Keeping Things in Perspective During the Holidays

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Holiday season is upon us and it’s time for the 3 “F’s”… friends and family, festivities, and food. My message to you is quite simple…keep the last “F” in perspective.

This is the season when we give thanks, cherish our friends and loved ones, share experiences, have fun, give gifts and look forward to the promise of the new year. Food and eating is intertwined with all of these activities, but should be neither “THE” activity nor “THE” focus.

Each of us would probably love nothing more than to stop thinking about eating, food or (most of all) our weight. During this time of year, focus on enjoying your loved ones and the opportunities to celebrate the season. This is what life is really about so try to enjoy every moment. Sure, continue to watch what you eat and don’t let things get too out of hand during the season of fruitcake and chocolate covered everything… but even if you do, just let it go. It’s really not that important. If you eat too much one moment, just begin anew the next…don’t make the mistake of making yourself miserable over a stupid piece of cake.

I promise you that twenty-five years or more from now, when you’re older and grayer….you’re going to tell yourself that you should have enjoyed your loved ones and all of the opportunities you had to spend with them even more than you did. I guarantee that when you’re rocking in your rocking chair you will not be telling yourself that you should have spent more time focusing on your weight and you’re certainly not going to lament about the extra scoop of mashed potatoes that you ate on Thanksgiving in 2008!

If per chance the holidays are a painful or lonely time, make every effort to begin new traditions with new people. You don’t have to allow every holiday season to be a reminder of those you have lost or memorable times gone by. Every town and community has holiday social events that you can plug into. It requires some work, but things can absolutely be different if you make the effort to make it so.

So, should an errant chocolate melt-away or piece of pecan pie or turkey drumstick wind up in your belly by mistake, keep things in perspective. Don’t condemn yourself for hitting a bump in the road en route to whatever weight loss goal you are pursuing….that just leads to self-hatred and more eating. Let it go, give yourself a break and most importantly….enjoy your loved ones and the holiday season. Happy holidays!

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The Moment

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The Moment

As I was reaching for one of the few remaining pieces of Halloween candy that is still in my kitchen it occurred to me that successful behavior change is all about what you do “in the moment.” “The moment” is that brief second between initiating the behavior and executing the behavior. With regards to eating it is the millisecond between reaching for the food and putting it in your mouth.

There I was standing in my kitchen, holding the mini-Butterfinger that I just unwrapped in my hand. As I was raising it to my mouth…I stopped. I don’t know why I stopped on this occasion as I had eaten several pieces of candy over the past two weeks…but I did. In that instant it occurred to me that this is the exact moment where behavior occurs. This is the tiny window of time when I can alter my behavior or allow it to proceed as per usual. The window was open. I felt very powerful in that moment. I was in charge. I was mindful of the importance of this moment. It occurred to me that this is “thee” moment…the only moment where behavior change occurs. Not before and certainly not afterward. I felt as if I was in total control.

Although the moment could have lasted for just a nanosecond, I stayed in it for what seemed like an hour. It seems like a simple reflex of either putting the candy in my mouth or putting it down, but it really isn’t. “The moment” involves a series of small but crucial steps that dictate what will happen next…

The first and most important step is to STOP! Most of our behavior occurs while we are completely on auto-pilot. We just go about our day doing 95% of what we do without a thought. We walk without thinking, we drive without concentrating, we eat without being aware. Most behavior can proceed without conscious thought. To change, you have to stop and step out of auto-pilot. On this moment, for whatever reason, time stopped for me. I suddenly became mindful of the moment and stopped what I was doing.

The next step is to BREATHE. Really this step involves taking a second to step back from the moment, now that you have stopped what you were doing. It is advisable to take a breath to relax and focus on what is happening. You’re in charge. You can to alter your behavior.

The next step is REFLECT. Reflection is thinking. What do you want to do? What are your choices? Do you want to go about business as usual or do something different? What will the consequences be if I change or if I proceed as usual! I asked myself…”Do you want the chocolate?” “If you eat the chocolate, how will you feel about it afterwards?” “Aren’t you trying to control your weight?” “Is eating this chocolate really what you want to do?” Of course these questions occur in an instant, as do most thoughts, but they definitely were flying through my mind as I was holding the candy in hand.

The next step is CHOOSE. I had to make my choice…eat it or put it down. Having reflected on the moment, you choose what to do. You execute your decision. I put the candy bar in the garbage.

The final step is EVALUATE. This is a post-behavior reflection. How do I feel about my choice of behavior? Would I do it again? If not, what would I like to do differently? How can I make sure this behavior either happens again or how can I prevent it from happening again?

So there it is…”the moment”…a nanosecond of time during which we have the ability to change. The time to step out of auto-pilot and be mindful. I was fortunate that this moment arrived with little help from me. I am confident that you have had these kinds of moments as well. Perhaps you never realized just how much was going on in your mind during that instant of time. Going forward, especially when you’re eating or are about to eat, try to STOP!..BREATHE…REFLECT…CHOOSE..EVALUATE and see if you can more consistently alter your eating behavior so that it is more consistent with your long-term goals of losing and maintaining your weight.

Consider writing down this little series of steps and reading it several times per day in an effort to commit it to memory so that you can make mindfulness more automatic.

STOP! > BREATHE > REFLECT > CHOOSE > EVALUATE

Best of luck!

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Tackling Emotional Eating by Shifting Out of “Autopilot”

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Perhaps no topic in the area of weight loss and weight loss surgery receives as much attention as “emotional eating.” Hundreds of articles and books are written on this topic every year appearing in magazines, newspapers, websites and other media sources. But what exactly is emotional eating and why does it receive so much attention?

Emotional Eating Defined

The term “emotional eating” is in many respects a “garbage-pail term” that is often used to refer to any form of eating that is not purely hunger-based. Most discussions on emotional eating also explain it as a behavior that one should make every effort to minimize, if not terminate completely. However, the irony is that everyone is an emotional eater to some degree and life would be quite joyless if all forms of emotional eating were to be eliminated. Fortunately, this is not necessary.

Most folks seem to make a distinction between two types of emotional eating: eating in response to positive emotions and eating in response to negative emotions. Positive emotions are desirable or pleasant such as happiness. This form of emotional eating often relates to celebrations or accomplishments. In this way, holiday meals are a form of positive emotional eating as is going out to dinner to celebrate a promotion at work. Negative emotions are unpleasant and are generally seen as undesirable. Eating in response to negative emotions is often a way of attempting to provide oneself with comfort. Eating when you are depressed or lonely or nervous are examples of eating in response to negative emotions. In general, eating in response to negative emotions is the type of emotional eating most folks view as being more problematic as the former seems to be almost an inherent part of every culture on the face of the earth. As an example, one of my former patients, a rabbi, jokingly describes the three characteristics of a Jewish holiday as: “they tried to wipe us out, God saved us, let’s eat!” I’m not suggesting that there is no benefit in addressing eating in response to positive emotions; however this is not the focus of the current discussion. So let’s focus on eating in response to negative emotions and to simplify our discussion, simply refer to this as “emotional eating.”

One interesting aspect about folks who describe themselves as “emotional eaters” is that in my experience the behavior is often described as being non-conscious or out of their awareness. I refer this state as being on “autopilot,” similar to a plane that is flying itself without a pilot making active decisions as to where the plane should be going. Here’s why. Very rarely do patients describe incidents when they would feel an unpleasant emotion and then consciously decide to immediately march to the refrigerator or corner Quick-mart for a snack. Emotional eating is far more subtle than that. Much more common is that the person recalls a situation when they were surveying the contents of their cabinets or refrigerator and doesn’t even know why they’re there. Some folks go so far as to recall times when they were halfway through eating a bag of corn chips and they don’t even recall eating the first half. They were on autopilot. How does this happen and what can you do to stop it?

The Evolution of Eating on Autopilot

Consider that eating is almost an automated behavior in that you can do it without paying attention. Walking is much the same way. Initially, when you first learn to eat or walk as an infant, you need to pay attention to learn the skill. Watch any infant taking her first few steps and you will see the focus and determination she has to stay upright and not to fall. She’s really concentrating on what she’s doing. Similarly, when feeding babies with solid food for the first time, we cut up the food very small and feed the baby very small bites because we recognize that eating solid food is a skill that babies do not yet have. We make the decisions on food types and sizes at this stage because we don’t want them to choke. However, in very little time, both eating and walking become activities humans can do with almost no effort. Think about this for a moment. Now, as an adult, when you walk, do you actually think about which leg to move next or do you just seem to go? You can walk a mile without once thinking about your legs or feet for even one second. There’s no thought at all…you’re on autopilot. When you eat it’s the same story. Most adults don’t think about chewing. They can hold a conversation with five people and wipe out an entire plate of food without ever paying attention to their chewing at all.

If you’ve had weight loss surgery, you know just how powerful this “eating autopilot” can be because you’ve had to relearn a lifetime of eating behavior that no longer works. After surgery, you had to learn to pay attention and chew more, eat slower, avoid drinking while you eat, etc. These behavior changes probably took awhile to master. In fact, many of my patients who’ve had gastric banding, for example, commented that relearning how to eat was the most difficult part following their surgery. Now let’s turn back to emotional eating.

Many of you can recall experiences from childhood where food was given to you as a reward for good behavior or withheld from you for unwanted behavior. Similarly, you may have been offered food to make you feel better when you were disappointed, sad or experiencing some other unpleasant emotion. Almost immediately food and eating was linked to emotions. My grandmother was convinced that chicken soup could cure anything! And you know what…she was right! It doesn’t take a rocket scientist to recognize that you do feel a bit better while you eat chocolate or nacho chips or whatever your favorite food is. Even folks that didn’t have food thrust upon them to help them cope with negative emotions as children can often recall picking it up themselves later as adults. It seems very easy for humans to learn to eat as a means of coping with emotional upset. Let’s face it…for most of us, eating feels good. Whether it’s the taste or the emotional associations we make with certain foods (comfort foods) or certain people (grandma) or purely a neurochemical affect (serotonin, etc) eating feels good.

Unfortunately, what you also probably know is that if you are eating ice cream at night because you are feeling lonely and sad, while you might feel a little sense of pleasure from the ice cream, it does nothing to address the loneliness and sadness and it does wreak havoc on your waistline. Even though it doesn’t really help us cope with emotional upset in the long run, we keep on doing it because it feels good immediately and the consequences of emotional eating are generally delayed, if only by a few minutes. What happened is that over a period of many years, you “learned,” that food has, or is believed to have, the ability to minimize or eliminate your emotional distress. Now, when those feelings arise, you feel compelled to eat as if you’re automatically programmed to do so without even being aware. You’re now running on autopilot. When asked to describe the feelings they have just before eating, many of my patients describe feeling bored or calling it “blaaaaah” referring to some vague, negative emotional state. So if you’re an emotional eater as I’ve described, and you’ve put on a lot of weight as a result, you are not stupid, you are not lazy, you are not pathetic…you are human. Most important for you to understand, you are most certainly not helpless. You need to fix your hard drive and get you out of autopilot by unlearning some ingrained, overlearned maladaptive behaviors in favor of some new more adaptive ones.

Shifting out of Autopilot

“Recognizing that you have a problem is half the battle!” No it isn’t. That sounds good when people say it but if it were true then being aware that you were 100 pounds overweight would immediately result in a 50 pound weight loss! Not so simple. What this expression means is that if you don’t become aware that you have a problem you can’t possibly do anything to remedy the problem. You must first be aware that this pattern exists in order for you to change it.

There is a simple process that you can follow to help make changes in your behavior:

Stop→Breathe→Reflect→Choose→Evaluate

Let’s go through this one step at a time:

1. Stop! When you’re about to put food in your mouth, stop what you’re doing. It may sound easy but this is clearly the most difficult step. It’s hard to stop engaging in a behavior that you can do without a single thought. Eating is a mindless behavior. As I said earlier, you don’t have to think in order to eat any more than you have to think in order to walk. Hence the autopilot problem.

The trick is to develop an improved awareness of your behavior. How can you learn to be more aware? One of my favorite techniques is to put written reminders all over the place. Putting them where you eat is a good idea but other places are great as well. You’re trying to bake this awareness into your brain and knock your brain out of autopilot. Stick those colorful sticky square notes on your bathroom mirror to remind you first thing in the morning to change how you eat. They can say “Be aware of your eating” or even just “STOP!” You’ll remember what it means. Put another note on your rearview mirror in your car. Put another one on your computer screen. Put another one on your refrigerator. Sounds a bit nutty, but if you are truly committed to change you need to remind yourself to do it, otherwise autopilot will rule the day! Just like a computer that has default, automatic settings, so does your brain. Unfortunately, for many of us eating has become the default setting, so without the reminder NOT to eat, eating occurs almost automatically.

Another recommendation is that you write down what you eat by keeping a food diary. I know, you’re sighing because you’ve heard this before and you hate this. However, the truth is that when you get into the habit of writing down what you eat, it definitely affects what you choose to put in your mouth. This is why you probably hate writing it down…because it works! After a few weeks of monitoring what you eat your eating habits will change. You will become more “mindful” of the entire practice of eating and will therefore be in a much greater position to change your behavior and CHOOSE to eat differently.

Another idea is to put a message of some kind reminding you to eat differently in your schedule book or on your screen saver or on your PDA devise or anywhere that you look numerous times per day. On many occasions, I have written a phrase such as “focus on food” in my schedule book because I look at this book at least 25 times per day. With all of these tactics, and I encourage you to think of your own, the effort is to force your brain to focus on what is going on at this very moment rather than reverting back to old habits we are calling autopilot.

2. Breathe. The idea here is to create a natural pause and to gather yourself and your thoughts. Take a minute and stop what you’re doing and be mindful that you are about to make a change. Breathing helps us relax and makes it easier to focus on your thoughts and block out the world around you. When you find yourself holding open the doors of your cabinet searching for a snack…STOP! and then take a few breaths to gather your thoughts so that you can better decide what you really want to do. The breathing and the few second pause give you a space to slow the wheels down and make small but meaningful changes in your behavior.

3. Reflect. Reflect is a nice way of saying “think.” Now that you’ve stopped and taken a few breaths, think about what you’re about to do. You’re about to eat. Ask yourself a few questions and write them down because they’re going to be the same questions every time and it would be helpful for you to become familiar with the answers: • Am I really hungry? • Do I really want to eat this? • Why am I choosing to eat at this particular moment…what’s going on? • What is the purpose of my eating? • Will eating help my problem beyond making me feel good for 37 seconds? • If I do eat, how am I going to feel after those first 37 seconds? • What is the real issue that I’m using food to try and medicate away? • What is (are) the particular emotion that I’m feeling? • What else can I do other than eat that actually may address the real problem?

This step is very important because it can help you understand the reason(s) that you are eating. As we said, eating is your autopilot or your default behavior. If you can learn to stop and think about what’s going on, there will be times that you recognize that your decision to eat was not random. At other times it will be simply because you were truly in the mood for a chocolate bar…and that’s ok from time to time.

4. Choose. The last bullet point above asks “What else can I do other than eat that actually may address the real problem.” This is the key to the whole process. This involves choosing alternative behaviors rather than eating that actually addresses the emotional distress that is leading you to eat. This is where actual change occurs. By choosing an alternative behavior you are actively shifting out of autopilot and proving to yourself that you are capable of making change and that you are not a drone who must obey the urge to eat. I strongly recommend that one of your alternative behaviors be contemplation and journaling. It’s great to develop alternatives to eating, but even better to gain a more thorough understanding of WHY you feel the need to do anything at all.

One could make the argument that simply choosing an alternative to eating without becoming aware of why you need to do anything at all is just running away from your discomfort. For example, exercising instead of eating might be good for your health, but it doesn’t go any further in terms of helping you understand what’s causing your emotional upset and how to address it. I’m not suggesting that you need to make yourself miserable, but it is important that you learn what is creating your discomfort. It is also essential to learn that you can tolerate emotional discomfort which I discussed in my previous article on willpower.

Seeking professional help or group support is definitely worth consideration if you are struggling on your own. Whatever new strategies you employ, you must practice your strategies every day. Your emotional eating autopilot evolved over a series of years and is quite ingrained. New strategies are going to take a while to take hold and become second nature. Keep the log of your eating long after you think it’s necessary. Keep the sticky square notes around for awhile. It’s important to know that you are going to have setbacks when you resort to emotional eating. Every battle will not be a victory. When these setbacks occur, don’t “catastrophize.” As I said in a previous article, it’s important that you not categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything.

5. Evaluate. Did your choice of strategy help? Were you able to close the cabinet and go back to the couch without a snack? Were you able to diminish your emotional upset some other way with some effectiveness? These are the questions you need to ask to implement the new changes. It is very unlikely that you’ll find one strategy that works all the time. Calling a friend might help some times, while taking a walk might help at others. Keep track of which strategies are helpful and under which circumstances so you can develop a whole toolbox of ways to combat emotional eating and better take care of yourself.

Going Forward

Most of the people that I have known who seem to have won the battle with emotional eating will admit that they’re still fighting the fight even years later. Although their new habits are strong and the old pattern of emotional eating seems to be gone, they still show up from time to time. I think about all of the people who told me how well they were doing on their diets and on their eating behavior change plans prior to 9/11/01 who recalled the whole thing seeming to unwind overnight in the face of such an incredibly stressful event.

So many people tell me their goal is to be cured from the pull of emotional eating. They want the urges to eat in response to these negative feelings to stop occurring in the first place. While this is an understandable goal, it is not necessary one. If you really do your homework and learn new behaviors, learn to tolerate some discomfort and hopefully get at some of the other issues affecting your eating, through time, your new habits will become stronger and stronger and it will become far easier to resist the urge to eat. Even if the day when you no longer even consider eating never comes , it won’t need to. You’ll be able to handle it. Best wishes!

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Unraveling the Myth of Willpower

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Unraveling the myth of willpower

I’ve always despised the term “willpower” because it’s one of those words that seems to say something, but says nothing. Applied to weight loss or keeping weight off, willpower is always cited as something you must have to be successful. When patients struggle to lose weight, they tell me it’s because they have no willpower. Willpower is spoken of as if it is the secret weapon in the battle of the bulge but nobody seems to be able to define what willpower is or how to acquire it. What truly bothers me is that willpower is often explained as something intrinsic…that you either have it or you don’t. This is utter nonsense.
Anyone who has ever lost weight can recall at least one time when they thought “This is it! This is the time I’m really going to keep it off!” You felt as if you were in a groove. You turned away from cake and potato chips. You said no to second helpings. You were invincible! You even bought the smaller jeans to punctuate your accomplishment! But then there was a wedding, or a cruise or just a little, harmless piece of chocolate that you let yourself enjoy. Suddenly, your “willpower” seemed to be gone and you didn’t know how to get it back. Well that ends today. I have news for you. Successful weight losers do not have more willpower than you do. Unsuccessful dieters do not have less willpower than you do. The popular conception of willpower is nonsense. There is nothing magical about willpower. It is not something that you have one day and lose the next. I’m going to teach you how to make your own willpower. First, let’s expose the myth of willpower. Willpower found! When you lost all that weight way back when, it began with a conscious decision and a few key factors lined up in your favor. While it may seem that you suddenly had the willpower to start the diet and successfully begin to lose weight, what actually occurred was that emotion (motivation) and an awareness of the positive and negative consequences of weight loss were both in focus. Often by chance, the emotional energy to persevere is so strong that we tolerate hunger, frustration, cravings, etc. You might think that you were not feeling hunger, cravings, or frustration when you were losing the weight but in fact you were. They were simply dwarfed by the high level of emotion and motivation you had to tolerate them.
Willpower lost! Unfortunately, this initial emotional thrust eventually wears off if there’s nothing else to give it more fuel. When willpower seems to suddenly disappear what has happened is that the equation has shifted. Reasons to eat the chocolate and the desire to eat it are suddenly greater than the initial emotional thrust to tolerate this discomfort. At this point, you begin giving yourself permission to go off track. You find yourself in an environment where temptations seem greater than before. You tell yourself things that enable a setback. Willpower didn’t go anywhere. And as you well know, from that point on, it was only a matter of time until the weight returned. You probably remember that awful feeling of powerlessness that you couldn’t grab hold of the reigns and turn things around. Of course, there are also times where an overwhelming emotional event may occur that throws your motivation out the window. 9/11 was such an unfortunate example for many of my patients. Making your own willpower Whether it is losing weight, quitting smoking, or accomplishing any other endeavor, there are a few specific actions that successful people take that make them successful:

1) Create measurable goals and write them down. If you’re not willing to write them down then you’re not really serious about success. Keep reading your goals every day or they won’t stay in the front of your mind. If they’re not in the front of your mind, they’re in the back of your mind. If they’re in the back of your mind, they’re useless.

2) Motivate yourself to accomplish each goal. Ask yourself “What’s in it for me (WIIFM) to accomplish this goal?” Then ask yourself “What is the consequence of failing to accomplish this goal?” Identify short and long-term goals as well as short and long-term consequences. Don’t dance around this issue…be honest. There are real negative short-term consequences of dieting and keeping weight off. Hunger, feelings of deprivation and temporary emotional distress are a few. Fear of being without food as a comfort is another. Having a clear list of benefits that you will gain in the future in exchange for tolerating these negative consequences in the short-term can help you through these tough times. Ask yourself “What do I stand to gain, both now (within a few days) and in the future if I stick to my goal of losing weight.” This is the real definition of willpower: being able to tolerate frustration or discomfort in the present in exchange for a desirable outcome in the future. Perhaps a better phrase for willpower is discomfort tolerance or frustration tolerance. Take your time with this step. Remember, in order to have the ability to tolerate frustration and discomfort when they strike, you need to be acutely aware of “what’s in it for me?”

3) Make clear action steps that you plan to take to accomplish the goal. The goal itself is not as important as understanding the behavioral steps you plan to enact in order to accomplish them. Ask yourself “what am I going to do to accomplish my goal. Also ask, “What do I need to stop doing or do differently if I am to accomplish this goal. For example, don’t ask yourself “How am I going to find the time to exercise?” Ask yourself “How am I going to make the time to exercise.” Then take out your blackberry or schedule book and figure out exactly what you are going to shift around to create the time to exercise.

4) Practice your strategies. Ever notice that the best athletes practice almost EVERY DAY?! Batting practice, free throw practice, the driving range, and on and on. Practice is what makes people successful. It’s not willpower. In case you’re telling yourself that it’s the money, you’re mistaken. There are plenty of highly paid athletes that are bums. Our favorite athletes are generally the ones that practice the most. They try harder and give a little more than the “prima donnas.” We tend to like the players who are shorter, slower, injured, or who are older but simply refuse to give up. Its constant effort, and a refusal to quit, not talent that makes the difference.

5) Think like a winner. When a winner has a setback, they don’t pack it in. They start over. Don’t “catastrophize.” Don’t categorize everything into good or bad, pass or fail. Stop being critical and demeaning of your shortcomings and missteps. If you have a bad day at the Chinese buffet, it’s just one high-calorie meal. It doesn’t mean a thing…unless you tell yourself it does. If you tell yourself it’s a bad day, it becomes a bad day. Tell yourself that your Chinese meal ruined the weekend and you’ve ruined the weekend. Suddenly you’re telling yourself that Friday is a wash and that you might as well give yourself the weekend to have some fun promising that you’ll get back on track on Monday, only Monday never comes. How you think is everything.

There you have it…the mystery of willpower unraveled. The power to make real change and MAINTAIN real change is well within your grasp. You don’t suddenly get it and just as suddenly lose it. Make a commitment to your goals, write them down, document what’s in it for you, read your goals daily, diligently engage in behaviors that support each goal, think like a winner and you will be successful. I know that some of you are reading this and sighing, saying that it’s not so simple. It doesn’t have to be so complicated either. Take a bold step. Start writing some goals down right now and follow the steps I’ve outlined above before you log off. You have the power to change right at this very moment. No willpower required!

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Developing Discomfort Tolerance

(Something to try when you get hungry)

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One of the most common questions I am asked by patients prior to surgery is “What do I do if I want to eat something after surgery when I know I’m not hungry?” This question stems from anxiety regarding emotional eating and the possibility of weight regain. Many patients recall that these thoughts and feelings triggered relapse from previous efforts to lose weight. There is also the growing concern about what is being called “addiction transfer.” Patients are nervous that if their ability to eat is inhibited by the surgery or by efforts to avoid eating that this urge will somehow morph into some other maladaptive coping mechanism like consuming alcohol. Interestingly, despite much anectodotal discussion about “addiction transfer” there is not much clinical support for such a phenomenon. But the question remains…”What do I do if I want to eat after surgery and I know that I’m not hungry?”

Many patients tell me that they have tried at least one of hundreds of suggestions to cope with hunger…drink some water, go for a walk, eat something healthy, do a crossword puzzle, call a friend…and the list goes on and on. One suggestion that is seldom discussed is to do nothing at all, but rather to try and understand and tolerate the discomfort. Perhaps this sounds shocking to you. Our culture places such a premium on being comfortable that we seem to have lost the ability and the skills to tolerate discomfort. We have 26-way adjustable seats, televisions in every waiting room, drive-through pharmacies, and remote controls for every electronic device. Heaven forbid that we experience any inconvenience or discomfort! Where did we get the idea that we must be comfortable all the time? Why do we believe that we must deperately try to distract ourselves away from all sources of discomfort such as hunger or emotional distress by talking with friends, taking walks or doing crossword puzzles?

These activities of distraction, although not harmful, are a means of escape. By engaging in one of these activities we are essentially telling ourselves that “I can’t stand the discomfort of being hungry…I must find something to distract myself away from this absolutely intolerable feeling…danger, danger, danger!” It’s simply not true.

The next time you experience the urge to eat something when you’re not truly hungry, instead of engaging in an activity to escape from the discomfort, sit with it for a few minutes. Examine the feeling and ask yourself just how intolerable it is. Consider rating it on a 1-10 scale and ask yourself if you truly “can’t stand it!” Is it a mild discomfort or genuinely painful and intolerable? Try sitting in a chair and taking a few deep breaths over the course of two to three minutes and see if you can manage to reduce the anxiety and discomfort. Sounds crazy but at times it will most certainly work. By practicing this exercise and gaining some mastery and control over your response to the discomfort of hunger, you learn that you can actually tolerate the discomfort. Therefore, it is less likely that you will feel anxiety the next time the hunger occurs as you will know that you can “stand it” and that you don’t have to run away. This is how we develop discomfort tolerance and the ability to take care of ourselves despite the presence of discomfort. We try very hard to teach it to our children as we do not indulge all of their crying episodes and tantrums. We teach them to try and cope until the discomfort subsides. It is a great skill to learn to tolerate discomfort and ride it out until it subsides. Try it out!

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