Of all the health concerns I come across in my practice, weight issues may be the most pervasive. It's not that the majority of my patients are overweight; some are, some aren't. But very few have a healthy, easy relationship with food and their bodies.

There may be nothing more fraught with complexity for women than their weight -- both real and perceived. On one end of the spectrum, we have the obesity epidemic and its real, alarming health risks; on the other, the equally damaging cult of skinny. Many women find themselves on one end of the spectrum or the other, but even those in the middle often have an uneasy feeling about what they see on the scale.

Women's reproductive phases -- PMS, pregnancy, menopause -- affect our metabolism, so our weight is inherently more dynamic than that of men. This presents a challenge, both in maintaining stability, and in accepting our bodies' natural highs and lows.

Of course, weight issues aren't all about hormones. The roots of this phenomenon are, not surprisingly, multidimensional. In the here and now, there's the "super-size" mentality, which has had an enormous impact on what we, as a culture, perceive as normal. And it's not just the obvious stuff -- french fries and snow cones -- that comes super-sized; upscale restaurants serve vast portions, too. Our upbringing also wields enormous influence. Working with patients over the years, I've seen that those whose parents eat nutritious foods and exercise regularly are far more likely to maintain those habits as adults. Values, too, can be hereditary. One of my patients who overeats was raised by Depression-era parents who placed stock in the "clean-plate club." Another patient's father weighed her every night before bedtime; needless to say, she has an obsessive relationship with food and the scale.

Despite challenges like these, you can always cultivate a healthier approach to your weight for the simple reason that the impact of culture and the habits you grew up with are ultimately determined by you. By bringing these underlying dynamics to light, you make them conscious. And by becoming more conscious, you reclaim your power to rewire old habits and make healthier choices.

When I work with women on weight issues, I often employ a less-than-weighty metaphor: Inside each of us is a gremlin -- a mischievous creature who delights in undermining our efforts at what we say we want to do, whether it's losing weight or sticking to an exercise routine. It's the gremlin who sees a platterful of nachos and whispers "Eat it!" and who will choose the couch and TV over the treadmill or hiking trail every time. The gremlin is always on the lookout for partners in crime, from bags of Cheez-Its to billboards that splash images of waif-like or impossibly toned bodies.

The gremlin's real "fuel," however, comes from within. Unhealthy behaviors, including eating habits, often function to help satiate emotional needs, that aren't being met. Disempowering the gremlin requires an exploration of those needs. When you begin to understand why you keep eating, when you're full, for example, you can address the underlying emotional issues directly. Then, almost incidentally, the unhealthy relationship you had with food or with your weight will correct itself.

Here's how to begin.

Step 1: Reflect

Take a few minutes to think about how and when you eat. Do you usually eat when you're hungry? How often do you eat for other reasons, such as fatigue, stress, loneliness, or anger? Then reflect on whether you usually stop eating because you're nearing fullness or for other reasons -- perhaps because the plate is empty, you feel happier, or your stomach is aching. Next consider your relationship to exercise. Does the thought of it make you cringe? Think about the type of physical activity you really love and when you last did it regularly.

Now think about your weight. Are you conscious of your current weight and your target weight? How do you feel in your body? Notice how you respond emotionally to these questions. Remember a time in your life when you were at your healthiest weight. Recall that time and how you felt. Think about the circumstances in your life then -- your work life, relationships, activity level, and lifestyle -- and what's different now.

Step 2: Observe + Act

Take at least a week and, trying not to alter your behavior, simply notice your relationship with food and with your body. Write down your thoughts in a journal. After this period of observation, experiment with a more conscious relationship with your weight and habits. First, calculate your current body mass index, or BMI, a measure of weight for height (see Think about your ideal weight, making sure that it falls within a BMI of 18.5 and 24.9. (If you have a history of an eating disorder, talk with your physician or an objective friend about whether your target is reasonable.) Rather than making a timeline for attaining this weight, simply be conscious of your goal.

After a week, start practicing mindful eating. Before reaching for food, check in with yourself. Are you hungry? If not, identify what you're feeling and try to address it directly. Your goal should be to eat when you're hungry (a 7 or 8 on a scale of 1 to 10). When you do eat, tune in to the smell, taste, and texture of your food. Be conscious of how satiated you feel, and stop when you're almost full.

Learning healthier ways of addressing your underlying needs -- whether through asking for support from friends, communicating more effectively, or making a change in your career or relationships -- has benefits that go beyond your waistline. Consciousness begets consciousness. When you have fewer buried emotional or physical issues driving your eating, you'll find that it's enormously easier to maintain a balanced weight, and you'll see healthier patterns in the rest of your life, too. And when you experience how good it feels to be healthy and conscious, inside and out, you'll be motivated to stay there.

Find Your Perfect Weight

My colleague Ruth Quillian-Wolever, Ph.D., a clinical health psychologist and the clinic director at Duke Integrative Medicine, recommends several take-home points for attaining -- and maintaining -- a healthy weight. The suggestions below are adapted from her recommendations.

Ditch the diets.

Conscious eating is a lifestyle change and, consequently, a long-term solution to achieving a healthy weight.

Keep what you love.

Depriving yourself of your favorite foods can backfire. Instead, allow yourself indulgences, but remember that they're treats, not snacks. If one of your treats is alcohol, note that one recent study showed that when people drink wine with a meal, they tend to increase their food calories.

Learn to trust your body.

When you really start paying attention, you'll begin to recognize the true signs of physical hunger and come to distinguish these signals from emotionally driven needs.

Move more.

Increase your overall physical activity in addition to exercise. If you work in an office, get up from your computer at least every half hour; whenever you can walk rather than drive, do so; and if you watch television, make it a more active experience by doing shoulder, neck, and ankle rolls.

Soothe your sweet tooth.

If sweet cravings are a big issue for you, increase your intake of protein and "good fats" (from fish, nuts, olive oil, and flaxseed). This can help decrease your dependence on sugar and refined carbs.

Pay attention.

Notice how you feel -- physically and emotionally -- when you're more active and eating more consciously. Pay attention to the subtle shifts that come from early changes in your weight and/or activity level, and appreciate those sensations. Do you have more energy? Do you feel stronger? This will create a momentum that helps you sustain these new patterns.

Text by

Dr. Tracy Gaudet

Comments (1)

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