Mind Over Appetite
EatingWell interviews John Foreyt
Pull up to Amarillo's Big Texan Steak Ranch ("Home of the free 72-ounce steak") and you step into a microcosm of modern American eating.
Here, if you can down a 72-ounce sirloin (41/2 pounds!), complete with baked potato, salad, shrimp cocktail and a dinner roll within an hour, the meal is yours free, compliments of the house. Some 30,000 people have tried the feat, and almost 4,800, including a 69-year-old grandmother, have won the free meal.
"The youngest winner was an 11-year-old boy," bemoans behavioral psychologist John Foreyt, who for 30 years has watched the eating patterns in this country change. In his own home state, serious eaters throng to the Big Texan, and a quick look at the recent winners of free 72-ounce steaks shows them to be, on average, 34-year-old males, standing six feet tall and weighing in at 264. The body mass index of these diners is 35.8. Obese. Foreyt, a nationally known expert on eating habits and weight loss, says they are far from alone in a country where bigger portions, fast food, fewer meals at home and more lonely eating are contributing to a national health emergency.
At Baylor College of Medicine in Houston, Foreyt has helped thousands of patients lose weight, published hundreds of research studies and helped to revolutionize the field of behavior modification to sustain weight loss. He has taken the field from focusing purely on dropping pounds to focusing on lifestyle intervention, in which the total person, with all of his or her individual quirks and challenges, is considered and given a sense of empowerment to help themselves.
Q: You warn that with the path we are taking, by the year 2040, 100 percent of Americans will be overweight; by 2100, 100 percent will be obese. Do you truly believe that?
Yes, I do. I just projected out from the NHANES data [National Health and Nutrition Examination Survey], which records real heights and weights of a random sample of the United States adult population. They show that we're getting fatter, one percentage point a year. There's always going to be a small group of people who are protected genetically, but that number will be quite small and not significant. Remember, two-thirds of us are already overweight.
Q: How much extra weight is unhealthy?
Physiologically, with just 15 pounds of extra weight your blood pressure begins to go up, your cholesterol goes up, your good cholesterol, the HDL, goes down, your blood glucose starts going up. By the time you get up to 30 pounds overweight, most people will have either hypertension, hyperlipidemia or type 2 diabetes.
Psychologically, you're definitely in trouble by 15 pounds overweight, especially women. The damage comes in poor self-esteem, which can lead to anxiety, depression and stress. Your work is affected by it, and you may have a lower quality of life and that's very serious. Men sometimes aren't as aware of weight gain. They can get really heavy and deny it, or they don't even notice.
Q: How does psychology factor into obesity and weight loss?
It's not that people just eat because they're hungry, but they eat for so many other reasons: stress, tension, anxiety, loneliness, depression, anger, boredom. So in order to lose weight you have to focus on diet, but you also have to deal with those emotional factors. Following a healthy diet and an exercise program is all motivation and behavior.
Q: How can someone who has been eating the same way for 30 years make changes to lose weight?
The problem is that most of us want to lose weight tomorrow. So you have this cognitive dissonance between what is practical and possible versus what you really want to do. All of us want to be skinny, but the way to achieve that is not overnight.
If people make big changes they can lose weight, but the rebound tends to be quite quick. We counsel people to make small changes they can live with-start with a little less salad dressing or a little less mayonnaise or butter on your bread, and add a little bit of physical activity.
Q: Many people are claiming they've found success on the low-carbohydrate Atkins diet, but it entails rather large changes.
I'm just a data person so if you say that you like this or that diet, just show me the data. There's no evidence to support that radical changes make a long-term benefit.
I think that we'll see data within the next couple of years that these diets are probably not very healthy long-term. But we don't know yet. Until then, I certainly wouldn't recommend that anyone stay on one of these diets long-term.
Q: Sometimes, when people want to quit smoking, it helps if they change their environment as much as possible. Does this also apply to successful weight loss?
It can help. I always tell people when they're making changes with their weight to keep their old friends but find new friends who didn't know you when you were heavy. A different environment, of course, would be ideal for all of us. But the practicality of it all is that we have to go back to day-to-day existence. Environmentally you can make some changes to make the job easier-don't drive past the doughnut shop on your way to work.
Q: You claim small changes are the key to successful diet changes, but many of those small changes take significant effort, using an entirely different way of thinking.
If it were easy, everyone would be skinny.
Q: I just saw an appealing ad with sizzling shrimp tumbling out of a pan onto a plate, and an all-you-can-eat-message for a local restaurant. We know it's unhealthy to gorge: what is the appeal?
Americans want to get their money's worth. What better way to get your money's worth than a bottomless shrimp bar or a buffet?
We teach people to stay away from places where they'll be tempted. It's like the addicted gambler who goes to Las Vegas for the buffet-not a good idea.
Q: You place more importance on "lifestyle intervention" rather than simple weight loss. Where do they differ?
There are a million ways to lose weight-but the focus for most of us should be on a healthy lifestyle. To me that means eating healthy all the time-or nearly all the time-exercising regularly and dealing with the stresses of daily living. The way to do that is through behavioral strategies: self-monitoring, stimulus control, cognitive restructuring, stress management, social support.
Q: What does socializing do?
Meals are part of the whole ritual of rebuilding relationships with family and friends. It's a critical element to health. You feel better about yourself when you're around other people and you tend to pace yourself at a much better rate. You won't overeat, gobbling down food, when the person next to you is not. And food becomes less salient than when you eat alone. We've lost that here in America. We eat for the food itself, not for the family or friends.
Q: What if your friends overeat?
Well, make new friends. I had a patient who had made changes and was losing weight successfully but her husband was afraid she would leave him if she kept losing weight. So he would bring home her favorite loaded pizza and plop it on the table in front of her. We see that kind of sabotage regularly. You try to deal with the sabotage. If not, change your lifestyle. Get rid of the jerk. That's what she did, by the way. You make choices.
Q: How important is it to get on a scale every day, and to count calories?
Self-monitoring is the most critical element in this whole business of managing one's lifestyle. For someone to change what they eat, they've got to know what they're eating-it raises awareness.The ideal would be to carry a food diary, a notebook, write down everything you eat, look up the calories (one of those little paperbacks would be fine) and make adjustments.
You can argue the validity of this business. You're not going to get the right portion size, so precision doesn't matter, and you're going to underreport your calories by a third. I don't really care about whether it's true or not. It's just raising awareness that I'm interested in.
Now, along with self-monitoring, of course, is weighing yourself daily and keeping track of minutes of exercise, or using a pedometer.
Q: Do you wear a pedometer?
I have one on right now. I aim for 10,000 steps a day for weight maintenance. Ideally, 10,000 additional steps would lead to a pound-a-week weight loss-50 pounds a year. Ten thousand steps is equal to about 5 miles, and you burn about 100 calories a mile.
Most people tend not to get more than 3,000 steps per day. Most of my steps happen in the morning when I jog for 45 minutes. I'm a slow jogger, I'm not a runner. And I don't always do it-the goal is I try.
Q: You say that while people generally underreport calories by one-third, they also overreport physical activity by one-half. Is that an active deception?
Most of us are just not aware of how much we're eating or how inactive we really are.
Q: What other behavior strategies help individuals keep control of their weight?
The next step in weight control is controlling the stimuli that are associated with overeating or underexercising. It's laying out exercise clothes or putting that sign on the refrigerator door to remind you to stick to a regular schedule. I have one on my refrigerator, a picture of a pig, that says, "You back again?" It's just to remind me, do I really want to take out that yogurt?
Also, you can change the way you think about yourself and set realistic goals. In a study by nutrition researcher Gary Foster at the University of Pennsylvania, most people said they wanted to lose 36 percent of their weight when in reality they could lose 8 to 10 percent. Aim to lose a pound a week rather than three, and give yourself positive encouragement, telling yourself: I can do this today, I will do this today.
Q: You claim that the true secret to weight loss and maintenance is "eternal vigilance." What does it mean?
Eternal vigilance is constant awareness of what you eat, of when you exercise. Our most successful patients watch themselves from the minute they get up in the morning.
Q: That seems exhausting.
Managing weight is exhausting. Part of the challenge is the way we've all chosen to live-we're all too busy, we've all taken on too much.
Q: How much does stress factor into weight?
Stress is the number one predictor of relapse. But there are lots of ways to reduce stress, including physical activity, meditation and progressive muscle relaxation, which is tensing and relaxing different muscle groups. Practicing stress-reducers in two 15-minute sessions a day can really help.
Q: Over the many years you've been helping people lose weight, what are some of the lasting philosophies you've put together?
Make small changes, one day at a time, and be realistic. There is no magic, but all of us have the power, within ourselves, to be healthy, to focus on eating correctly and being active.
The real issue today is the low activity level for all of us, but especially our children. Remember, when you're exercising or being more active you feel good about yourself, and people who feel good about themselves have an easier time eating healthfully than people who don't. Even if you don't lose a single pound, it's still important to exercise for the psychological state of well-being.
Finally, we're all human. Your weight is important but there are things that are even more important-loving your family and getting on with living.
Breakfast: When I'm home and I have time I'll make oatmeal and orange juice. If I don't have time I'll drink Slim-Fast. Meal replacements work like a charm-there are 10 years of published data to support that. You know precisely what you put into your body. When I drink a Slim-Fast I know I've taken in exactly 220 calories.
Lunch: When I have time, I'll have a sandwich.
I have no problem with carbohydrates-I love them.
Dinner: I make pasta or a Healthy Choice meal. Over the day I'll take in about 20 percent of calories from protein. I'm not a fanatic, by a long shot.
-By Allison J. Cleary