Laugh Yourself Thin PDF EBook

Laugh Yourself Thin
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Laugh Yourself Thin
Making Happiness, Fun,
and Pleasure the Keys
to Permanent Weight Loss
Melanie W. Rotenberg, MD
With Mitch Rotenberg, PhD
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This book is dedicated to our son.
Aaron, growing up in our joyful and off-beat household,
you have happily borne the brunt of our jokes. But, in so
doing, you have learned the ways of the humorist.
Your comedic talents and level-headed disposition have
led us to conclude Our work here is done.
I cant see my shoes.
Aristotle*
*Just not that Aristotle.

Contents
Acknowledgments ix
Introduction: Laugh the Pounds Away Forever xi
PART I: ATTITUDE AND BEHAVIOR
ONE: Turn Your Head and Laugh: Happiness, Joy,

and Pleasure in the Pursuit of Weight Loss 3
TWO: Im Allergic to Food, It Makes Me Swell:
Thought and Mind for Success 23
THREE: Tossing Your Cookies: Food Behavior That Works 45
FOUR: Laugh Your Butt Off: Activity Behavior That Works 67
FIVE: Im on the Duct Tape Diet: Handling Hunger 83
PART II: INPUTFOOD AND DRINK
SIX: Eat Right, Die Anyway: What Are Good Foods? 105
SEVEN: Put the Muffin Down and Slowly Back Away:
What Are Not-So-Good Foods? 125
viii Contents
EIGHT: Water Intolerant: The Right Drinks 143

NINE: Living Extra Large: How Much, When, and How to Eat? 153
PART III: OUTPUTMETABOLISM AND ACTIVITY
TEN: That Which Doesnt Kill You Makes You Fatter:

Increasing Metabolism 173
ELEVEN: Dinosaurs Refused to Exercise and Look What
Happened to Them: The Right Activity 195
Conclusion: I Told You That There Would Be a Quiz at the End! 215
Notes 221
Resources and Further Reading 229
Index 231
Acknowledgments
First and foremost, I must thank my agent, Ellen Pepus, of Signature

Literary Agency. Without her terric guidance, great advice, and gen-
tle coaching, this project would never have come to fruition.
Thank you as well to my editor, Debbie Carvalko, and all the won-
derful people at Praeger/Greenwood for encouraging my passion to
teach and entertain.
And a big thank you to all who offered stories and advice or their
time by reviewing the manuscript. The friends and family who assisted
include Debbie Bernier, Joe Bernier, Amelia Torre, Marcia Weinstein,
Marylee Fennell, Terri Hamilton, Laura Fausone, Dawn Mineo, Pam
Wheeler, Dawn Fuller, Bob Taylor, Rick Fennimore, Fred Mullins,
Christine Folkes, Susan Jackson, and Sherri Garafolo.
I am truly grateful to all the enthusiastic participants of the annual
conference of the Space Coast Writers Guild. You people helped me
ferment this crazy plan, and I do appreciate all the wonderful guidance
through the maze of the book industry.
Real gratitude goes out to comedian Kevin Hughes, for inspiring
my husband and me to start writing humor and for encouraging me to
get up in front of a crowd and tell jokes.
And Id like to give a huge thank you to my son, Aaron Rotenberg,
and my husband, Mitch Long-Suffering Rotenberg, for putting up
with me all these years.
x Acknowledgments
Finally, the biggest thanks goes out to my patients, who inspire

me to write, to teach, to learn, and to grow. Where would I be with-
out you?
Melanie Rotenberg, MD (aka Dr. R)

Introduction: Laugh the
Pounds Away Forever
Roller Coaster Haiku

Oh my Freaking God
I think Im Going to Die
Oops, There Goes my Lunch
The weight-loss journey, for most people, is a lot like a theme park
ride, a very stressful and scary one. It doesnt have to be. Ideally, it
should be more like a fun, exciting adventure, with a safe and pleasant
outcome.
Although I hope you will think this book is funny, please realize that
the weight-loss concepts are serious. Healthy skinniness cant occur
without laughs, since negative emotions undermine successful weight
loss. Laughter is the hallmark of a life lived better, a life full of pleasure
and joy.
LIFE IS ALL ATTITUDELUCKILY, IVE GOT LOTS OF THAT

A warning to my readers: my husband, Mitch, has a black belt in humor,
and I use his material every chance I get. If you arent in the mood to
xii Introduction
laugh while you read, put the book down and back away. I am intent on
making the experience enjoyable for you. In my spare time, when Im
not seeing patients, Im writing or practicing comedy. I started doing
stand-up routines just after my 40th birthday; you could say Im hav-
ing an unusual midlife crisis.
When I asked Mitch if he would help me write this book, his re-
sponse was Id rather put eye-hooks through my hands. The man
blurts out funny stuff all day long, and then I run and write it down.
Lets just get it straighthis blurting got him credit for co-authorship,
but I did the hard work, and thats why the book is written from my
perspective.
I also have to tell you this: most of the stories here about my pa-
tients, friends, and family are true, but the names have been changed to
prevent unwelcome visitors to our house in the middle of the night.
GONE WITH THE CHIN

One other thing you need to know: this is not a quick-x diet book. If
you are looking for a way to lose a few pounds and then want to go
back to your previous lifestyle, look elsewhere. This book is meant for
people who are tired of traditional dieting and are now looking for
permanent, healthy weight loss. Ill teach you how to do it by taking a
humorous, positive, joyful approach.
Here you will nd information about wellness. I discuss not just food
choices but approaches to eating, exercise, behavior, and thinking. I
talk about mood and activity. I dont tell you what to eat and what not
to eat, but I do advise on good choices and not-so-good choices.
I will talk about activity and exercise. I have to because, ultimately,
regular exercise is how successful people lose weight and keep it off
permanently. Besides, I am an exercise doctor, and Id be a fool if I did
not talk about something near and dear to my heart. Activity works,
and in this book Ill tell you why it works and how you can make it
successful for you, even if youve never thought of yourself as an exer-
ciser. Many of my patients in my medical practice cant even get out of
a chair on their own when they meet me, yet they all learn to exercise.
Im very creative.
Most people gain back all the weight they lose through a traditional
diet plan shortly after going off the diet. In fact, the saddest part of
weight-loss research reveals that the majority of dieters not only gain
back their lost weight; they gain even more than what they lost. This
Introduction xiii
does not have to happen. It will not happen to you if you follow the
scientically based suggestions in this book.
Its like everybody and their brother has written a diet book or a cook-
book. Even dead people and fictional characters are getting in the act.
Im afraid it wont be long until we see Noah Cooks for Two.
People gain back their lost weight for one very important reason: they
havent embraced weight loss through a thinking and behavioral whole-
life approach. For most people trying to lose weight, the word diet
implies a temporary state of food restriction. Either types of foods or
amounts of foods are restricted until the desired weight is achieved.
However, there are three parts to successful and permanent weight
loss: (1) thinking and behavior; (2) input, as in food and drink calo-
ries; and (3) output, as in metabolism and activity calories. Most diet
books, even those written by physicians, have an overemphasis on the
input part of the equation. A typical diet book will give you pages
and pages of food rules and recipes. These books rarely talk about the
behavior, attitude, and cognitive processes that go into how and what
we choose to eat. They rarely give more than a page or two to the issue
of activity and exercise. Weight loss cant be permanent unless all three
areas are addressed in a balanced manner.
Now remember, health advice works only if you act responsibly with
the information. Which reminds me of the time my hospital offered
a breastfeeding course but had to cancel it because more men signed
up than women.
Back to weight loss: calories are just a convenient way to measure

our bodies fuel. Weight loss occurs when there is more fuel burned
than taken in. Activity (output) is just the way we burn the fuel that we
get through food (input). If we put out more calories than we take in,
we lose weight. Maintaining that loss permanently is just maintaining
the balance between input and output. Its really very simple.
xiv Introduction
STUDIES SHOW THAT WOMEN PHYSICIANS

ARE 100 PERCENT MORE LIKELY THAN MALE
PHYSICIANS TO HAVE BABIES
I have a lot of experience with health and weight loss, personally and
professionally. When I was pregnant, I suffered severe morning sick-
ness and ate anything I could to calm my queasy stomach. (Patients
dont think its very professional when the doctor barfs on them.) By
the time I gave birth, I was 50 pounds heavier than before my preg-
nancy. It took me a long time to lose that extra weight, but Ive kept it
off for more than a dozen years. More important, Ive been a disabil-
ity physician for a couple of decades, and Ive counseled thousands of
patients on weight-loss techniques. Obesity is the number one cause of
disability in the United States and also the leading cause of prevent-
able death.
Youthful gures and activity levels are not just for the young but
can be in the grasp of anyone who is willing to make health a priority.
My goal is to teach people how to avoid becoming chronically sick or
disabled in the rst place and then stay in great shape for the rest of
their lives. I have a wild fantasy that if enough people read this book,
Ill put myself out of the disability business for lack of patients. Truly,
that would make me ecstatic. Read this and enjoy a slimmer, more vi-
brant, fun, and happy life, permanently.
The key to weight loss is to start from a good point and go to a bet-
ter onethe joy, laughter and happiness that you develop will be all
your own.
Melanie Rotenberg, MD
(Oh, and one more thing: pay attention throughout. My husband

and I are professors. Dont be surprised if theres a quiz at the end.)
PART I
Attitude and Behavior
ONE
Turn Your Head and Laugh:
Happiness, Joy, and Pleasure
in the Pursuit of Weight Loss
People want quick results, but there are no healthy ways to rapidly slim
down. Health spas often promise serious weight loss with only one ex-
pensive session of an exotic treatment. Usually it involves being slath-
ered, enveloped, and heated. None of those techniques really work; they
are only sucking water out of your system. However, I guarantee that
you will experience rapid and dramatic weight loss with the piranha
swim.
Laughter is the key to weight loss. Well, really, its those things that
cause laughter, like happiness, fun, and pleasure. But we can use laugh-
ter as a good gauge of how happy and content we are. Stress, negative
emotions, and misguided thought patterns are a leading cause of obe-
sity. Yet diet books almost never address an overweight persons men-
tal state or level of joy. They might have pages of dietary restrictions
and recipes, but rarely is there more than perfunctory prose on reliev-
ing negative emotions. There might be a chapter or two on exercise, but
nowhere is there a description of the cardiovascular benets of a good
pillow ght.
And we all need a good pillow ght on a regular basis. The way to
lose weight and to keep it off permanently is to lower stress, depression,
4 Laugh Yourself Thin
and other negative emotions through positive thinking, humor, fun, and
lots of laughter. A lighter approach to life leads to a lighter waist line.
A recent study by Dr. Mark Wilson at Emory University brings home
this point. He offered unlimited nutritious food to two groups of mon-
keys, high-status, contented, happy ones and their miserable, stressed-
out, low-status subordinates.1 All the monkeys ate about the same
number of calories. However, when Dr. Wilson substituted high-fat and
sugary junk food pellets in unlimited supply, the high-status monkeys
ate about the same calories as previously, but their stressed-out brethren
couldnt stop munching. Those miserable primates continued to eat the
junk food all day long and well after sundown, similar to human snack-
food grazers. The researcher concluded that eating high-calorie foods
is a common coping mechanism to deal with daily life stressors, even
in those who dont have a cranky boss, prolonged commute, or nasty
mother-in-law.
YOUR PERSONAL WEATHER FORECASTCHANCE

OF SCATTERED BRAINS
Unfortunately, the majority of modern people live stressed-out, de-
manding lives. Most of us spend our days rushing from responsibil-
ity to responsibility, with little time to relax, enjoy, or meditate. A
while back, my son saw my drivers license and read the words organ
donor. He exclaimed, Oh, cool, mom, which organ did you donate?
Thats when I informed him that normally people wait until theyre
dead to donate their organs, but, in my case, I had already given my
brain at the office.
The biggest stress in my life is keeping house. Im not much of a domes-

tic engineer. I was completely stumped one time when I had to wash
a black-and-white-striped sweater and the instructions said to wash
with like colors. To me that was a laundry IQ test, and I had to be Ein-
stein to figure it out.
And, speaking of chores around the house, Ill never forget the pa-
tient I had who went home from the hospital with hospice care. That
nurse was so terrific, she took days to help the elderly gentleman clean
his completely unkempt house before he died. Exhausted, she finally
reached the bottom of a huge pile of junk. The last thing she picked up
was a book titled How to Clean Practically Anything.
Turn Your Head and Laugh 5
HELP! IVE EATEN AND I CANT GET UP

People say they want to lose weight for a lot of reasons, like I want
to look better in my clothes or I just want to get back to my college
weight. But the real reason is only twofoldeither its for health or its
for happiness. Theres no point to being thin, sick, and miserable. We
all know people who are like that. Generally theyve got cancer or they
hate themselves, and, either way, you dont want that for yourself.
Mental and physical health is the primary goal in permanent weight
loss. This book is about accomplishing both. When you set yourself on
the path of mental and physical health, the weight loss will follow. If
you try to shortcut the process, you wont get very far. A positive at-
titude and a focus on pleasure and joy are an integral part of losing
weight forever.
Laughter is a key component to weight loss. There have even been
research studies looking at laughter as a weight-loss technique. But
Im not particularly interested in seeing how many calories a day you
can burn by watching reruns of television sitcoms. Im more interested
in the bigger picturehow can positive thinking and happiness bring
about better health?
We medical types know a lot about the physical implications of being
overweight. We know that obesity leads to all sorts of bad medical out-
comes, including cardiac disease, diabetes, arthritis, and cancer. Hav-
ing extra belly fat even increases your risk of developing Parkinsons
disease! However, weve had a tough time getting people to lose weight.
Even those who lose the weight usually cant keep it off. But the focus
has been lopsided. Most weight-loss programs concentrate on the physi-
cal issues, usually the food and sometimes the exercise. It is my belief
that the most important component is often ignored: the brain. Our
thoughts, emotions, and behaviors drive every action and decision that
we make, and they certainly drive our weight problems. The bottom line
is this: we know that permanent weight loss will not occur in people full
of fear, unhappiness, and boredom.
IF STRESS CAUSES HIVES, I OUGHT TO BE ONE

GIANT RED BUMP
So if a person is stressed, depressed, or bored with life, attempts at per-
manent weight loss will be futile. The best hope we have for true success
is to start with our most critical fat-preventing organ, our brain, and
whip it into the best shape possible. The rest of the body will follow.
This chapter is about ways to increase happiness, lower stress, improve

coping mechanisms and social relationships, and reduce self-critical
behavior in pursuit of thinness. All of these are crucial to mental and
physical health and permanent weight-loss success. Even if you think
your life is going well emotionally and mentally, there are things you
will learn in this chapter and the next that will make the journey to nor-
mal weight much easier. Take the time to read Part I of the book (Atti-
tude and Behavior, Chapters 15) before delving into the later sections.
Chapter 2 deals with the proper mindset for weight loss, and Chapters 3
and 4 address the behavioral aspects (Chapter 5 is about hunger). Once
you have read the entire rst section of the book, you will have a much
better foundation to approach the specics of the rest of the equation,
that is, the input and output of fuel. When you have a good understand-
ing of the thoughts and actions that lead to success, you can apply them
to your own situation and immediately start making positive changes.
THE UNIVERSE IS EXPANDING, AND SO AM I

A study done at Northeastern University, in Boston, in 2003 showed
that the more depressed adolescent girls were, the more likely they were
to become obese later in life.2 That same year, Johns Hopkins published
a study showing that in adults, there is a strong link between depression
and weight, particularly in those who are very obese.3
I have a patient who is extremely overweight, as is his wife. Recently,

the wife underwent surgery. While coming out of anesthesia, she was
particularly anxious and upset. Her doting husband offered all his emo-
tional support. Later that day, apparently still suffering the effects of
the medications, she turned to her spouse and said in her most grate-
ful manner, Oh, honey, thank you for being there for me when I really
needed you. You are my Rock of Giblubber.
IVE ALREADY LOST THREE SIZES:

SMALL, MEDIUM, AND LARGE
Think about ways to increase your pleasure and happiness in day-to-day
life. Fun with food will lead to weight loss, not weight gain, as is often
assumed. Its an exciting paradox: the more you truly love and enjoy
food, the less you will eat of it. (Well talk more about that in Chapter 9.)
Weight loss should be approached as painless. Eating is pleasurable.
Having fun and laughter around meals and playing with food are im-
portant. Additionally, exercise and activity are not burdensome but in-
vigorating. Those who are most successful with permanent weight loss
are those who consider regular physical activity an enjoyable, integral
part of their daily life forever.
WHO KNOWS IF A CLAM IS REALLY HAPPY?

So what are the keys to happiness? In my experience, there are several
keys that drive most people toward happiness. Loving and sharing in
meaningful relationships is a big one. Having a purpose is very impor-
tant. Being present-centered, living life here in the moment, is another.
(Dont dwell in the past or constantly dream of the future.) Having au-
tonomy and control over ones life is extremely important to happiness,
as is being rewarded for effort.
All of these keys to happiness are relevant to weight loss. People who
are in meaningful, supportive relationships are more likely to follow
good health habits. People who feel that their actions have a purpose
are more driven and motivated and stick with a plan. Those who live
now, in the present, are more attuned to their bodies needs. Its been
shown that personalities that are more autonomous and independent,
sometimes called having an internal locus of control, are less likely
to be obese. Finally, those who feel that they are getting positive feed-
back for their efforts are more likely to continue those efforts. Thats
why there is so much emphasis in some diet programs on the regularly
scheduled weigh-ins.
THE CABLE COMPANY SAID THEYD BE RIGHT OVER,

SOMETIME BETWEEN BIRTH AND DEATH
If you want to get skinny for the long term, its time to embrace laugh-
ter, compassion, and contentment and abandon anger, cynicism, and
pressure. There is a very clear and consistent relationship between how
stressed and unhappy people are and how obese they are. Stress also re-
sults in anxiety; people who have the most work and life stress are the
most anxious and overweight.
A study by Paula Rhode, PhD, of the University of Kansas, showed
a direct correlation between the frequency of everyday life stressors (like
arguments with family members, waiting for the repairman, or being

stuck in traffic) and obesity.4 Her results demonstrated that for weight
loss to be permanent, one must address the psychological factors of
daily stress and loss of control, thus preventing the need to soothe fraz-
zled emotions through eating.
When people have passion in their lives, true meaning, deep pleasure,
and feelings of living a worthwhile life, it is much easier to achieve goals,
including weight-loss goals. Ah, I know what you are thinking: Sounds
great, but I live in the real world.
So do I, and Im a physician, mother, wife, daughter, sister, friend,
comedian, volunteer, bad golfer, worse surfer, writer, speaker, and con-
sultant, and I play a host of other roles. We all live in the real world, with
loads of responsibilities. Unfortunately, sometimes people use their roles
and responsibilities as an excuse to stay unhappy and not work toward
changes. Dont do that.
I believe eliminating stress is one of the keys to permanent weight
loss. You can be very busy and not be stressed. They are not the same
thing. Indeed, having too little meaningful work to do results in bore-
dom, which is a pervasive but often overlooked cause of stress.
CUSTOMER SERVICE IS OUR MIDDLE NAME.

NOPE, WE DONT USE IT EITHER
How can you eliminate stress in pursuit of permanent weight loss? Learn
more about yourself by carefully studying your reactions to everyday
events. Start examining what really makes you happy and what turns
you off. Gravitate toward those things that really give you pleasure, and
dont worry about what others may expect of you.
Nothing aggravates me more than dealing with rude and incompetent

companies. I swear some of them must use the motto Why buy from
the best when you can buy from us? The worst is when I want to talk
to a real live person, and I have to navigate an unending phone mes-
saging system or leave a message and hope that someone will call back.
A friend of mine told me that her church recently got rid of purgatory,
and now I understand why. We dont need purgatory anymore; we have
voice mail.
Are there things that you do that feel purposeless? Realize that a role
that feels important and satisfying to you (such as work or houseclean-
ing) may feel unfullling to others. Examine your own values and emo-
tions while in those roles. What do you enjoy about them, and what do
you dislike? Are there responsibilities that you could eliminate, that give
you too little pleasure? Are there ways to make them more pleasurable?
Are there roles that you enjoy and would like to expand? Much of our
lives is spent fullling functions that we never question. One of the best
ways to decrease stress is to question assumptions that you have made
about your day-to-day activities. Examine everything you do, take a
step back, and begin to look for ways to increase your happiness and
pleasure.
IF YOURE NOT BUSY LIVING, YOURE BUSY WORKING

There are some pressures that may be daunting to you to change, such
as work environment or overload. Back in 1976, psychologists demon-
strated that if you stress lab rats by pinching their tails repeatedly for
weeks on end, they will become severely overweight, much more than
those rats that werent stressed.5 Do you come home from work feeling
like the equivalent of that pinched rat? Americans are the most over-
worked, and therefore overstressed, people on the planet. Its no sur-
prise that they are also the fattest.
Some peoples idea of work stress is different from others. Ill never for-
get the attendant who ran the canoe rental at my favorite remote vaca-
tion site. She sat under a palm tree and read novels in between handling
her three or four customers a day. Last time I saw her, she was com-
plaining about how she couldnt wait to go on vacation. I wonder where
she goes to relax: Manhattans Friday afternoon rush hour?
Take stock of what isnt joyous and humorous, and approach rea-
sonable ways to x the pressures. Note that if you constantly worry
about your weight, you can take the issue so seriously you stress your-
self into weight gain. Conversely, many people who are chronic dieters
report that they feel exhilaration when they start a new diet. The excite-
ment of a new diet likely comes from the enjoyment of envisioning your
new body, your new energy level, and perhaps all the other things you
think a slimmer body will bring to you (perhaps an improved social life).
Unfortunately, traditional dieting is all about deprivation and discom-
fort. Abandon that mindset. But if you are the type that has gotten some
enjoyment at the beginning of a new diet because you are envisioning
what a thinner, healthier you will do, maintain that vision, but without
all the pain.
While you are examining what brings you more joy and less stress,
think about things like walking, biking, singing, dancing, meditating,
music, and sounds of the beach or the woods. Im always surprised how
few people I see outside enjoying nature and using their muscles. Exer-
cise is an antidepressant and works as well or better than medications,
so not only will it help you to lose weight, it will also relieve stress and
improve mood.
HAVE A FOOD FIGHT, BUT STOP FIGHTING YOUR FOOD

Traditional dieting doesnt allow eating to be pleasurable because it
comes with a deprivation mindset. But eating the healthiest foods for
the body isnt restrictive and is always sensual. (That subject is covered
in detail later in the book.) Make a point to have fun around meals, with
lots of laughter. One of my favorite memories from middle school was
the day the cafeteria erupted into a food ght, I remember laughing so
hard I almost split my seams. (Yes, I am giving you permission to have
a food ght, but, no, I am not coming over to your house to clean up.)
Whats wrong with playing with your food? Try doing this with a
straight face: put black olives on all your ngers, then eat the rest of
your meal. Youll be laughing so hard, you might forget to clean your
plate.
Eating for pleasure can come from the company you keep at your
meals or the silence and quietness of the moment. In Chapter 9 we talk
about increasing the enjoyment of savoring what you are eating with the
art of meditation.
MY BOSS IS HAVING A NEAR-HUMAN EXPERIENCE

I am good friends with a lot of nurses. Nurses are some of the most
stressed-out people on earth because of all the problems in health care.
It seems that no matter how hard they work, someone above them is
saying that it isnt good enough. As a physician, I observe the coping
mechanisms of great, loving, smart people under tremendous pressure.

What Ive discovered is a very high rate of lousy coping mechanisms,
including smoking, eating, and drinking to excess. These are very de-
voted people, putting everybody elses needs ahead of their own. Does
this sound like someone you know? If you are the caring, compassion-
ate, put-everybody-else-rst kind of person, perhaps you are using self-
destructive coping mechanisms to deal with the stresses in your own life.
Just remember, you are no good to those you love and care for if you are
running down a self-destructive path.
Its time to put your needs rst, even if others arent used to it. You
have the right and the responsibility to take care of your health rst.
Think about the instructions you are given when oxygen masks drop
on an airplane. You are told by the ight attendant to put your mask
on before helping others. Treat all aspects of your health that way. The
stronger you are physically and emotionally, the better you are for those
you love.
There is so much aggravation built into health care. I was scheduled to

see my eye doctor for a checkup. Before the appointment, his office sent
me a list of things to bring with me that day. You know you are going
to be in the waiting room a long time when they tell you to bring your
lunch, a sweater, a book, and a tent.
You have coping mechanisms for each major person in your life and
each part of your life. But are they successful, positive coping mecha-
nisms, or are they self-defeating? Do they reduce stress in the long run
or add to it? If you take a drink when you get home from work and
then a couple more before you can face the kids or the spouse and make
dinner, is that the best way to treat your body and your mind? What
would benet you both physically and spiritually and be better for you
and your family? How about stopping for yoga class on the way home,
walking in the park on the good weather days, meditating for 15 min-
utes in pure silence before the gang gets home, or dropping that extra
project at work thats been causing you all those extra hours? Perhaps
your best coping mechanism could be setting limits for the superwoman
or superman inside of you and refusing to push yourself harder or re-
fusing to let others push you into responsibilities that you dont want
or need.
HEY, DID THE BED GET SMALLER?

Once youve targeted self-defeating coping mechanisms, you must re-
place what you dont want with something that is uplifting. If you only
vow to stop doing the destructive habit, you will not succeed. You must
nd something that is extremely pleasant to do instead. When one of
my overweight friends whom I coached nally admitted that she and
her husband were drinking too much every night after work, she wasnt
able to eliminate the habit until they came up with other fun activities to
substitute for their nightcaps (hint: lets just say it involved more calo-
rie expenditure). She and her husband have both lost substantial weight
from just that simple substitute in behaviors.
WHATS IT GOING TO BE LIKE WHEN THESE WERE

THE GOOD OLD DAYS?
Think of a list of easy, stress relieving good-for-you activities. These
can be as simple as taking a walk, getting into nature, listening to calm-
ing music, or having game night with the family. They might include
reading a joke book, calling a supportive family member, or sharing
time with friends. These do not need to be time-demanding activities but
should be included every day in your schedule. Add more active things
to do, not because you have to but because you want to.
Try to laugh, joke, sing, dance, or nd pleasurable activities for at
least an hour a day. Keep it positive and mentally and physically ac-
tive. If you are doing something more passive, like television or movies,
choose uplifting and humorous or silly topics. Avoid the depressing
search out comedy, joy, giggling, friends, and spontaneity.
When picking good-for-you music, be selective. I was a child in the

1960s. Everybody always thinks the 60s was about people doing drugs
and that the music was a consequence of that. Theres this idea that Jimi
Hendrix and Puff the Magic Dragon came out of heavy inappropriate
drug use. In reality, what people dont realize is that it was the other
way around. Folks did the drugs because the music was so bad. If you
dont believe me, we could test this. Take a bunch of laboratory scien-
tists and expose them to 60s music for 18 hours straight and see if they
dont start drinking hydrochloric acid right from the beakers.
Im a big believer in a daily regimen of at least 15 minutes of what I

call nonactive moments. Perhaps this could be prayer, meditation, or
something that you would otherwise feel is indulgent time. For me, its
time at the beach just watching the waves. Increase your me time away
from energy- and mood-sucking activities. Practice a habit of quiet mo-
ments, whether it is sitting on your porch and listening to the birds sing
before you begin your day, or listening to some calming music while sit-
ting in a dimmed room, or soaking in a warm bath before bed. This sim-
ple daily activity will not only lower your blood pressure; it will lower
your stress level and improve your coping skills. Defend that time daily,
and dont let anyone, particularly yourself, steal it away from you.
The way that you cope with life is critical to your weight. Back in
1990, the University of California and Kaiser Permanente showed that
obese women who confronted problems directly were much more likely
to lose weight and keep it off permanently.6 Ninety percent of the for-
merly obese women who successfully lost the weight used that coping
mechanism, whereas only 10 percent of those who gained the weight
back did so! Thats a remarkable statistic. In fact, if you take away noth-
ing else from this chapter, understand that the way you choose to cope with
lifes challenges will determine your weight. This fact is more important
than what you eat or how you exercise.
A brand-new speech therapist was working on cognitive tasks with a pa-

tient of mine to determine whether the patient had good coping skills.
The dear old lady had macular degeneration in one eye and glaucoma
in the other. The therapist quizzed her with a theoretical scenario to
find out how well she could problem solve. She said to the patient, You
drive your car to Wal-Mart and get out, realizing that youve just locked
your keys in your car. What would you do? The patient responded, Id
say, thank God. Im blind and I shouldnt be driving.
SHE WAS SO MATERIALISTIC, SHE WENT OFF

THE SHALLOW END
Another way to decrease negative emotions is to give up materialistic at-
titudes. The pressure to acquire the trappings of status tends to increase
stress. Besides, more things cause more aggravation, more bills, more
ghts, and more work. Ask yourself, What can I give up that might be
stressing me and making my life less fun? Then start searching for
nonmaterialistic friends and have heart-to-heart talks with your family
about what your real monetary goals need to be. Consider moving to a
less fancy neighborhood if you have the opportunity to move. Even if
you can afford the luxuries and a high-end neighborhood, what unwrit-
ten messages are being transmitted to you and your family? Find places
that t your personality; whether they t your scal abilities should be
secondary. I truly believe that materialism is rotting the American soul
and leads to a great deal of unnecessary stress, anxiety, and depression.
THE BEST THINGS IN LIFE ARE FREEOR

AT LEAST LESS THAN $1.99
Youll notice throughout the book that I emphasize frugal ways to ac-
complish weight-loss goals. That is a reection of my personality. It
is unnecessary to spend large quantities of money to be healthy. The
most precious gift that you can give yourself, the gift of excellent health,
should not be expensive.
And theres nothing wrong with a modest lifestyle, most of the time. I
read about a famous director who named all three of his kids after the
locations where they were conceived. I think one was named Houston
and another, something like London. Obviously, he traveled a lot. I
wanted to do that with my own kid, but Motel-6 Rotenberg just didnt
have the right ring to it.
Another way to decrease negative emotions is to encourage your

own positive health behaviors with what I term benecial self-reward.
There is a difference between materialism and self-reward. When you
pamper and love yourself with positive behaviors, it is not decadent
or hedonistic. During your weight-loss journey, when things are going
right, like you slip into those jeans that havent t since forever, its time
for self-reward. No, Im not talking about the trip to Dunkin Donuts.
But I am talking about the 30-minute bubble bath, the drive to the lake
to go shing, or the afternoon off to be utterly indulgent with your time.
Ask your partner for a luxurious massage, or drive an extra couple miles
to that really nice park for a walk or bike ride under the trees. Better yet,
plan to meet a friend there to join you. These types of rewards are best
when they dont involve excess calories or monetary expenditures. Find

behaviors that are truly rewarding and that will not result in additional
stress on your waistline or your wallet.
WHEN OUT IN THE COLD, LET YOUR NUCLEAR

FAMILY GENERATE HEAT
Remember that University of California study that I mentioned earlier
about those study subjects who lost weight permanently versus those
who gained it back? The women who permanently lost the weight were
much more likely to lean on social support than those who gained it
back.7
Find connectedness with people who are helpful to you and give you
proper encouragement. At the same time, move emotionally away from
those who generate negativity. Search out a positive community to sur-
round yourself with, and constantly gauge if this community continues
to be positive and inspire you. Avoid those who give unwelcome advice
and criticism. Find people who will listen in a nonjudgmental manner,
and use a support group if you nd it helpful.
Not everyone in your social circle will support your endeavor as you
think they should. Sometimes family members get comfortable with
a certain familiar lifestyle or partner, and they may be threatened by
your attempts to change your habits. Friends can quickly become jeal-
ous. They may be intentionally or accidentally undermining your suc-
cess. Sometimes its just a lack of education and understanding (such
as a well-meaning but misguided Lets go out for ice cream to cele-
brate the 10 pounds you just lost.). Often the family member or life-
long friend may have the same old self-defeating habits that you are
trying to change. You may need to do gentle re-education with them
to encourage behaviors that are useful to you. Dont get defensive if
they are being well-meaning but stupid. However, if repeated education
on your part doesnt change their behavior, you need to nd someone
else (or just rely on yourself) to continue your progress. You can even
look online for support groups that will help you feel less alone in your
journey.
Under the category of people with good intentions doing stupid things
would have to be the people who planned the annual fundraiser at our
local zoo. It was a big evening barbecue. They called it the Zoo-b-q.
They should have called it the Lets Celebrate Animals by Eating Them
Night. Im glad Habitat for Humanity isnt doing anything similar:
This weekend, were having our annual cannibalism social!
Approach social occasions (especially with food) with a positive, joy-

ful approach and concentrate on receiving pleasure from your dining
companions. Enjoy the small moments of life. Take the time to notice
not just the smell of the owers but the smile of a co-worker, the hug of
a child or lover, the sound of new music. Concentrate more on enjoying
these little pleasures, working them into a part of your daily life.
Find new ways to recommit to your lover or spouse. Be there more
fully in your attention, and truly listen. Be creative in your signs of af-
fection, and act like you did when you were rst dating. Be on your best
behavior, and dont expect anything back (but dont be surprised if your
new activities get a very positive response). Spend more time really lis-
tening to your signicant other and your family members; take special
time out for a friend that you havent made enough time for.
A MIND IS LIKE A PARACHUTE. IT WORKS BEST

WHEN OPENOR WHEN FALLING FROM A PLANE
Dont hesitate to ask yourself daily, What is my passion? What is my
purpose, and what gives meaning to my life? Answer carefully, always
keeping an open mind. A happy life is driven by meaning and purpose.
The best, easiest stress-reducing activity that also lowers blood pres-
sure and improves daily coping skills is physical touch. This includes
hugs and cuddling. A fun little study done by the University of North
Carolina and the University of Pittsburgh showed that women who
hugged and touched their partners most frequently had the lowest
blood pressures and the highest oxytocin levels.8 The hormone oxytocin
is thought to be involved in trust, relationships, sexuality, bonding, and
maternal behaviors. It is believed to decrease anxiety. There has been
research to demonstrate the health benets from physical contact and
the need to hug and touch others, from the time we are born until the
time we are aged and dying. Yet our modern world scorns physicality,
leaving it for only a bedroom activity or the interaction between parent
and child. Adults have inadvertently sexualized touching and hugging,
even when it is meant platonically. Unfortunately, because of abuses by
the perverted few, the rest of us are forced to abandon physical signs of
appreciation with most of the people we interact with on a daily basis.
In the proper and acceptable setting, put physical touch back on your
to do list.
As a physician, I sit at the bedside and touch my patients on the arm
or hold their hand just to connect with them and make certain they un-
derstand that I care. (With the use of high-tech equipment, doctors have
almost eliminated the need to touch patients. Some of us have gotten
lazy and have forgotten that medicine is still as much an art as a sci-
ence.) Healing touch does matter. I do hug my patients and their fami-
lies often, and they appreciate and ask for it.
There is one precaution I have about doctors touching patients. It seems

some dont bother to wash up between patients, transmitting diseases. I
wipe my stethoscope between each patient I examine. Whats amazing
is that most doctors dont. In fact, a study was done a few years ago that
found that the typical physician cleans his stethoscope once a month,
say about every 300400 patients. So why does he bother to wash his
hands? Next time a physician comes at you with a stethoscope, remem-
ber to yell, Have you washed that? Wheres that thing been? Just
make sure you are pointing at his stethoscope and not any lower.
If you truly nd that you cannot increase your hug factor with family
or other situations, then by all means get yourself a huggable pet from
the animal shelter. Do a good deed and save an animal from destruc-
tion, and watch that animal save you, as well.
My husband offered to get me a pet; he wanted to know which animal I

liked. I suggested an elephant. That way there would be more than one
gray and wrinkled creature around the house.
Overweight people feel less huggable because of the stigma society

attaches to fatness. Heavy people feel less desirable and less accept-
able to others, resulting in less physical interactions, both sexually and
nonsexually. If you believe that this may be a problem for you, avoid-
ing the issue is not going to help. Talk about this with your signicant
other or make honest, frequent attempts to correct your unwanted habit
with others. Often we are our own worst enemy and undermine our own
mental health. Everyone needs to feel wanted and loved, and physical
touch is one of the most immediate ways to express this.
IM FOUNDER OF THE ORGANIZATION DOCTORS

WITHOUT BOUNDARIES
Another very important way to bring more positive emotion into your
life is to give more of yourself to others, but not in a stressful way. Make
a positive difference through volunteering, giving, and showing com-
passion. Donating time and money is not only emotionally rewarding,
its been shown to increase immune function! Practice random and de-
liberate acts of kindness. Put yourself in situations that allow you to see
the life of those who are less fortunate or who are struggling. There are
always those who have less. It makes it easier to feel grateful for what
you have, rather than dwelling on what you are lacking or have lost.
WHY DONT WE DO FUN RAISERS?

When we are concentrating on the needs of others, we are less full of
ourselves and our own problems. Then our personal fulllment soars. I
believe thats why there are so many problems with wealthy celebrities,
particularly the young, hedonistic types. They havent learned that the
more you try to feed your own emotional needs (particularly with ma-
terialistic objects), the hungrier you become. Self-obsession, hedonism,
and materialism inevitably lead to self-loathing. This often results in de-
pression, anxiety, and, for many, addictions to food and other things.
When you are tending to the needs of the less fortunate, you have the
opportunity to build empathy. There is a strong relationship between
empathy and ones level of happiness. When you feel for others, your
own positivity rises.
Lessen negative emotions with gratefulness, including gratitude for
food. Whether you use words prior to eating, such as saying grace, or
just pause in the realization that you are lucky to have food, this act
brings joy. We are blessed to live in a land of plenty, but dont forget
the hundreds of millions who dont. Gratitude should become a practice
for you, if it isnt now, for the health that you do have and for the abil-
ity to make it even better. In my family, we practice a ritual of gratitude
by getting together weekly and reciting the special things that we are
grateful for at that moment, including our freedoms, our friends, and
our community.
REMEMBER, THE FAMILY THAT LAUGHS TOGETHER

IS LESS LIKELY TO KILL EACH OTHER
When stressed and overwhelmed by work, family, or life, remind your-
self of the big picture. Keep proper perspective on the small stuff and
the little bumps in the road that we too easily enlarge. A sense of humor
is especially important here. People who are able to laugh at the smaller
annoyances of life cope better in general.
In terms of my own family life, I have to admit that Im not your typi-
cal mom. Ive never been someone who fits neatly into the traditional
mothering role. So when my son was younger, I used to teach him nurs-
ery rhymes that were a little different, imbued with my own odd sense
of humor. For example, The queen of hearts made some tarts. She ate
them all and got the farts! Which was great fun, that is, until the pre-
school principal called me. And then I had to pretend Id never heard
that rhyme before.
I believe in what I call the art of contentment. Much of daily stress

is self-induced by dissatisfaction with ourselves or others. Expect less,
look at the positive side of life, and dont be so hard on other people and
yourself. But, at the same time, work toward steady improvement. You
dont need to be a perfectionist, but also dont settle for mediocrity.
NEWSPAPER HEADLINE: MODERATES DEMAND

TO BE HEARD, AT LEAST A LITTLE BIT
Eliminate negative thinking. Be constantly aware of how your cogni-
tion is framed, in positive approaches or with a sarcastic, negative,
pessimistic, undertone. Optimistic, positive thinking attracts success
in all areas of life. Our society tends to focus on the negative, cynical,
and sarcastic. Note that the news emphasizes the violent, the angry,
the ugly, and the unusualthats what makes it news. Learn to tune
out that emphasis, and embrace the beautiful, the compassionate, and
the positive. Guard your brain from assaults by those who dwell on
the darker, pessimistic side of life, and guard your own emotions to
keep from dwelling on this. Being positive-minded in your thinking is
not improper or unrealistic any more than dwelling on the negative,
the violent, and the miserable is proper (even if it has become nor-
mal in our society).
THAT NEW TRAVEL AGENCY NAMED

JUST DONT GO THERE
Concentrate on losing weight for the joy of feeling and looking better,
rather than because of the fear of illness or the fear of being lonely.
Toss guilt, fear, and shame (the three most common emotions in diet-
ing) out the window, and embrace joy, compassion, and contentment
as part of your new attitude about weight loss. Learn to accept and
like yourself as you are right now. Understand that you are not perfect
and are a work in progress. We all are. Do not become defeated by
lapses in judgment while you are on your weight-loss journey. Dont
go there. If you learn to like yourself right now, even with imperfec-
tions, this will lead to greater happiness and better follow-through
with weight-loss behaviors.
Eliminate self-criticism. Overweight people contribute to their nega-
tive emotions by being very harsh on themselves. In the business world,
it has been demonstrated that an uplifting management style is a much
more effective way to change behavior permanently than a negative
one. Concentrate on positive feedback when things are going right, and
leave it at that.
Successful permanent weight loss occurs through laughter and happi-
ness. Develop joy through positive physical and social activity. Happy
people are busy, unself-conscious, productive, fullled, and realistic in
setting goals. Accept mistakes. Forge close, loving relationships, and
focus on the positive. Then watch how easy it is to slim down forever.
WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

You will lose weight permanently with happiness and laughter.
Stress, negative emotions, and mistaken thinking are leading causes
of obesity
Concentrate on mental and physical health, and the weight loss will
follow.
The fatter you are, the more likely that you are depressed.
To get thin, believe that eating is pleasurable and exercise is invigo-
rating.
There are several keys to happiness, and they impact weight loss.
To decrease stress and anxiety, eliminate unfullling work and
boredom.
Increase pleasure with music, dance, tness, and nature.
You are no good to those you love if you use self-destructive coping
mechanisms.
Search out comedy, joy, giggling, friends, and spontaneity.
Use daily nonactive moments away from energy and mood-sucking
activities.
The way you choose to cope with lifes challenges will determine your
weight.
Decrease negative emotions by giving up materialistic attitudes.
Encourage your own positive health behaviors with benecial self-
reward.
Those who lose weight permanently lean on good social support.
The easiest stress-reducing activity: hugs, touches, and cuddling.
Give more of yourself to others, and practice gratefulness.
Be positive-minded in your thinking; guard against pessimists and
self-criticism.
TWO
Im Allergic to Food, It Makes
Me Swell: Thought and
Mind for Success
Im a big believer in integrating delight, fun, and happiness into every-

day life. We humans underutilize our natural abilities to enjoy life. I
bragged to my husband one day, I have an organ whose only purpose
is pleasure and you dont.
He retorted, True, but at least I have two organs for thought.
This book is about lifestyle change; its not about a diet. Good food
choices and increased activity feel positive and are not restrictive. When
you follow the ideas of the book, you will say to yourself about your new
habits, I choose this lifestyle because of the wonderful way it makes me
feel. There is no guilt, nor are there any absolute restrictions or com-
mands. You will behave in a certain way because you are positively mo-
tivated to do so. Nobody will watch over you, because you will learn to
motivate yourself. Thats how permanent weight loss is achieved. As a
physician, I see myself as an advocate for my patients. I dont command
or even cajole; I only advise. In this book, I can give you advice, but the
ultimate responsibility for your health and habit choices is your own.
Once you make positive new habits your own, you will achieve a new
level of health, happiness, and easy weight loss that is truly enjoyable,
for a lifetime.
A BALANCED DIET IS NOT SNACK CRACKERS IN ONE

HAND AND AN ORANGE SODA IN THE OTHER
I work with a nurse who is a 40-year-old single mom of two teenage
boys. Her kids are the center of her universe, and she proudly recites
their latest perfect report cards and amazing athletic achievements every
chance she gets. She has more energy than anyone I know. In fact, re-
cently I asked her, Linda, are you taking anything that makes you
hyper? She shook her head, laughed, and replied that people ask her
that all the time. Im high on life! she exclaimed. Then she showed me
a photo of herself from ve years ago. I didnt recognize the person in
that picture. That woman was 80 pounds heavier and looked absolutely
miserable.
Linda told me about how, when she was fat, her mom used to call her
lazy because she had so little energy. Finally, her sluggishness got to her,
and she was determined to be a healthier person and a better role model
for her sons. She walks every day, drinks green tea, limits her sweets, and
eats a balanced diet. Now, she has boundless energy and an amazing
positive attitude about life. What an inspiration she is to her two boys,
teaching them that they can reach any goal with patience, optimism, and
perseverance. Shes so happy and healthy, why wouldnt she want to feel
like this the rest of her life?
Linda is African American. When she was 80 pounds overweight, not
only did her obesity put her at risk for heart disease, but her misery and
sluggishness put her at risk for a stroke. Yes, the Centers for Disease Con-
trol published a study in 2000 showing that depression is an independent
risk factor for strokes, and that risk is signicantly higher in blacks than
whites.1 Lindas lifestyle changes are self-propagating. She feels better
mentally and physically, and she carries that old photo of her miserable
former self to remind her of how far she has come.
LIFES A JOURNEY, NOT A RACE

Weight loss and maintenance are lifestyle management issues. You arent
going to keep the weight off if you dont practice a lifestyle that includes
healthy eating and activity, as well as stress reduction. Attitude adjust-
ment is crucial for permanent weight loss. Those who are still thinking
in the back of their minds, When I get to my goal weight, I can go back
to my old eating and exercise behaviors wont succeed. Dont even try
the ideas in this book if thats your mindset. You have to accept that this
Im Allergic to Food, It Makes Me Swell 25
new pattern of eating, exercising, and living is just the way it is, forever,
and its going to be terric for you.
Daily exercise works because it decreases stress, anxiety, and depres-
sion. People who exercise as part of a weight-loss plan feel better physi-
cally and mentally and are more likely to reach their goals. And, since the
goal should be to enjoy the journey as much as the destination, I cant
emphasize this habit enough.
People say to me, I wish I were thinner, but I dont have time to ex-
ercise and eat right, even though I know I should. Do you like feeling
tired and stressed and fat and out of shape? If not, then you have time to
exercise and eat better because, in the long run, you havent much time
for anything else.
Exercise would be much more acceptable to the masses if we saw more

regular people exercising on television, not just the elite athletes. In
fact, the Olympics ought to go back to being just amateurs only. And
lets make it so all the contestants have to be naked because thats the
way it was originally. Think of what that would do for the TV ratings!
Of course, then the Olympic rings wouldnt be the only things inter-
locking.
Throughout the book I avoid using the word diet as much as possi-
ble because that word implies short-term and restrictive behavior. When
talking about intake of calories, I prefer to use the term food choices.
This implies active, positive, lifelong behavior.
The truth is, most traditional diets do work for weight loss, but only
for a little while. And none has been proven to be superior to the others.
Thats because they all do basically the same thing; all diets make us
think about what we stick in our mouths.
But traditional diets fail eventually because we stop thinking about
what we put in our mouths. The only way to modify the input perma-
nently is to ingrain the new eating habits. But the bigger reason that tradi-
tional diets fail is that we hate restrictions and commands. When a human
feels forced to do a behavior but doesnt learn to enjoy it, eventually the
behavior stops.
MY SON PRACTICES RANDOM ACTS OF GROOMING

Most weight-loss books are traditional diet books because they con-
centrate on the diet component, that is, the food part of the equa-
tion for weight loss. Yes, food choices are important, but theyre only
a third of the formula. The biggest component of successful weight
loss is the mind (behavior), not the food component. And just as big
a component as food intake is the activity. An overemphasis on what
to put in the mouth misses the truth about permanent and successful
weight loss.
So now you understand my mentality: dieting is not the goal. Rather,
the goal is learning permanent good habits for a lifetime. The great news
is that you dont need any willpower for this kind of weight loss, unless
you need willpower to brush your teeth! When you were a kid, someone
had to remind you to practice hygiene habits. As an adult, nobody forces
you to brush your teeth. You do it because you realize that it makes you
feel better. Good food choices and proper exercise really will make you
feel wonderful. If you follow the advice in this book, you will seek out
good habits voluntarily.
THE DISHWASHER DIET: USE THE HOT WAX

SETTING (THE FOOD SLIDES RIGHT OFF)
I put an emphasis on semantics. Saying food choices is so much bet-
ter than the word dieting, which is very negative. Dieting implies a con-
stant battle of restriction, denial, and restraint, rather than positive
choices. The joy of choices makes a world of difference in peoples ability
to stick to a healthy program and takes away the damaging effects of oc-
casional liberties. One doesnt feel punished or bad for making a differ-
ent food choice, whereas failing to follow a restriction is something that
obliges one to feel upset or angry.
Strangely, restricted diets for weight loss are tremendously popular.
Each diet has strict rules about what you cannot eat or drink. Many re-
strict even when you can eat or limits items at certain stages. Many peo-
ple respond well to lots of restrictions and rules in the short run but feel
deprived and fail in the long run. Very few people stick to those plans
for years, and certainly far fewer stay on them for a lifetime. Your job is
to learn to make wise choices for yourself, where nothing is completely
off limits and nothing is periodically restricted. Surprisingly, its not that
difficult, and it works better for physical and emotional good health. We
become more vested in our own health when we understand and make
our own decisions. I encourage you to be educated and unafraid of this

freedom.
Speaking of being unafraid of freedoms, a friend of mine started dating

again after a long marriage and a nasty divorce. Her kids are grown and
gone. The guy that shes dating just got divorced after 30 years of mar-
riage. Over lunch recently, she told me, Safe sex used to mean use a
condom, but now its oh, good, we didnt break a hip!
Its been shown in the weight-loss literature that when you set up a
bunch of strict rules of how, when, or what to eat, the perception is that
when you break a rule (which happens inevitably), a tendency to binge-
overeat occurs. This is what researchers Janet Polivy and C. Peter Her-
man, from the University of Toronto, call the what-the-hell effect.2
Banishing foods from a persons diet usually results in increased cravings
for that food. Never think of any food as forbidden; then it will never
be coveted in an unhealthy or excessive way. Eating without guilt is
the goal.
Good habits are not stressful and demoralizing; they are uplifting and
invigorating. Drop the do I have to do this the rest of my life thinking.
Its self-defeating. Nope, you dont have to do anything. But healthy
weight-loss behaviors, done right, mean youll want to do them the rest of
your life. Theyre fun.
THE DANCE INSTRUCTOR WAS SO FAT,

HE COULD ONLY TEACH THE CHA
Our bodies are built for physical activity, as much as they are built for
breathing. To say I hate exercise is like saying I hate breathing; it just
doesnt make any sense. (Well talk more about this point in Chapter 11.)
Exercise, done right, builds endurance and self-esteem and lowers stress;
it makes you feel mentally and physically better.
Duke University did a study that demonstrated a relationship be-
tween increasing exercise and lowering stress.3 Overweight individuals
were put in a regular exercise program. After six months, the participants
in the exercise groups not only had improved heart function and blood
pressure but also became less stressed when put into an emotionally chal-
lenging situation. They dealt with the everyday stresses of life better than
those who didnt regularly exercise. Walk every day before work, and you
will be able to handle both the difficult commute and your annoying co-
workers!
When you exercise, think about the positive changes your body is go-
ing through. Recognize the improvements that you see and feel on the
outside, and envision the improvements that are happening on the inside.
Note that the blood vessels are opening, the muscles are building up, the
fat is truly melting away every time you move. Your brain is growing
clearer and sharper. The hormones are happily signaling youthful mes-
sages to your private parts (ah, what a vivid imagination you havekeep
going with that thought . . .) Even though you need to visualize those
improvements that you cant see, they are just as important as what you
can see.
I HAVE NO CONTROL, I LOST MY REMOTE

People who have chronically dieted with restriction often feel they can-
not trust themselves around food. The attitude is why should I trust
myself, when Ive failed to lose weight so many times before? The abil-
ity to trust yourself to eat what you want, when you want, and how much
you want is extremely basic. You must have this belief to be successful at
permanent weight loss. Abandon the battleground in your head.
What do you love to eat? Self-trust leads to self-respect. How can you
respect yourself if you dont even let yourself enjoy your meals? What if
you ate only food that was tasty and pleasurable? Do you do that now?
Chances are that if you are overweight, not only do you deprive your-
self of your favorite foods, but you might not even remember what they
are. Spend time relearning and rediscovering what foods you truly love
to eat, both those that are nutritionally packed and otherwise. Try new
tastes, new combinations, new textures, and new spices. Dont be afraid
to experiment; explore and enjoy. Learn to love food and eating again
and you will learn to respect your body and yourself.
People who chronically diet have increased feelings of failure, lowered
self-esteem, and social anxiety. Dieting makes you feel lousy about your-
self. When you constantly cheat on a restriction diet, you lower your
self-esteem. This leads to anxiety and depression, which lead to obesity.
Its a vicious cycle that is rampant in our society.
I have a good friend who is very overweight and swings from one fad
diet to the next. Two years ago, she went on an all-fish diet and lost
60 pounds, then gained it all back, plus 20 more. Usually fish is one of
the better foods for weight loss, when eaten in moderation, except for
swordfish, which is high in mercury. It should be eaten only rarely. But
the good news is that, when cooking swordfish, you dont have to check
the temperatureit tells you what it is.
A SIGHT FOR BLIND EYES

Remember to treat yourself with kind and gentle words. Think and be-
lieve that you have the right to be fed and nourished, body and soul. This
means avoiding disparaging remarks from the person who is most likely
to dish them outyourself. How often, honestly, do you look in the mir-
ror or at your reection in a window and self-criticize? Most overweight
people do it all day long, often not even realizing it.
Focus on the person you are and the inner strengths that you have.
Pick specic character traits or accomplishments that have made you
proud. Move away from self-damaging mental scripts that many people
run over and over in their heads. The rst step is becoming aware that
you do it. The next step is replacing the script with words that nurture.
The third step is repetitive practice and devotion to positive thought.
Interestingly, although the mental script is entirely your secret
thoughts, I guarantee that if you convert those mental comments from
constant negatives to positives, others will notice your improved atti-
tude. People who think positively about themselves (without being gran-
diose) are extremely attractive to others. Those whose internal thoughts
are negative and critical subtly drive others away.
Its amazing how much your spirit and emotions can be detected by other
people, and sometimes in the most unusual ways. A woman who lives by
me advertises that she is a spirit photographer. She says that she can take
photos of the colors of your natural aura for you, your kids, and even
your pets. The more money you have, I guess, the greener your aura.
Weight loss and maintenance are an ongoing process, so dont think

in terms of mistakes. When either eating or activity isnt pleasurable,
take the time to ponder why and learn from that, without guilt or self-
recrimination. Even binging one time wont destroy a body. Learn and
move on, but lose the habit of chronically binging and restricting. Eat
smaller amounts of yummy food without the emotional chains that drive
people to feel deprived.
Realize that most people who lose more than 20 pounds do it suc-
cessfully over a period of 6 to 24 months. Quick, permanent weight loss
does not happen, and it is dangerous and damaging to the body to at-
tempt it.
THERES NO ACCOUNTING FOR WAIST

Some people are internally driven, that is, they use their own thoughts
and emotions to assess and motivate themselves. But many people are
externally motivated. They need others to tell them their accomplish-
ments, tasks, and self-worth and to encourage motivation. This is an
important point: those who are externally driven are more likely to
be overweight, since so many cues to eat surround us in our modern
existence.
If you are externally driven, you may undermine your ability to lose
weight by blaming others for your own behavior. You may say that
you cant lose weight because my husband likes to eat out a lot or I
have to keep junk food in the house for the kids. Nobody forces you
to put food in your mouth, and nobody forces you to sit on the couch
at night except yourself. (However, if people are tying you to the couch
and force-feeding you potato chips, I suggest you put this book down
and call 911.)
DEFINITION OF LAZY: WHEN YOU THINK

A NEW EXERCISE MEANS MASTURBATING
WITH YOUR LEFT HAND
You will not reach permanent normal weight until you take responsibil-
ity for your own actions or inactions. The buck stops with you now. If
you are externally motivated, you will need to outline specic steps, mea-
sure outcomes, and set up your own external cues to succeed. In later
chapters, Ill talk about how to do this, but you should be aware that
you need a major revision of your environment for your new lifestyle
habits. This may include putting more emphasis on limiting exposure to

the not-so-good-for-you foods and being selective about your exposure
to friends and family who do or dont support your efforts. This may
also include things like placing obvious cues to exercise, such as the sta-
tionary bike in front of the television.
Take steps to put yourself back in the drivers seat of your health. The
more control you have, the more likely you will get to your goal. And
note that research has shown that people who exercise regularly while
losing weight feel more in control of the process and are more likely to
lose the weight permanently.
Beware, there are exceptions to the rule that exercise makes you feel
more in control. Golf is not an exercise that breeds that feeling. What
is it with golfers and those little head covers they put on their drivers?
Theyre thinking, It protects my club so it wont get scratched. Then
they take the cover off, whack a hard ball as fiercely as possible, hit a
really bad shot, wrap the club around a tree . . . then put the head cover
back on.
Why is control so important in weight loss? Its because not every per-
son who succeeds does it the same way. This book is a description of the
best proven techniques that lead to sustained weight loss. However, no
program is one size ts all. Take what works for you and make it your
own. To keep weight off permanently, you should individualize the ideas
from this book to t your own style so that you can maintain your suc-
cess through the years.
Persistence is the key. Keep trying different ideas from this book, until
you nd the best t for you and your lifestyle. Those who succeed keep
trying different approaches until they nd the methods that work for
them. Then they stick to those methods.
THE THIN-YOUR-WALLET DIET

Many people are under the impression that they can lose weight only
in a special program, whether it is a diet center or a costly food plan.
Interestingly, the research shows that the majority of long-term losers
of major amounts of weight have traditionally done it on their own,
outside a special weight-loss program.4 I believe this is because people

who learn to take their signals from their internal environment and are
self-motivated will do better. They accomplish this without the struc-
ture of a specialized weigh-in program or using diet-program foods and
supplements.
There are so many dietary supplements that dont work. People dont
realize theres no government regulation for checking the effectiveness
of the claims of any type of nutritional supplement. People out there
are selling supplements that are supposed to boost memory and cogni-
tive function by increasing blood flow to your brain. The funny thing
about that claim is the real medical research shows that the better your
brain is functioning, the less blood flow it requires. Psst, want to be
Einstein? Ill sell you something better than a supplement. Ill sell you a
tourniquet to put around your neck.
Some people initially lose weight with a structured program, such as

Nutrisystem, Jenny Craig, or Weight Watchers, but then most design
their own maintenance program for the long term, for the years after-
ward. Very few people who lose weight and keep it off stay in a struc-
tured weight-loss program for years. Occasionally, people who were in
such a program return to it when they notice their weight creeping up.
There is no relationship between the cost of a weight-loss program and
its long-term success. Realize that there is a difference between a struc-
tured weight-loss program and groups that offer only social support and
encouragement. A study published in 2009 in the journal Evidence-Based
Nursing found that structured diet groups sometimes worsened par-
ticipants feelings of low self-esteem, negative feelings, and self-blame.5
However, the National Weight Control Registry found that groups that
offer positive social support are very useful to successful big-time weight
losers in both the short and the long term.
Stop blaming your body parts. I hope you arent thinking, If it
werent for my big belly, Id be happier. Thats silly. Realize that you are
more than your weight. Do not base your self-esteem on a number on a
scale.
HE WHO HESITATESIS LATE

Dont procrastinate on happiness or on making changes. Having goals
is important, but, if you delay your happiness until you reach your goal,
youve missed the point of life. Concentrate on your happiness along the
way and the journey will be more enjoyable. If you postpone happiness
until you reach your goal, it is likely you will never reach it or that youll
still be miserable when you get there.
Life is a balance. Denying oneself pleasure in the present so as to live
a pure life mentally and physically is demoralizing. The best solution is
to seek physical, intellectual, and emotional pleasures that are not harm-
ful at work and in personal relationships, as well as in eating and exer-
cise. Find physical pleasures that you can do now that are positively
rewarding.
It is difficult for many overweight people to accept that they eat too
many calories. Most obese people want to blame slow metabolism, hor-
mones, or increasing age. If you are overweight, you are eating too much
for your body and its present activity level. There is no way to get around
that fact. You will never succeed in permanent weight loss until you are
willing to accept the fact that you are ingesting too many calories for
your body at this point in time.
YOU LOOK LIKE YOU BELONG IN HOT AND SOUR SOUP

One of the most common reasons that people take in too many calories is
emotional eating. Dr. Edward Abramson, author of the book Emotional
Eating, describes anxiety, depression, boredom, loneliness, and anger
as the major emotional triggers. He says that emotional eating usually
takes the form of spontaneous snacks, not planned meals, since the calo-
ries ingested are in response to immediate emotional distress. Often these
snacks are eaten after a regular lunch or dinner, when the person has
recently eaten and is clearly not truly hungry. If you nd that you fre-
quently eat when you are not hungry or overstuff yourself, you may need
to ask yourself if you are eating to satisfy a deeper spiritual need.
Men do not report emotional eating as much as women. This may be
because they do less of it or because they just dont recognize that their
emotions are tied to their eating. Boredom, the biggest cause of emo-
tional eating, is probably one of the biggest triggers for male overeating.
Yet men do not see boredom as a root cause of excess calories. Boredom
comes with fewer physical signs than other emotions and gets missed as
an emotion.
FRANKENSTEIN WAS LEVEL-HEADED

How do you avoid emotional eating? If you nd yourself reaching for
food and you arent truly hungry, identify the emotion. At home, perhaps
you need to go out and garden, sit by the re with a cup of herb tea, take a
walk, call a friend or family member, write something inspirational, read,
or clear your mind. Would meditation or music help? How about just
deep breathing and relaxation? Maybe you need heavier breathing and
some great sex?
When you phone a friend for comfort, just remember to eventually

hang up. I have a relative who calls frequently and never stops to take
a breath. Theyve invented a pedometer to count the number of steps
you take in a day, but theres no wordometer to measure words spo-
ken in a day. Can you imagine how many husbands would buy that for
their wives? Husband (ears bleeding, checks device): Honey, youre at
youre 10,000 word limit, now shut up! I could make millions on that
invention.
Meditation, which we talk about in a later chapter, allows you to be

more aware of your physical and emotional states and satises needs
other than hunger. It tunes you into those needs and makes you less in-
clined to indulge in emotional eating. Emotional eating is a response to
poorly understood agitation of the mind. Becoming aware of your inner
states decreases that muddle.
How to deal with anger? If you are angry, decide if its serving a pur-
pose. Do you need to be angry? How can you defuse the anger? Would
relaxation and meditation work, or do you need to confront the focus
of your anger? Would writing down your feelings help, or would exer-
cising help you to blow off steam? Should you go for a walk and calm
down? Do you need to read about anger management or even take a
course on it?
Anxiety can feel like butteries in the stomach. Some people feel
those butteries and try to feed them, mistaking the feeling for hunger.
If you are chronically anxious, you may subconsciously feed your but-
teries, rather than deal with your anxiety. (Chronic anxiety disorder
is the most common undiagnosed and untreated psychiatric illness.)
You should identify what makes you anxious and nd ways to reduce
the anxiety either by seeking treatment or by dealing with the source.
Or you should practice reducing anxiety through breathing exercises or
meditation. Then you will succeed in avoiding this common cause of
overeating.
Theres no doubt that modern life leads to a lot of difficult emotions and
stressful situations. Did you ever wonder about Rapunzels reaction to
being saved if she were a modern woman? Shes locked up in a tower,
away from kids, boss, stress, and traffic. Hey, it sounds pretty good to
me. Modern Rapunzel: Go away! I dont want to be rescued. And get off
my freaking hair!
Are you lonely? Get on line and nd someone decent to chat with.
Join a class or a support group, or arrange to teach a skill at your local
community center. Sign up for a hobby club, exercise class, or the rac-
quetball league. Volunteer at a school, hospital, nursing home, or
pet shelter. Make yourself useful to others and they will reward you
10 times over.
What if you are bored? If you nd yourself rummaging in the cabi-
nets for food and you are not hungry, you are very likely bored. Go for
a bike ride, call a friend, visit a neighbor, do crafts, grab a fun book, or
watch the educational channel on television. If you are bored at work,
ask for more challenging assignments or learn new skills. Do something
that stimulates your mind and your heart.
MEET MY FRIEND, THE INCREDIBLE SULK

Are you depressed? If seriously depressed, seek professional help. If more
mildly depressed, the best treatment is daily moderate aerobic exercise.
A walking program works as well as medications, and the research is
pretty consistent on that point.6 Exercise is mood-enhancing, so youll
treat your mind and body in one fell swoop. Call people who make you
laugh and write to people you love. Seek out friends and helpful support.
Take a mental health day from work and responsibilities, but not to sit
home and brood. Instead, do something positive and uplifting with your
day off. Go to the park and ride the swings. Walk in nature. Play, laugh,
sing, and force yourself to get out of your depressed comfort zone. Rec-
ognize that your mood is down and make a deliberate effort to change
it with positive activity. Read about depression on university Web sites
and ways to recognize if its serious enough to warrant professional inter-
vention. Depression causes most people (normal weight and overweight
individuals) to eat more, but people trying to lose weight who are de-
pressed overeat the most calories.
I believe in communing with nature to lift the spirits. But here in Florida,
the nature often comes to me. Ive had snakes in my closets and a wolf
spider that was bigger than a tarantula in my baking pans. Ive had large
frogs come up from my sewer akin to a biblical plague. The nickname of
Florida is The Sunshine State, but the motto should be What the hell
is that in my commode?
If you think you are emotional eating, do the following:
1. When you are about to eat, ask yourself, Am I truly hungry? If

yes, go ahead and eat.
2. If not, think about why you feel the need to eat; pin down the emo-
tional triggers.
3. When you have determined the underlying cause, act on the triggers,
and ignore the urge to eat. Find another constructive outlet that isnt
taking in calories. Remind yourself that you are in control of your
behavior and that you have the capacity to break old habits, no mat-
ter how ingrained.
4. Groove the habit by practicing steps 13 each time you are about
to eat until the process becomes automatic. Your goal is to eat only
out of hunger.
EAT, DRINK, AND BE BURIED

If you avoid dealing with what is bothering you or use escapism as your
form of coping with difficult problems, you are more likely to overeat
and gain weight. People with escapist and avoidance tendencies also
tend to excessive drinking as well as other addictive behaviors. Over-

sleeping, excess television watching, and similar behaviors are often used
to numb emotions when someone is unwilling to confront problems.
Recently, a news program announced that researchers are very close to

producing human babies without mens help. Soon, women will have
no purpose for men, they claimed. Thats not true. Women need to have
menwho else would we have to blame?
Some people use food like an addiction. Food becomes another de-
structive way to soothe the hurting soul. Dr. Mark Gold at the University
of Florida has stated that he believes hedonistic overeating is an addic-
tive disease and needs to be treated the same as other addictions.7 His
research shows that, in obese people, beef broth does nothing for brain
chemicals, but Kobe beef lights up functional brain scans as if an addic-
tive drug were being given. Food causes dopamine release like sex does.
Receptors light up in PET brain scans as they do in cocaine and alcohol
abusers. When overeaters are shown a photo of the Golden Arches, their
brain brightens like a reworks display at Disney World.
Interestingly, the portion of the brain devoted to the sensations of
texture, taste, and feel of the mouth and tongue is also enlarged in over-
eaters, thereby reinforcing the sensual pleasures of food. In Chapter 9,
youll see why this isnt a bad thing.
Addiction is one of the greatest scourges of humanity. I dont under-

stand the push by some people to make illicit drugs legal. Whats next
forcing the drug cartels to dispose of their old cocaine by using it as
bricks on their enemies? Then the coke will have to have a stamped
best if snorted by date.
If you think you are suffering emotionally, get help. People with real
psychological problems that need treatment lost only half the weight of
those without emotional problems in the same weight-loss study. Dont
focus just on your weight. You need mental and physical strength and
healing to achieve your weight loss goals.
Addictions are a serious problem in my patient population. Still, as a

physician, I have a problem with the euphemism substance abuse. Im
fairly certain that chocolate and peanut butter are both substances. And
I will admit Ive occasionally used them for the euphoric mood they pro-
duce, not because I was hungry. Ive even used them together. Does that
make me a multiple substance abuser? Someday youll find me in a dark
alley whispering, Ghirardelli dark and Jif creamy, oh God, I need it
quick.
Emotional eating is not always a negative. Sometimes we are feel-

ing emotions that we dont want to admit, even to ourselves. If you are
reaching for food and arent hungry, use that behavior to analyze what
is bothering you. Let it become a positive signal, as if you have an early
warning system for your emotions. Then act on them before they over-
whelm you or lead you into crisis.
JEWISH AND CATHOLIC GUILT IS SIMILAR,

EXCEPT CATHOLICS HAVE ORIGINAL SIN AND
JEWS HAVE EXTRA CRISPY
There are a lot of mind games that people play with themselves that un-
dermine their success. Teach yourself that food isnt the enemy, and nei-
ther is your waist or the scale. Learn that weight loss shouldnt be painful
and that pleasure in food and activity is safe and encouraged. Eliminate
guilt and enjoy physical indulgences and you will actually eliminate
yo-yo dieting.
There are a lot of myths in weight loss that arent substantiated by the
health research. Here are the myths and the truths:
Myth: Im fat because of my genes.
Fact: Yes, some people certainly gain weight more easily than others,
but our present obesity epidemic has nothing to do with a sud-
den appearance of fat genes in our DNA. Look at the old photos
or videos of slim people from the 1970s and earlier. These people
have your genes. Get them back.
Myth: I was fat as a kid, so Ill be fat my whole life.
Fact: Its harder to lose weight the longer you have it, but thats prob-
ably due to lifelong behaviors that become more ingrained over
time. You can always change behavior. (Interestingly, according
to a 2005 article in the American Journal of Clinical Nutrition,

its also easier to stay thin the longer youve been thin. This is
true even if you were very obese when you were younger.)
Myth: Theres a 95 percent failure rate for diets, so why bother to try?
Fact: That oft-quoted statistic comes from the toughest cases at uni-
versity centers and also from measuring each attempt at a short-
term restrictive diet. We already know those dont work. Duh!
Myth: Im fat because I have character aws and no willpower.
Fact: You are overweight because you have learned lousy behaviors
that arent any fun, lowering your self-esteem and increasing guilt.
These behaviors have nothing to do with character aws or will-
power and can be changed with simple behavioral intervention.
IF WE COMBINE THANKSGIVING AND PASSOVER, WE

CAN HAVE THE NEW HOLIDAY OF LEFTOVER
Myth: I can lose weight only if I have a target date to be thin.
Fact: Many people target specic life events or holidays in their weight-
loss goals, for example, I want to lose 25 pounds by Christmas or
I want to t into a size 6 wedding dress. This is outrageous and
self-defeating behavior. If your mindset is to be good just until
you can t into those special clothes on that special day, then you
will face only frustration afterwards. You must think long term.
Your target date is everyday and no day; its the rest of your life.
If you cant get your head around that idea because of a lifetime of
crash dieting, please work on it. Accept this important point, and
you will eventually enjoy lifelong normal weight success. Ignore
it, and you commit yourself to a lifetime of yo-yo dieting and un-
happiness.
The wedding day is still the most common target date for crash diets.
But due to changes in society, weddings are less common than they used
to be. On the other hand, things are looking up for the funeral industry,
as baby boomers are dying in droves. In fact, wedding planners are now
doing funeral arrangements so they can stay afloat. This is a quote from
an article in my local paper, given by a funeral director: Other than the
fatality, whats the difference between a wedding and a funeral? Well,
in one case, youre less likely to have kids afterwards.
Myth: If I start gaining weight, even a little bit, it will all come back.
Fact: People who successfully maintain long-term weight loss monitor
themselves constantly. As soon as they notice a slight weight gain,
they have an action plan to reverse the trend. This is a normal part
of the process, not a failure.
Myth: I cant quit smoking because then Ill gain weight.
Fact: If you dispose of addictive behaviors, you gain control over your
life. And the more you practice healthy habits, the more likely you
are to lose weight permanently.
I have patients who insist on smoking while wearing oxygen. Ive been
thinking of opening Doctor Rs Institute of Patient Rocketry.
This reminds me of an 89-year-old patient of mine who explained
that she started smoking as a child when her mother forced ciga-
rettes on her. Up in the mountains, they thought it got rid of intestinal
worms. The lady is still smoking 80 years later. I said to her, Isnt it
funny that worms are smarter than people? They know to leave when
tobacco is around.
Myth: I cant have a baby and lose the weight afterwards.

Fact: Most women who are successful long-term losers do it. You
can, too.
Myth: Im fat because I love food.
Fact: Food and love are four-letter words, and sometimes we treat
them like that. Most overweight people actually have many neg-
ative emotions tied into food, like guilt, fear, and anger. Loving
food isnt evil. Its not foul-mouthed or even wrong. Its okay
to love food. Were born with the capacity to suckle the breast;
that rst food we encounter is comforting. So dont be hard on
yourself if you truly love food. Its normal.
IF WORDS DIDNT MATTER, THEN ALL LOOSE

WOULD BE BREAKING HELL
Once again, notice the semantics that I use. This is a journey, not a
battle against obesity. Dont downplay the importance of the phrases
playing in your head. Think about how differently you feel when you
say to yourself that you are in a ght rather than a learning ex-
perience about your weight. Reframe the words and thoughts that
you use, to yourself and to others, when thinking about eating, exer-
cise, and your approach to weight loss. You are not avoiding cer-
tain foods; rather, you are choosing more of this food or less of that
food. When things dont go quite right, its another learning oppor-
tunity, not a failure.
AND ON THE EIGHTH DAY, GOD MADE CHOCOLATE
Remember, no matter how bad life is, it can always be better with choc-
olate. Unless, of course, you are severely allergic to chocolate; then it
will be over.
Good self-esteem is needed when weight loss begins and is often

propagated by losing weight. Dont live for the day when you lose the
amount of weight that you want; start living and enjoying today. People
who deprive themselves of pleasurable food often get into a habit of de-
priving themselves of other joyful things like dancing, riding a horse, or
even taking a vacation. How emotionally damaging is that?
Not every vacation is full of fun and joy. The last cruise I went on, the
economy was at its worst. For many people on board, they were looking
at a lifetime of investments and retirement savings suddenly gone. Ev-
eryone was so depressed that at the muster station, the crew was teach-
ing people how to take their life jackets off.
Be careful with focusing on negative body image; this can lead to self-
criticism and unhappiness. Overweight people often delay socializing or
having enjoyable experiences, like going to their high school reunion,
waiting until they have their idealized body. Take steps to say and be-
lieve that you have a positive body image now and always. Have those
special experiences now, as that will lead to more happiness, which leads
to more success in weight loss. Buy the clothes that make you feel beauti-
ful and handsome now, not when you are a size whatever smaller. Enjoy
them; this will bring you closer to thinness and to mental and physical
health. Misery, self-deprivation, and neglect certainly wont. Take the
time to make yourself look your best now, every day. Do what you can now
to improve your self-image, both inside and out. Dont wait until some
nebulous future time.
Chinese fortune cookie: Over every mountain there is a path although
it may not be seen from the valley. You may feel like you are looking
upward at a very steep mountain to reach your weight-loss goals. If so,
redirect your view. Start looking at the lovely foothills right in front of
you. Then you can enjoy the path along the way.
WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

Good food choices and activity are desirable and not restrictive.
Attitude adjustment is crucial for permanent weight loss.
Saying food choices instead of diet implies active, positive
behavior.
Traditional diets fail because we hate restrictions and commands.
Healthy behaviors done right are fun. Youll want to do them the rest
of your life.
There is a direct correlation between increasing exercise and lowering
stress.
When you love food and eating again, you learn to respect your body
and self.
Traditional dieting makes you feel lousy; eat without guilt.
Treat yourself with kind and gentle words.
Weight loss is an ongoing process, there are no mistakes. Learn and
move on.
If you are externally motivated, you are more likely to be overweight
Individualize the ideas here to t your own style, and be persistent.
Most big-time weight losers lose weight on their own, outside a struc-
tured program.
Your self-esteem isnt a number on a scale. Dont procrastinate on
happiness.
Anxiety, depression, boredom, loneliness, and anger are major eating
triggers.
Escapism and addictions are destructive forms of coping and lead to

overeating.
Address the myths and mind games of weight loss. The truth will make
you thin.
Use upbeat words and positive body image and thoughts, right from
the beginning.
People who deprive themselves of pleasurable food deprive themselves
of other joyful things. Live and enjoy today.
THREE
Tossing Your Cookies:
Food Behavior That Works
People who are fat have fat kids. We know that. The argument is whether
that is the effect of nurture (environment) or of nature (genes). Since fat
families also tend to have fat pets, Im betting it is more nurture rather
than genetic predisposition. Unless, of course, you are related to your pets.
If you have been blaming your obesity on your lousy genes, its only go-
ing to make your ancestors feel bad, and its not going to help you get
healthy and skinnier. Leave Aunt Tillie out of this.
However, if Aunt Tillie was the one who taught you to always eat din-
ner at 8 p.m. and never to leave the table until you clean your plate and
that exercise is only for athletes, then Tillie is in the doghouse after all.
MY BIRTHDAY SUIT IS TIGHT

I rmly believe that it doesnt matter how much a person exercises or
how little he or she eats if there isnt change in the fundamental underly-
ing behaviors that result in weight problems. Short-term successes will
be lost every time. Those behaviors are the result of habits, as well as ex-
pectations and assumptions about food, eating, weight, and activity.
Most of these behaviors are formulated in childhood, reinforced in adult-
hood, and carried onward for a lifetime. Permanent weight loss occurs
when we examine and change our actions. In this chapter, we discuss
proven successful food behaviors. In the next chapter, we talk about best-
known behaviors for activity.
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*Just not that Aristotle.

PART I: ATTITUDE AND BEHAVIOR

ONE: Turn Your Head and Laugh: Happiness, Joy,

PART II: INPUTFOOD AND DRINK

EIGHT: Water Intolerant: The Right Drinks 143

PART III: OUTPUTMETABOLISM AND ACTIVITY

TEN: That Which Doesnt Kill You Makes You Fatter:

First and foremost, I must thank my agent, Ellen Pepus, of Signature

Finally, the biggest thanks goes out to my patients, who inspire

Melanie Rotenberg, MD (aka Dr. R)

Roller Coaster Haiku

LIFE IS ALL ATTITUDELUCKILY, IVE GOT LOTS OF THAT

GONE WITH THE CHIN

Back to weight loss: calories are just a convenient way to measure

STUDIES SHOW THAT WOMEN PHYSICIANS

(Oh, and one more thing: pay attention throughout. My husband

YOUR PERSONAL WEATHER FORECASTCHANCE

The biggest stress in my life is keeping house. Im not much of a domes-

HELP! IVE EATEN AND I CANT GET UP

IF STRESS CAUSES HIVES, I OUGHT TO BE ONE

This chapter is about ways to increase happiness, lower stress, improve

THE UNIVERSE IS EXPANDING, AND SO AM I

I have a patient who is extremely overweight, as is his wife. Recently,

IVE ALREADY LOST THREE SIZES:

WHO KNOWS IF A CLAM IS REALLY HAPPY?

THE CABLE COMPANY SAID THEYD BE RIGHT OVER,

arguments with family members, waiting for the repairman, or being

CUSTOMER SERVICE IS OUR MIDDLE NAME.

Nothing aggravates me more than dealing with rude and incompetent

IF YOURE NOT BUSY LIVING, YOURE BUSY WORKING

HAVE A FOOD FIGHT, BUT STOP FIGHTING YOUR FOOD

MY BOSS IS HAVING A NEAR-HUMAN EXPERIENCE

mechanisms of great, loving, smart people under tremendous pressure.

There is so much aggravation built into health care. I was scheduled to

HEY, DID THE BED GET SMALLER?

WHATS IT GOING TO BE LIKE WHEN THESE WERE

When picking good-for-you music, be selective. I was a child in the

Im a big believer in a daily regimen of at least 15 minutes of what I

A brand-new speech therapist was working on cognitive tasks with a pa-

SHE WAS SO MATERIALISTIC, SHE WENT OFF

THE BEST THINGS IN LIFE ARE FREEOR

Another way to decrease negative emotions is to encourage your

when they dont involve excess calories or monetary expenditures. Find

WHEN OUT IN THE COLD, LET YOUR NUCLEAR

Approach social occasions (especially with food) with a positive, joy-

A MIND IS LIKE A PARACHUTE. IT WORKS BEST

There is one precaution I have about doctors touching patients. It seems

My husband offered to get me a pet; he wanted to know which animal I

Overweight people feel less huggable because of the stigma society

IM FOUNDER OF THE ORGANIZATION DOCTORS

WHY DONT WE DO FUN RAISERS?

REMEMBER, THE FAMILY THAT LAUGHS TOGETHER

I believe in what I call the art of contentment. Much of daily stress

NEWSPAPER HEADLINE: MODERATES DEMAND

THAT NEW TRAVEL AGENCY NAMED

WHAT YOU SHOULD REMEMBER FROM THIS CHAPTER

Im a big believer in integrating delight, fun, and happiness into every-

A BALANCED DIET IS NOT SNACK CRACKERS IN ONE

LIFES A JOURNEY, NOT A RACE