Pray it Off 04/21/2011 Right-Sizing by Dr. Ran Anbar

In my experience: Right-sizing works better than losing weight

John Berry / The Post-Standard Dr. Ran Anbar has lost 70 pounds by modifying his diet and working out with Wii Fit in the basement of his Fayetteville home.

By Dr. Ran D. Anbar Guest columnist

How do we react when told we need to lose weight? "I know, but it's too hard," "I should do that sometime," or "I'm not that fat, and it won't hurt me."

And how do we react when our obesity leads to diabetes, hypertension, or heart disease? "I guess my luck ran out," or "Doctor, what can you do to fix the problem?"

All of these reactions have run through my mind at different times of my life. Finally, because of some wisdom gained through my work as a pediatrician, the time came when I learned to react differently, and to accomplish major weight reduction. Here's how:

My personal physician of nearly 15 years held a small green leaf in his hand. "Do you know what this means?"

I stared, bewildered. I looked at my wife sitting next to me. She shrugged. "It's time for you to turn over a new leaf," he announced, flipping the leaf.

Now I understood. My blood sugar was elevated, at 145 milligrams per deciliter. Many experts recommend it be less than 100 mg/dL. My cholesterol was elevated, at 273 mg/dL -- a normal range is below 200 mg/dL -- and I could not tolerate cholesterol-lowering drugs. At 237 pounds, I knew I was obese. My physician, a bright and caring professional, had previously talked to me about the high cholesterol that runs in my family, my weight and my risk of heart disease. Today he provided a diagnosis.

"You have type 2 diabetes," he explained. "In the old days we would tell you to go lose weight, and when you had your first heart attack 10 years later, we would begin treatment. But now we can take care of you immediately with medication.

"If you had surgery to staple your stomach and make it small, you would lose a significant amount of weight, and your diabetes would resolve. But you're not overweight enough to need such an operation. We can give you a sugar-lowering pill, but most of those have the side-effect of causing weight gain. That's why I'll probably prescribe injections."

Wait a minute, I thought. If weight loss can resolve my condition, why would I want to take a medication that would cause me to gain weight? Is that how medical "care" can lock patients into their diagnoses, by implying there is no alternative? Certainly, I did not want injections. So I decided that if weight loss would solve my issue, then I would lose weight. I would turn over a new leaf.

As part of my medical practice, I instruct patients in self-hypnosis. Through this work I have learned about the power of words and suggestions. Thus, rather than working to lose weight, I chose to "right-size." After all, we tend to miss something that has been lost. Instead, I focused on imagining my appearance after right-sizing.

My wife and I became hungrier by restricting our caloric intake, so we made hunger our friend. Since hunger starts with the letter "h," whenever we felt it, we told ourselves we were "happy" or "healthy." Many times, we discussed how we were very, very happy.

I guessed I would need to eat 1,000 fewer calories per day than I had been eating in order to become 60 pounds lighter. Then I came across a calorie calculator from the Mayo Clinic that showed me I needed to eat just 100 fewer calories per day, and I became convinced that right-sizing would be manageable. One hundred calories is found in a couple of cookies, a quarter of a piece of cake, or an 8-ounce soft drink. I felt I could make that kind of change easily.

I set a goal of eating approximately 400 calories per meal, and three snacks of approximately 100 calories each. In order to achieve rapid right-sizing, I chose a total of 1,500 calories per day, significantly below the 2,400 calories per day that I would need to maintain my target weight.

Over a number of weeks I learned to make smarter food choices:

1. I began eating more vegetables instead of bread and pasta when I realized, for example, that ¾ pound of cauliflower contains only 80 calories, which is the same as contained in one slice of bread.

2. I found that pickles curbed my appetite and contain almost no calories.

3. I learned that a "healthy" sandwich wrap (without the other ingredients) contained 150 to 250 calories, so I began to avoid them.

4 I began eating a lot of broiled or baked fish, because a serving typically contains fewer than 200 calories.

5. I discovered that most restaurants will make the caloric value of their foods available on request, which made it easier to pick healthy selections.

6. I learned that a chicken Caesar salad can contain 1,200 calories because of the dressing, and therefore I started asking that the dressing be served on the side.

7. It turned out that even Chinese restaurants would serve many of their dishes with gravy on the side. This allowed me to drizzle dressing or gravy on my food rather than it being soaked in calories. I found that food still tasted good even with a small amount of dressing.

Exercise, also an important part of right-sizing, is not sufficient on its own. During 10 years when I used a treadmill for 30 minutes a day, I remained overweight because I continued to eat too much.

I decided to purchase a Wii,
a gaming console that offers an exercise program called Wii Fit that would weigh me and graph my results. Thus, I was able to track my progress, which was very reinforcing. Also, it was helpful that my wife and I took monthly photographs of ourselves in order to track our progress visually.

Finally, I told several colleagues, friends, and family members that I was on a right-sizing mission, so they were able to encourage me.

My return appointment with my physician took place four weeks later -- and 25 pounds lighter. As I sat in the waiting room, I read a pamphlet from a pharmaceutical company full of good ideas regarding how to control type 2 diabetes. Nowhere did it suggest that diabetes can resolve with a concerted right-sizing effort.

My physician was impressed and asked how I had made such progress. I replied that I decided to take care of myself. He asked why I hadn't decided to lose weight when he had suggested it in the past. I replied I had not previously felt that my weight was responsible for my health problems. I was in a state of denial.

He said, "Well, if you keep this up you will be quite healthy."

"What do you mean 'if'?" I retorted. "I will be healthy 'when' I keep this up."

"That's hypnosis talk, isn't it?" he asked.

"Yes," I replied. "Instead of expressing doubt with an 'if,' you can express confidence and support with a 'when.'"

As my right-sizing continued, I felt energized and had more stamina. I received many compliments and was told that I appeared younger. Some people did not recognize me. People wanted to know what special diet I was using.

I was disheartened by some negative responses. "Are you sick?" was a common question. "Don't lose weight too quickly," and, "Don't become anorexic," were common reactions as well. I wish people realized how harmful such comments can be, because they implicitly suggest something might go very wrong.

After three months I had lost 35 pounds and was still in the "overweight" range, according to medical charts. Nonetheless, I started hearing comments such as, "Stop losing," or "You're too thin." I wondered whether the people making such comments were reflecting discomfort with their own weight. I thought, perhaps in America we are so used to obesity that we may view someone in the normal weight range as too thin. When I verbalized this idea, some people responded emphatically that the normal range was unrealistic. I recognized this as another example of denial.

After four months, at minus 45 pounds, my physician removed the diagnosis of diabetes from my records, since my fasting blood sugar had dropped to below 100 mg/dL. Amazingly, my total cholesterol also had dropped to160 mg/dL.

My physician was pleased and confessed, "I didn't believe you could lose so much weight. You must have amazing willpower." I thought to myself, is it possible that your patients don't right-size, in part, because you don't have an expectation that they can succeed?

When I reached my target weight after six months, some people asked if I was worried about maintaining it. "Of course not," I replied. "I have chosen to weigh this much, and I choose to remain this way."

I had the pleasure of replacing my wardrobe. My waist size decreased from 42 to 33 inches. I shrank into my 20-year-old wedding suit, and then shrank further out of it. My wife had never known me to be as thin as I had become. Much to my consternation I found I needed to replace my shirts as well, since they had become too big around my neck. Even my wedding ring became loose.

Looking at my most recent photographs I decided that I really liked this new leaf. In the past, I never cared about my appearance, which probably was another example of denial. Now I cared and was happy with what I saw.

--Dr. Ran Anbar is an associate professor of pediatrics and director of pediatric pulmonary medicine at Upstate Medical University and president of the American Society of Clinical Hypnosis.

PHOTO: John Berry The Post Standard Syracuse NY