to collect our sons from school. I raised the subject of the above mentioned bitter gourd also known as bitter melon, balsam pear, karela – or to give it its scientific name, Momordica charantia. I’d read about its use in traditional medicine in many countries in Asia and Africa, as well as Turkey and Jamaica to address complaints as diverse as digestive disorders, rheumatism, gout, skin diseases, parasites and diabetes. A quick glance through some recent research literature revealed claims about its many health benefits to be more than mere folklore. For example, the pathways through which the bitter gourd exerts its preventive effects against insulin resistance – at least in rats – are now partially understood and its potential use as a therapeutic agent for breast, liver, and kidney & colon, among other cancers is being actively investigated.

I was excited to see they were part of Sri Lankan cuisine. Did my friend personally eat them? “Yes,” she giggled, with a twinkle in her eye.

Some days later her son handed me a carrier bag containing three bitter gourds. They nestled in the bottom of the bag looking like cucumbers afflicted with a serious dose of leprosy. I couldn’t wait to take them home and try them! My friend had also provided a link to a recipe for Bitter Gourd Masala “just in case you want to disguise their taste” she said, smiling. I was making a curry that night so it seemed like the perfect accompaniment. I decided to boil some as well, so we could try them without masking their natural flavour, and I’d read you could drink the juice they’d been boiled in for added health benefits.

A few days later I saw my friend again. She read my expression from a distance of ten feet and we both erupted in laughter. “I had no idea they would be so…..um..bitter,” I say, trying not to hurt her feelings.

“It’s really terrible, isn’t it? ” she laughed, seeing through my attempt at politeness. “We don’t often have them because no one except me really wants to eat them,” she explained, adding,  “I think you have to grow up with the taste to really appreciate it – and also to know that it’s doing you some good.”

Bitter might not be the most helpful word to describe this vegetable. I’m thinking more along the lines of – poisonous, acrid, heart-rendingly nasty, or just plain cruel. If I hadn’t expected it to be quite such a challenge (I’d done my homework) I’d have seriously wondered whether I’d eaten a lump of pesticide residue. It was actually so bitter I worried it might be potentially harmful (it is, if you are pregnant or take diabetes meds – so beware). I also wondered whether I might risk poisoning my family…..

I needn’t have worried.

My husband nibbled a minuscule piece before looking at me in disbelief, shaking his head and slinking out of the kitchen. “Come on, dad! Be brave. You only tried, like, a few atoms” taunted my son, who, hats off to him, tried slightly more than a few atoms worth. His response was to give a Munchian Silent Scream and fall to the floor laughing hysterically while kicking his legs in the air. He then clasped his hands around his throat, widened his eyes and shook his head in disbelief. Watching this dramatic, unbridled expression of unadulterated disgust from a 9yr old was amusing, but disappointing. He’s usually up for anything on the taste front. I turn back to the gourd sighing, “I guess that’s a no!”

The bitter-gourd masala sat in the fridge for quite a few days before we dared try it again. Oddly, it didn’t taste quite so bad. Bitter, yes sure, but not quite as potentially lethal. I ate a few mouthfuls – determined to find some way to outsmart my tastebuds. I was sure reason could trump senses. Sadly, most of it went straight in the bin.

I’m determined to try it again soon. I conquered Brussels Sprouts – and even learned to enjoy them, so I know can do the same with this. Taste avoidance and taste aversion are apparently different processes. The point being that as long as a food doesn’t produce physical symptoms of illness (e.g. nausea) it suggests avoidance can be overcome – or unlearned. My learned associations with respect to Bitter Gourd’s taste are negative, because to me it tastes just like bile. But knowing that it’s a learned association, that it has health benefits and that it won’t make me sick means I can potentially conquer this Pidurutalagala of taste humps.

I’ll keep you posted. I simply refuse to be defeated by a warty, green (healthy) vegetable!

The recent news that obesity is the new smoking is not so much news, as a new way of saying the same thing that’s been said for years. I understand the chief executive of NHS England – Simon Stevens’ – point, and agree that tackling obesity, as with smoking, needs to be a concerted effort involving producers and advertisers. However, as behaviours go, there’s a huge difference between eating and smoking that needs to be recognised, and that is –  we need to eat!

According to the World health Organisation worldwide obesity has more than doubled since 1980. Most of the world’s population now lives in countries where being overweight or obese kills more people than being underweight. How many ways will we frame this problem before changing our approach? Evidently, telling people to “eat less” and  “take more exercise” isn’t working.

As a Nutritional Therapist I often meet people who are overweight or obese, or who have diseases directly related to these conditions – or related to a poor quality diet. Usually weight gain in adults is the symptom of a deeper underlying (often emotional) issue. Patients often say they feel unable to control their cravings, sometimes citing feelings of addiction when it comes to particular foods – the Holy Trinity often being doughy products, crisps and chocolate. Whether this is mainly a physiological addiction – or more of a psychological need for gratification – is debated, but it seems both play a role. Other common issues are: defiance, boredom, denial, lack of self-discipline, bad habits, apathy, low self-esteem (often stemming from childhood), stress, depression, relationship woes, work pressures, loneliness, unhappiness, lack of meaning, spiritual emptiness, family stress, use of food as a pleasurable reward, thoughtlessness ….or any combination of these, including others I’m sure I’ve missed. Unlike smoking, eating has an added level of complexity because the drive is so primal. Restricting food intake only increases our desire to eat, trumping conscious control of our intake. The hungrier we are, the more likely it is we’ll choose palatable (high fat, high sugar, high salt) foods.

For an adult, trying to lose weight or admitting to having an “over-eating” disorder can be extremely difficult without recognising the interplay of the above issues – each will be as individual as its owner. Taking time to listen to people and discover how other areas of their lives influence their eating behaviour, as well as fostering a deeper understanding of their own physiological drives, are often overlooked. I believe they are important links in solving the obesity puzzle. How can someone “fix” something if they don’t know where it broke, and why?

My training involved a good deal of listening and open questioning. We were taught to ask about past health history and diet, of course, but also about how the patient feels – and all that this word encompasses in their lives. Also, how much do they understand about the way their bodies and minds work? It’s not rocket science – it’s actually more complicated than that because we’re dealing with human beings and, as listed above, their vast repertoires of emotion and individual experiences.

We’re also dealing with food and someone’s ability to nurture themselves. Depending on how we view it, food can be delicious, joyful and potentially healing or guilt-ridden, forbidden and poisonous.  Most of us tend towards the positive end of that spectrum of “good” to “bad” – which is helpful because without food we die.

Self-nurturing is often confused with self-gratification or hedonism. Being constantly told to “live in the moment” may only add to the confusion. For some, being totally in the moment means gobbling an entire family sized bar of Dairy Milk in one sitting. For others it means savouring the taste and texture of one delicious square of Divine 70% dark chocolate.

Acknowledging behavioural complexities always brings someone closer to understanding themselves  – and IMHO will always beat handing someone a leaflet instructing them to “Eat-5-A-Day”! Unfortunately, this kind of support takes some time and consistency. Perhaps because of this it isn’t (yet) widely available on the NHS. More’s the pity as it would undoubtedly save money in the long term.

A questioning & listening approach to tackle obesity in children, called  Motivational Interviewing, is currently being researched. Motivational Interviewing (MI) encourages the child to think differently about themselves. It fosters self-belief and provides, as the name suggests, motivational support to help them make positive and lasting changes. It often includes education of the parent as well as the child. So far, results from MI have been largely positive. To those of us already using similar approaches this is good news.

Education is key, and can be a great motivator when personalised. Most children could probably guess that doughnuts are not as healthy as tomatoes, but unless it means something to them, it’s just an obvious, boring and irrelevant fact. Again, consistency of messages – and time – are crucial factors.

It’s disheartening that children should have to think about their body size at all. As parents we believe we can shield our children from such grown-up concerns. But we’re often swimming against a tide of negative influences (from the food and advertising industries, TV and other media, friends and family, etc.) that erode our confidence and ability to parent as effectively as we’d like. Sometimes parents struggle with food themselves, unaware that this may be influencing their children too.

For a child it’s even more difficult to deal with weight gain than adults, because although there may well be some underlying issues at play, the biggest problem seems to be a lack of recognition that they are overweight at all! A study in March revealed, parents rarely spot that their own child is overweight or obese, let alone decide to do something about it. This is very worrying.

If you can’t tell whether your child is overweight by looking at them – check their BMI. The sooner you admit there’s an issue, the sooner you can help them. You don’t need to discuss it with younger children at all – but you should start considering action.  That may mean looking first at your own attitudes and behaviour around food, and taking it from there. With teens, raise the issue of weight in the context of health, not looks.  Be gentle, but honest. Make sure your partner and other family members are on board – and get professional support if you need it.  Overcoming denial and accepting the well established consequences of overweight and obesity on quality – and length – of your child’s adult life are crucial in helping your child take increasing responsibility for their own future health.

As with smoking, simply telling people not to do something because it’s bad for them is unlikely to work long term.

Helping them to understanding the reasons for their behaviour, and motivating them to appreciate good food, their bodies and their lives, probably will.