Living a Healthy Life with Chronic Pain (37 page)

Exercise can help you lose weight and keep it off. But it is very difficult to exercise enough to lose weight without also changing what you eat. It is true that the more calories you burn with exercise, the more weight you can lose. However, that is only one part of the story. The most success comes from making positive exercise and eating changes that become part of your daily habits over the long term. Many studies show that it is important to eat fewer calories and be physically active. Being active will not only help you burn calories, it will also help you build muscle (which burns more calories than fat) and give you more strength and zip. You will be able to move and breathe better, and your energy level will increase. For more information about exercise and tips for choosing activities that suit your needs and lifestyle, see
Chapters 7
through
9
.

Aerobic exercise (see
Chapters 9
) that gets your heart pumping is the best for weight loss. Walking, jogging, bicycling, swimming, and dance all do the trick. These kinds of exercises help you lose weight because they use the large muscles in the body that burn the most calories. The exercise guidelines for physical fitness in
Chapters 9
are also good for weight management: 150 minutes of moderate or brisk aerobic activity a week. Exercising in 10-minute bouts works as well as longer workouts. If you can add minutes to each brief workout, that is even better.

When you add more exercise to your routine, be honest with yourself about what you can do and what is safe and enjoyable for you. If you try to exercise too hard or too long for your current condition, you are more likely to stop because of an injury, fatigue, frustration, or loss of interest. Increasing your physical activity is helpful only if you do it regularly and at a pace that is right for you.
Chapters 6
has useful information on pacing activity and rest that can be helpful.

Some people become discouraged when they begin a weight management effort. The pounds may not melt off right away, or weight loss may stop. This may be true even if you are still exercising and being careful about what you eat. There are many reasons why weight loss slows. Exercise may be building muscle as well as reducing fat, and muscle weighs more than fat. You could be losing fat but the scale is not showing it. If you are seeing improvements in your body measurements or notice that your clothes fit better or are looser, this can be a signal that exercise is working even when the scale seems stuck. And remember, when you exercise regularly, even if you don’t lose weight, you are doing good things for your body. Regular aerobic exercise can help give you more energy and improve your sleep. It can reduce bad cholesterol and increase good cholesterol levels, reduce your risk of heart disease, and help with depression and anxiety. And it can help your chronic pain in the long run by managing symptoms such as depression and difficult emotions.

• Set small, gradual weight loss goals
  . Break the total amount of weight you want to lose into small, reachable goals. Think in terms of, say, 1–2 pounds (0.5–1 kg) a week or 5–7 pounds (2–3 kg) a month instead of looking at the total number, especially if you have a lot of weight you would like to lose. For most people, aiming to lose just a few pounds a week is realistic and doable. When you set small goals rather than large ones, your goals are more possible and practical.
  

• Identify the exact steps you will take to lose your weight.
  For example, it could be sticking to the 200 plan (
  page 242
  ) or walking 20 minutes a day five days a week, not eating between meals, and eating more slowly.
  

• Keep on top of what is happening.
  Keep track of your weight. Weigh yourself regularly according to a schedule that works for you.
  

• Think long-term.
  Instead of “I really need to lose 10 pounds right away,” tell yourself, “Losing this weight gradually will help me keep it off for good.”
  

• Be “in the present” when you eat.
  By focusing on what you are eating and not what you are doing (such as watching television), you will enjoy the food more, become satisfied sooner, and eat less.
  

• Eat more slowly.
  If you take less than 15 or 20 minutes to eat a meal, you are probably eating too fast and not taking the time to appreciate your meal. You can enjoy food more and eat less by eating more slowly. If you find it hard to slow down, try putting your fork down on the table between bites. Pick it back up only after you have chewed and swallowed the food.
  

• Become keenly aware of your stomach.
  Become aware of what it feels like when your stomach is just starting to feel full. As soon you get that signal, stop eating. Learning to recognize this feeling will take attention and practice. When you feel yourself becoming full, remove your plate immediately or get up from the table if you can.
  

• Portion out your food.
  Especially when you are first starting to make changes, measure out your portions. It is amazing how easily 1/2 cup of rice can “grow” to a 1-cup serving. When you can, eat food products that are already in single-size portions.
  

• Choose smaller portions.
  When eating away from home, select appetizers or first courses over entrées, or order a child’s meal. This will help you eat fewer calories. Over a year, it takes only an extra 100 calories a day to put on 10 pounds. That is like eating only an extra third of a bagel a day. The food guide,
  Table 13.2
  , on
  pages 226
  –
  233
  lists common serving sizes for a variety of foods.
  

• Clock yourself.
  Make it a habit to wait about 15 minutes after eating before serving yourself another portion or starting to eat dessert or a snack. You’ll often find that this is enough time for the urge to eat more food to go away.
  

Sound familiar? Almost everyone who tries to lose weight wants it off fast. There are hundreds of diets promising fast and easy ways to lose weight. These promises are false. There is no “magic bullet.” If it sounds too good to be true, it probably is.

During the first few days of almost any weight loss plan, your body loses mostly water, along with some muscle. This can add up to 5 or even 10 pounds. Because of this, fad diets can say they are successful. But the pounds come right back on just as soon as you return to your old ways. Also, fad diets are often badly imbalanced in the kinds and amounts of foods allowed. Because of this, you may experience light-headedness, headaches, constipation, fatigue, and poor sleep.

Rather than wasting time with fad diets, do it right. Set small, realistic goals. Do action planning, and use positive thinking and self-talk (see
Chapters 2
and
5
). You didn’t put the weight on overnight. It won’t go away overnight.

Almost everyone reaches a point where weight loss stops despite continued hard work. These plateaus are frustrating and can make you want to give up. Plateaus are often temporary. They can mean that your body has adapted to its lower calorie intake and higher activity level. Resist the temptation to cut calories even further. This could actually make your body burn fewer calories, making more weight loss even harder.

Ask yourself whether those last 1, 2, or even 5 pounds really make a difference. If you are feeling good and doing well with your pain management, energy level, blood sugar, and other health issues, chances are you may not need to lose more weight. If you are relatively healthy, staying active, and eating a healthy diet, it is usually not bad to carry a few extra pounds. However, if you decide that those pounds must go, try the following tactics:

• Instead of focusing on weight loss, focus on maintaining the same weight for at least a few weeks. Then go back to your weight loss plan.
  

• Increase your physical activity. Your body may have adjusted to your lower weight and therefore needs fewer calories, so you may need to exercise more to burn more calories. Adding more exercise could help kick-start your body into burning more calories. (You can find tips for safely increasing your exercise in
  Chapters 7
  ,
  8
  , and
  9
  .)
  

• Keep thinking positive. Remind yourself of how much you have achieved. Write your achievements on sticky notes and post them where you will see them.
  

You are a special person. The changes you decide to make have to meet your special likes, dislikes, and needs. Unfortunately, our brains can get channeled into unproductive thoughts instead of being supportive or encouraging, especially
when it comes to losing weight. Replace unproductive thoughts with positive ones that work for you (more on positive thinking can be found in
Chapters 5
). Here are a couple of examples:

• Replace thoughts that include the words
  never
  ,
  always
  , and
  avoid
  . Instead, tell yourself that you can enjoy things occasionally “but a healthier choice is better for me most of the time.”
  

• Tell yourself that you are retraining your taste buds and that making healthier choices can help you manage your weight and feel better.
  

If you finish meals in just a few minutes or before everyone else at the table, you are most likely eating too fast. You may be doing this for a number of reasons. You may be letting yourself get too hungry because too much time passes between meals or snacks. When you finally do get to eat, you wolf food down. You may be hurried, anxious, or stressed when you sit down to eat. Slowing down your pace can help you eat less and enjoy your food more. Here are some tips for cutting down your eating speed:

• Do not skip meals. Eat regularly to avoid becoming overly hungry.
  

• Make it a game not to be the first person at the table to be finished eating.
  

• If you find yourself saying, “I think that was good; I better have more to make sure,” that usually means you aren’t paying attention to what you eat. Learn to be mindful about what you are eating and how you are enjoying it. While eating, avoid being distracted by things that take your attention away from your meal, such as friends, video games, or television.
  

• Take small bites, chew slowly, and swallow each bite before taking another. Chewing your food well helps you enjoy your food more and feel better after the meal. It reduces heartburn or other digestive upsets.
  

• Try a relaxation method about a half hour before you eat. Several methods are discussed in
  Chapters 5
  .
  

Losing weight is challenging, and sometimes you just need some outside support and guidance. For help, contact any of the following resources:

• A registered dietitian through your health plan, local hospital, or the Academy of Nutrition and Dietetics website, (
  www.eatright.org
  ). In Canada, log on to the Dietitians of Canada website (
  www.dietitians.ca
  ).
  

• A support group such as Weight Watchers or Take Off Pounds Sensibly (TOPS), where you can meet other people who are trying to lose or maintain a healthy weight.
  

• A weight loss program offered by your local health department, hospital, health plan, community school, or employer.
  

This happens to many people. It is the downside of quick-loss diets, because they typically involve drastic changes. They do not focus on lifelong changes in eating habits, exercise, and lifestyle. Typically, after you have gotten tired of the diet or have reached your goal weight, you return to your old ways, and the weight comes back on. Sometimes you even gain back more weight than you lost.

The key to maintaining a healthy weight is to develop healthy eating and exercise habits that you enjoy, that fit into your lifestyle, and that you can stick with. We have already discussed some tips earlier in this chapter. Here are a few more:

• Weigh yourself regularly and set a personal weight gain “alarm.” It could be a specific number of pounds gained (perhaps 3 pounds). If you hit this mark, go back on your weight management program. The sooner you start, the faster the newly added pounds will come off.
  

• Monitor your activity level. Exercising three to five times a week improves your chances of keeping the weight off. Research suggests that people who successfully maintain weight loss exercise nearly an hour a day. This may seem like a lot but it includes normal activities during the day as well as planned exercise. Also remember that increasing activity does not just mean exercising longer. It can mean going faster or doing something that is harder to do, such as walking uphill or swimming with paddles.
  

Everyone is going to slip at one time or another; no one is perfect. If it was only a little slip, don’t worry about it. Just get back on your plan. If the slip is bigger, try to figure out why. Is there something taking a lot of your attention now? If so, weight management may need to take a back seat for a while. That’s okay. The sooner you realize this, the better. Set a date when you will restart your weight management program. If the time is right but it is still a challenge to manage your eating, you may want to join a weight loss support group. Commit for at least 4 to 6 months and look for a group that does the following:

• Emphasizes healthy eating
  

• Emphasizes lifelong changes in eating habits and lifestyle patterns
  

• Gives support in the form of ongoing meetings and/or long-term follow-up
  

• Does not make miraculous claims or guarantees
  

• Does not rely on special meals or supplements