Farrokh Alemi, Ph.D.
The Introduction to “A Thinking Person’s Weight Loss and Exercise Program”
There are many who wish to lose weight—and cannot. Some do not even try any more. A few fortunate individuals, however, seem to be able to pull this off with no effort at all. They never diet, yet they remain fit. They do not try hard but they succeed. One fills with wonder watching the lucky few. Is it possible that they owe their success to some genetic advantage? Certainly genes matter, but they are not the entire picture. Nor is it their intelligence or willpower. A close examination shows that it is their environment that matters most. The secret of their success is in the buildings, people, and routines that are around them. In other words, there is something in the way they have arranged their lives that makes them fit. This book is about how to organize your life—your environment—so that you can join the "lucky few."
What can we possibly say about weight loss and exercise that hasn't been said before? The advice on weight loss is simple—eat less and exercise more—and is repeated over and over in the ever-multiplying books on dieting and exercise. From calorie-counting diets to "Zone" diets to the Mediterranean diet, the basic advice is succinct and clear. So when it came for us to write a book on this subject, we asked ourselves if there was actually something new we could add. What is there to add to "eat less and exercise more"?
Here, then, is what sets this book apart from others: it focuses on how habits are formed and maintained. It focuses on willpower and one's ability to carry out resolutions. You should want to eat less and exercise more. You must know how to diet and what forms of exercise are safe. But knowing what you have to do and wanting to do it are not by themselves enough. People fail in their resolutions everyday. This book seizes on that part of the equation—willpower, specifically, sticking with your diet and exercise resolutions—rather than focusing on any specific diet. While many books have been written on diet and exercise, little is known about how to keep at it. Many people diet and as a result manage to lose 10 or 20 pounds—only to gain those back shortly afterwards. Others start exercise programs; they join gyms, for example—only to find a year later that they have hardly used the facilities they so enthusiastically joined. This book helps people stay with their resolutions.
When it comes to diet and exercise what really matters is staying with your plans for the long term. Most people think of willpower as some untapped reservoir inside their mind, a part of their personality—they either have it or they don't, it's their luck in life. Many talk of lack of willpower as a character flaw, a personality trait. But nothing can be further than the truth. Willpower is not part of you and it is not something you are born with. Everyone can have it—because it is something that can be manufactured, bottled, and sold. It is a commodity of which you can keep getting more. You can create willpower; it is crafted out of your daily routines. This book will show you how. It will give you the tools so that you can stay with your resolutions.
A recent survey shows that in the 1990s the proportion of Americans who are overweight reached 56 percent. In short, one in two people is heavy. The same survey showed that one in five was obese. These are amazing statistics, and they prove that overweight and obesity are more prevalent than ever.
Eating poorly and lack of exercise are leading to various diseases, including diabetes. The number of people with diabetes in the United States has nearly doubled in the last decade, rising from 9 million in 1991 to 15 million in 2001. Obesity raises the risk for diabetes by 10-fold for men and an astonishing 20-fold for women. Over a single decade we have gotten a lot fatter and sicker, despite the fact that during the same decade we have seen the growth of a weight loss industry, the introduction of low-fat foods, and a growing number of books on how to lose weight. Why is it that we are gaining weight at a time when we are doing our best to lose it?
It seems that the ordinary person is caught in a callous spiral of events. He is told to lose weight and exercise. He does his best and makes many valiant attempts. But invariably, year after year, he gains weight. As if he's under a curse, no matter what he does, whose advice he follows, which diet he participates in, which foods he eliminates, he gains weight. It reminds us of the tale of Sisyphus in Greek mythology. You will recall that Sisyphus was a cruel king condemned by the gods to push a boulder up a mountainside, only to watch it plummet to the bottom when he neared the top. Sisyphus was forced to flee downhill, dejected and feeble. Then he would have to start once again from the bottom, with the same result, repeated over and over. Just like they did to Sisyphus, it seems the gods are punishing us. They have condemned us to gain weight no matter what we do. We are trapped in a series of invariably futile and pathetic attempts, which only serve to depress us. This book aims to break through this hopeless cycle by giving you new tools that enable you to keep your resolutions. This book can help Sisyphus get to the top—and stay there. Our promise to you, therefore, is that you can lose weight and keep it off.
We are a group of scientists, who since 1990 have been talking twice a month with one another about personal improvement efforts. Duncan Neuhauser is an epidemiologist; David Aron, Ethel Smith, and Linda Headrick are medical doctors; Bill Fallon is a surgeon; Shirley Moore, Linda Norman, and Laura Benson are nurses; Nancy Tinsley is an administrator; and Farrokh Alemi is a system analyst. We form an interdisciplinary team of people bent on solving the puzzle of willpower. We have many different perspectives on weight loss but what unites us is the application of system analysis to personal problems, a process we call “system thinking.”
System analysis started with the examination of computers and their fit with business processes. You may ask what system analysis has to do with weight loss. A nurse’s or a physician’s role is understandable—after all, excessive weight gain leads to disease—but what does a system analyst contribute to weight loss? Plenty. As it turns out, weight loss and exercise are heavily influenced by our lifestyles, and the tools of system analysis can be used to understand how our environment affects and maintains our habits. System analysis is the core guiding principle of how we look at the environment and its link to diet and exercise.
We did not arrive at this thinking easily; in fact we were at first skeptical. Like most other people, we thought that changing habits would be a matter of personal motivation. When a person opens the refrigerator and eats a slice of cheesecake, it is difficult to imagine the role of the environment. But over time we came to realize the role of one's environment in putting the cheesecake there and in creating the conditions that lead to making the person hungry for it. Over time, we came to see beyond the motivation of the individual and thus were able to create an approach that helps people restructure their environments. When we tried to teach this approach to others, its effectiveness surprised us. Eighty-three percent of the people who were exposed to the approach succeeded in keeping their resolutions over a relatively long period (several months). The success of our approach led to our writing about it, and ultimately to this book.
Since those early days numerous people have succeeded by following our advice. In a later chapter, we report a summary of the experiences of nearly 200 people. We are scientists and we look for evidence for our claims. Our advice is based on data and the experiences of a large cohort of people.
Perhaps most interestingly, many participants have succeeded despite themselves. Later in this book you will read about the case of a person who reduced his junk food consumption by joining a car pool. You will read about a person who stayed trim by raising the height of her work table; she worked standing up. These people succeeded in weight loss without dieting and calorie counts. They succeeded with little effort. For the most part, they were not even aware that they were losing weight. The participant who joined a car pool and ended up reducing his junk food intake did not do so in a direct way. He just never needed junk food anymore. He seemed to have succeeded with little effort. Even when he would eat junk food on occasion, he never went back to his previous habit of eating it regularly. In this book you will read numerous such examples of people succeeding in ways that are counterintuitive. Few people who diet or exercise would think that tables' heights or car pools could stand in as methods of weight loss. But they are doing just that. Life is an interconnected set of decisions. Every decision could matter. We show you how to change certain aspects of your life and start losing weight. We show you how to lose weight not by increasing your motivation, which invariably will change over time, but by changing your environment so that weight loss and exercise become inevitable. If you have had enough motivation to read this book and make changes in your environment, you will succeed without us cajoling you to have unwavering commitment to weight loss or exercise.
An easy way to think of the advice in this book is to picture it in terms of exercising uphill versus downhill. If you are going downhill, bicycling is no effort at all. It is easy, fun, and inevitable. You have to do something only if you want to stop going downhill. In contrast, bicycling uphill is lots of sweat and frustration—quite hard. If you stop at any time, you are likely not to want to continue. You may even roll backwards. If you rely on your own motivation, weight loss is like bicycling uphill. It is hard and you have to put a lot of effort just to stay at your current weight.
In the first chapter of this book, we lay out our ideas and give you the various tools that you need. We provide you with simple tools, such as making a list, as well as complex graphical data analysis tools, such as control charts. Don’t worry, even the most sophisticated tools we provide are easy to use. We show you how to collect and analyze data to see if you are progressing toward your goals. We show you how to put together a team to help you. In short, we give you the requisite skills and then set you loose in analyzing your own life. Throughout, we ask you to think hard about how your environment (not your motivation) affects your behavior.
Smart people like you first understand their world before they plunge into changing it. If you have failed to keep your resolution, you must first understand why. What in your environment has worked against you? We help you move away from seeing your success and failure as a function of your motivation. Instead, we help you see the role of your environment in your behavior. We ask you to analyze each time you fail to keep your resolution with the objectivity of a scientist. To help you do this, we give you the tools of the scientist. Overall, the first chapter helps you think much harder about your life and how to change it.
In the second chapter, we examine the experiences of nearly 200 people to see if our claims are supported by how they fared. These data support the importance of system thinking in bringing about lasting change.
In the third chapter we return to the principle of system thinking. Most people see their success or failure in terms of motivation. It is hard to break away from this method of thinking. System thinking puts a bigger emphasis on your environment. The chapter shows you how all of your decisions are interrelated. How what you do at night and during work affects your eating. How what you shop for affects what you eat. How friendships and social patterns affect your diet and exercise.
In the fourth chapter we take a deeper look at getting others to help you. Of course, losing weight and exercising are personal tasks. You would not need others if all you needed was to be motivated. But when you have to change your environment—which affects not only you but also others—you do need help. But how do you ask for help, whom do you ask, and what do you do together? By answering these questions this chapter enables you to organize the team to help you achieve the goal.
In the fifth chapter we help you examine your life and find specific processes that could be linked to your weight and inactivity. We provide tools such as flowcharts and lists of periodic events to help you analyze your existing lifestyle.
In the sixth chapter we take a more in-depth look at how you could monitor your progress. We provide you with control charts for weight and length of exercise. We also show you how to examine patterns of missed days. Throughout the book we ask you to be a problem solver and to look at data to see why you fail or succeed. This chapter provides you with detailed instructions on how to analyze data.
In the seventh chapter, we report on the case of Mary, who wanted to lose weight through exercise. Most people advise you that to lose weight you need to diet. Mary wanted to lose weight without dieting. She was exercising, but not enough to make a difference. She had to do a lot more. What is striking about this example is how well she succeeded and for how long. In the end, exercise became the norm for her.
In the last chapter, we examine the ethics of self-help books as a category and address our concerns about how this particular book may cause harm. Self-help books have been criticized as promising results without providing evidence that such results can be accomplished by ordinary people without unrealistic expectations. We present data from nearly 200 people regarding effectiveness of our advice. Self help books have also been criticized for over indulgence. For example, everyone is concerned if an anorexic follows the advice here in order to loose more weight. The behavioral modification technologies in this book are very powerful, capable of changing our personal habits and lives as pervasively as the advent of the automobile. But this technology can be misused to lose weight to unhealthy levels. We must constantly be aware of, and headed for better health, not merely a fixed goal provided by marketers or the extremes of our own personality. Let us not forget that unbalanced by other concerns; the technology of cars can lead to disabling pollution, congestion, a tyranny of transportation options, and isolation. Unguided by human intelligence and awareness, all technologies are as capable of ill as well as good.
The potential of misuse of this behavioral technology is lessened by the fact that it promotes integration and linkages among people. Central to the power of process improvement is our own awareness of the connections among ourselves, our environment, and the people around us. It is our hope that this awareness and your thoughtfulness will keep this technology working for your health and not against it.
This is not just a book to read and set aside. Our hope is that you use it as a workbook, recording your progress on these pages, analyzing your set backs in various tables and forms provided. We include throughout the chapters as well as at the end of the book a number of worksheets as well as instructions on understanding graphs and using Web sites for personal improvements.
The promise of discipline and willpower is never to be taken lightly, and to say that you can—that pretty much anyone can—lose weight and exercise is an especially tall order. To say that you can do so with ease is an even bigger pledge. Can we keep our promise to you? This book has set out to accomplish a big step. We do not want you to work hard or be terribly motivated while you are accomplishing this big change, however. All we are asking of you is to be smart and focus on problem solving. If you promise to act objectively to understand the reasons you fail, we promise you that you will lose weight and keep it off.