How to Transform Your Relationship with Food for Lasting Weight Loss

How to Transform Your Relationship with Food for Lasting Weight Loss

Every year, millions of Americans embark on the same quest: to lose weight and get healthy. We want more energy, we want to feel better about ourselves, and we want to live life more fully. And we know that at the core of all these changes is one roadblock: deeply ingrained eating habits. We know we need to make changes—the question is how.

There’s no shortage of simple answers out there. But simple, quick-fix solutions—in the form of conventional diets—take people on roller coaster rides that do more harm than good, damaging both health and self-esteem. At Duke Integrative Medicine, we’ve developed a revolutionary approach to managing weight that offers real answers and leads to sustainable change.

Part I: Setting the Stage for Change

Picture this: A woman sits down at a table to eat, closing her eyes for a moment to take a long, deep breath. She’s hungry, but not stomach-growling, light-headed famished. On her plate are sautéed Swiss chard, roasted winter squash, wild salmon with ginger, and a salad. She takes a moment to consider all it took to create this moment, from the farmers who grew the vegetables to herself for making time to shop for the groceries and thoughtfully prepare the meal, and feels grateful. 

She eats slowly, savoring the earthy flavor of the greens, the salad’s tangy crunch, and the creamy sweetness of the squash. She pauses to put her fork down between bites, sips a mug of green tea, and checks in with her body. When she senses that she’s had enough food—feeling satisfied but nowhere near stuffed—she stops. 

That’s lovely, you might be thinking, but that’s not real life. Real-life eating is often the polar opposite of the scene above. In real life, you’re trying to get a frozen pizza in the oven with one child pulling at your leg and the other needing help with homework. Or you’re alone, and who wants to go to the trouble of slicing vegetables when ordering Chinese takeout is so easy? In real life, “breakfast” was coffee on the way to work, the staff meeting starts in five minutes, and the bag of Doritos on your desk is looking good. 

In real life, you aren’t hungry, but not eating your mother-in-law’s chicken potpie feels rude, so you stuff it down. In real life, talking to your criticalolder sister triggers a Pavlovian response for dulce de leche ice cream. In real life, you blew your diet last night at your best friend’s birthday bash, so all bets are off, and the fluorescent Taco Bell sign up the road is beckoning like a siren.

In real life, you ordered a veggie sub for lunch and it’s a foot long, and while you didn’t ask for potato chips, here they are. In real life, chocolate is the most reliable, consistent pleasure you know. In real life, every diet you’ve tried has left you feeling two things: hungry and unhappy. You can probably think of a dozen other examples of how real life seems to undermine your desire to be a healthy eater. What seems on one level like a simple, straightforward act—nourishing our bodie —is often complicated by forces that feel beyond our control.

The New Status Quo: Mindless, Automatic Eating

It’s normal to eat too much, eat too quickly, eat for comfort, or choose unhealthy food on occasion. But for increasing numbers of people, these habits are not the exception; they’re the norm. There are many reasons this is so, which we’ll explore, but the underlying reality is that we often engage in the incredibly important act of nourishing our bodies without fully recognizing what we’re doing, and this has serious consequences. Consider the common habit of eating while doing other things whether that’s driving, checking email, walking through the grocery store, or watching TV. 

Research shows that when people eat while they’re distracted or multitasking, they eat faster, eat a bigger portion, don’t remember what they consumed, feel significantly less full, and continue to eat more throughout the day. In this book, we refer to unconscious eating—driven by habit and convenience rather than our wisest selves—as mindless eating. Does that mean you sleepwalk to the kitchen and wake up with the taste of French fries or chocolate cake in your mouth, remembering nothing? No, though for some people, eating feels like that. 

For most of us, though, eating is often what psychologists call an automatic behavior, akin to walking or driving (once we’ve learned those skills). Automatic behaviors are activities that have become so second nature to us that we do them on autopilot, without paying full attention and often while doing other things.

Our Food Culture: Fast, Cheap, and Out of Control

We all know the cliché that we’re products of our environment, and numerous studies over the past decade have shown how true this is for eating in particular. Research shows that human beings tend to eat food we see that’s within reach, regardless of our level of hunger or how the food truly tastes. And oh, the food we see! Our surroundings are filled with food or images of food—our refrigerators, that candy bowl at work, billboards and food stands on the streets we drive and walk down, cooking shows, food blogs. 

The quantity that bombards us is unprecedented, and our brains were not designed to resist it. In fact, seeing food makes our brain secrete chemicals that cause cravings, even if our bodies aren’t truly hungry.

What the Science Says: What You See Is What You Eat

A Cornell University study compared people who had a clear bowl containing candy on their desk with people who had a white bowl. The candy in the clear bowl was visible; the candy in the white bowl was not. People with a clear candy bowl ate 71 percent more candy than those with a white bowl.

As animals whose primary sense is visual, human beings have a physiological response to seeing food or pictures of food. Neurochemically, we anticipate eating it, and our brains start secreting chemicals that cause cravings and can lead to overeating. In addition, people who are obese tend to be more vulnerable to visual cues than normal-weight people.

Part II: Building Your Foundation

We all wish for positive change to come sweeping in like the wind, transforming us overnight. That’s part of the diet fantasy: presto, change-o, you’re different! But as with everything else in life, wishing doesn’t make it so. Gaining insight into the internal and external forces that shape your eating habits and developing intrinsic motivation—in part by connecting to your values—are essential. But actually changing your behavior can remain discouragingly difficult—not because you’re inherently lazy or self-destructive, but because eating is an automatic behavior you’ve been doing for decades.

In recent years, scientists have zeroed in on the neuroscience that creates habits and holds them in place. Doing an activity a certain way, again and again over time, gradually creates neural pathways in the brain so that the behavior becomes automatic, something we do without thinking. This process, known as procedural learning, occurs for mundane activities that most of us learn as children, such as brushing our teeth and tying our shoes, and it can occur for eating habits that we’ve come to follow almost automatically, whether they’re healthy or unhealthy. 

It’s helpful to think of any learned behavior that gets wired into our brains as a packaged response. Some packaged responses involve sections of the brain called reward centers, making them even more tenaciousand complex. Smoking, gambling, drinking alcohol, and eating high-sugarcontent or high-fat-content foods fall into this category. 

To understand how packaged responses work, let’s look at a common one that most of us can remember learning: driving. If you learned as a teenager, you probably still remember those herky-jerky first attempts that took all of your attention and focus, along with the look of thinly veiled terror on the face of your mom, dad, older sibling, or driving instructor sitting in the passenger seat.

But over time, the separate, specialized skills that driving requires—steering, accelerating or braking, shifting gears—gradually merged into a smooth, cohesive whole. Driving became automatic, something that you do without thinking much about. After years of experience, it’s now a packaged response. Now imagine that tomorrow, someone instructs you to drive in a whole new way: to brake with your left foot (instead of your right foot) and steer with your knees (instead of your hands). And then you get in the car and struggle to follow those instructions, eventually reverting to the way you’ve been driving for years. 

Why? Driving means something very specific to your body and your brain—it’s wired in your nervous system, and it can’t be rewired through sheer force of will. But it can be relearned differently. Like driving, eating habits, over time, get stored in our brains as packaged responses. From a health perspective, popping open a Coke every night when you get home or popping chips into your mouth while finishing projects at work are habits worth changing. But on a neurological level, following eating habits such as those are simply what your brain and body know how to do.

Packaged responses that involve eating are more complex than driving or tying your shoes, in that they involve many more chemicals—peptides, hormones, and neurotransmitters—throughout the body. Perhaps more important, whatever associations you learned between eating and emotions may also be packaged together: reaching for carbohydrates when you’re upset, for instance, is a common packaged response. These packaged responses are often automatic, entrenched, and encoded into our brain physiology. 

These associations likely helped you cope in some way in the past. If done too often, though, the costs outweigh the benefits, and it might be time to build new associations.

Part III: Eating for Total Health

Awareness and intention lie at the heart of lasting change. By now you’ve begun the process of recognizing your deeply ingrained eating patterns and building new ones. You’ve been learning to pay attention to why you eat and how you eat, to understand your internal and external triggers, and to listen to what’s happening in your body and your mind. You’ve learned how to recognize the diet mentality and use the power of mindfulness to slow down your automatic behaviors and make different, healthier choices. 

And you’ve learned to connect the dots between what’s happening in your life—your mood and stress levels in particular—and what and how much you end up eating. The skills and wisdom you’ve gained are your foundation for lasting change. Now it’s time to start building a way of eating that truly supports your health. 

That means, in addition to knowing when to eat, knowing what to eat. You might think it’s obvious or that it will take care of itself—just eat the healthy stuff! But in today’s world, eating a healthy diet takes knowledge, planning, and most important, intention. What has become the “default” diet in this country, the food that surrounds us and is easily accessed, gets people in serious trouble with their weight and their health. 

Food is powerful. Research confirms that the impact of our diet on our health goes far beyond a simplistic “calories-in-versus-calories-out” equation or gettingsufficient vitamins and minerals. In fact, your body is a biochemical environment that is deeply affected by what you eat and drink. Your body knows the difference between a handful of nuts and a candy bar, or between a homemade vegetable stir-fry and a frozen pizza. How? The compounds we take in—whether the antioxidants in blueberries or the preservatives in a Dorito—ultimately wash over our DNA and influence gene expression. 

A thousand calories of blueberries sends much different signals than a thousand calories of Doritos. Over time, what you eat and drink either supports or distorts the healthy functioning of your body. The chemistry is complicated, but what it boils down to is simple: Everything you put in your body matters.

Processed, fried, and high-sugar foods have become the status quo diet for adults, teenagers, and even children. This combination of unhealthy foods, known as the standard American diet (SAD), not only leads to weight gain but also sends the wrong signals to our DNA. Over time, this affects the proper functioning of all our body’s systems. From a public-health perspective, the SAD is a disaster that’s led to epidemic rates of obesity, prediabetes and diabetes, heart disease, and certain types of cancer. In short, our cultural diet plays a major role in the chronic, life-threatening conditions that affect about half of American adults—SAD indeed.

The good news is that the eating principles we teach have an equal and opposite effect on your body: they build your health and vitality from your cells on up and naturally guide you toward a healthy weight. Following those principles does not mean you have to eat perfectly all the time or that there’s no place for convenience or indulgence. Rather, it means that the majority of what passes through your lips should be foods and beverages that support your health. The result? Your odds for excellent health and a healthy weight skyrocket.

The Status Quo Diet: How Did We Get Here?

Just a few hundred years ago, most people subsisted on vegetables and fruits, whole grains, legumes, fish, and sometimes meat. But as the agriculture and food industries began to expand to accommodate a changing, more mobile society, a glut of far less wholesome foods started to work their way into the American diet. Manufacturers found that if they removed certain parts of foods and added other ingredients, such as preservatives, foods could be shipped greater distances with less spoilage.

As our culture shifted and processed food became widely available, our taste preferences shifted. We got turned on to refined sugar, refined oils, and refined grains as corner markets morphed into supermarkets, then into big-box stores. Meat emerged as a mainstay, and industrial farms began feeding their animals more cost-efficient grains instead of their traditional grasses and adding growth hormones to boost production and profits. Fast food became a cultural staple, as did processed foods devoid of nutrients but crammed with salt, sugar, and synthetic chemicals.

Today, most of the calories Americans consume each day come from refined grains, added sugars, vegetable oils, and solid fats—much of it in the form of foods that did not exist one hundred years ago. Consider sugar: whereas our ancestors ate very little refined sugar—about twenty teaspoons a year by some estimates—today Americans consume on average more than twenty-two teaspoons a day, much of it in the form of a highly processed variety called highfructose corn syrup. 

Besides the calorie burden and the harmful effects of these foods, they’re taking the place of foods that are essential to the proper functioning of our bodies—nutrient-rich foods like fruits and vegetables, which help us age well and reduce our risk of disease. Less than 25 percent of adults report eating five or more servings of fruits and vegetables per day.

America’s Top 10

According to the USDA, the leading sources of calories for adults in the United States are as follows:

Grain-based desserts
Chicken and chicken dishes
Sodas and energy beverages
Alcoholic beverages
Tortillas, burritos, and tacos
Pasta and pasta dishes
Beef and beef dishes
Dairy desserts

Conclusion: Making Change Last

At the end of our programs at Duke Integrative Medicine, participants are sometimes hit with apprehension. Will this approach really be different from the others I’ve tried? What’s this going to mean for my day-to-day life? Will I stick with the practices when things get stressful? Is lasting change really possible? Integrating behavior changes into our lives—with the people in our lives—is not always a smooth process. 

It’s important to acknowledge that making changes to your eating habits, even small ones, is a big deal, not only because of the internal work it requires but also because it often means rocking the boat. Eating based on your internal signals instead of the clock, eating slowly, shifting to a plant-based diet—every one of these health-promoting changes means going against the grain of our society’s eating culture and perhaps against your own social culture as well.

Practicing mindful eating will often mean being different—in your home, at work, and at a restaurant. It might mean saying no to the chocolate cream pie that your aunt made because it’s always been your favorite, or asking for a sliver instead of the big slice she just served you. It might mean bringing your own lunch to an all-day work conference when all your coworkers choose pizza, or asking for sparkling water instead of wine at a party. It might mean asking a waiter for something that’s not on the menu at a restaurant, like steamed or roasted vegetables. 

On a given occasion, you might decide to go with the flow or follow the path of least resistance. Guidelines (as opposed to rules) allow for that. But you’ll find that if you “bend” your guidelines every time it’s easier to do so, you’ll be bending them all the time. Better to prepare yourself for the discomfort of taking a stand and doing something different.

You now know how to take care of yourself. You know that means behaving in such a way that you meet your true needs instead of your immediate desires, cravings, and reactions. We’ll all continue to be barraged by the presence of unhealthy foods and the constant messages, overt and subtle, that we’re not good enough, that we need to be better—usually with the help of a product someone is selling, be it diet soda, a gym membership, a bikini, or a new car.

That’s a big part of why simply figuring out what’s really going on, in our environments and within us, requires the process you’ve learned here, starting with slowing down and tuning in to yourself with curiosity and compassion. 

And you know now that the more you care about yourself, the more you start expecting from your food: Is this food worthy of me? Is the reason I’m eating, and the way I’m eating, worthy? Do my choices align with my values and support my health? With practice and intention, you can move toward a place when the answer to those questions—not all of the time, but most of the time—is a resounding yes.

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