GET OUT OF THE DIET MINDSET: When we’re on a strict diet and eat something that’s not technically an approved food, we call it “cheating.” Get that word out of your system; all it does is make us feel terrible about ourselves and to continue eating poorly, feeling that we’ve already ruined the diet so why bother anymore? A healthier mindset allows for treats on occasion because you live a healthy lifestyle most of the time. Balance is a much better approach to wellness than restricting a particular food entirely.
So many of us have tried dieting. All too often though, many of us lose 10–20 pounds, but we end up gaining it back. Not only is yo-yo dieting unhealthy, it is also demoralizing and makes us feel like giving up. What exactly do we have to do to achieve a healthy body weight and to stick with it forever?
In this interview series called “5 Things You Need To Do To Achieve A Healthy Body Weight And Keep It Permanently” we are interviewing health and wellness professionals who can share lessons from their research and experience about how to do this.
As a part of this series, I had the pleasure of interviewingDr. Lori Fishman.
Dr. Lori Fishman is a child psychologist and parenting consultant, specializing in pediatric weight management. She has served as an attending psychologist in the Optimal Wellness for Life Program at Boston Children’s Hospital and as Instructor of Psychiatry at Harvard Medical School for over a decade. She is the founder of Past, Parent & Future, an online training program for parents concerned about their children’s weight: www.pastparentfuture.com
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
From a very young age, I knew that I wanted to be a psychologist; I’ve been fascinated by human behavior and the intricacies of the mind for as long as I can remember. I grew up in Northern New Jersey and received my undergraduate degree from Brandeis University in 2002. I deeply enjoyed the variety of a liberal arts education and the opportunity to take classes like musical theater, women’s studies and International business.
What or who inspired you to pursue your career? We’d love to hear the story.
My specialty in pediatric weight management stems from my ownstruggles with health during my youth. Options for supporting overweight children were limited in the ’80s, as the focus was primarily on adult diet programs, and I never felt I had the appropriate resources to make changes. So when I began my graduate studies at William James College, I found myself intensely drawn to their Health Psychology specialty track; the study of behavioral processes in health, illness, and healthcare. Fortunately, this allowed me to train in pediatric hospital settings while I obtained my doctoral degree.
None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?
It was a team effort! A mixture of friends, family, and professional mentors at multiple stops along the way. It’s very hard to pick just one but if I had to, it would be Dr. Cori Liptak, who served as my hospital supervisor for three years early in my career. She gave me confidence as a new provider when I was just starting to find my path. Her relentless positivity — and her support and guidance with regards to my work/life balance — helped me understand the importance of finding the right equilibrium to maximize my time and help people in the most effective way possible.
Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
Well, I knew from the outset that I wanted to work in a pediatric weight clinic but it’s a field with very few programs and options, meaning I had limited choices to pursue this specialty. So early on, I fixated on landing a position in the Optimal Wellness for Life Program at Boston Children’s Hospital. I quickly discovered that the psychologist currently working in the program was an alum from my graduate school.
Jumping on this fortuitous coincidence, I asked her if I could buy her a coffee and chat about the department and the folks who worked there. She said yes and I arrived at the hospital cafeteria excited and eager to listen…only to realize that I’d forgotten my wallet! I was beyond mortified, of course, but she laughed it off and kindly offered to buy the coffee. We had a lovely time discussing life at Children’s. Then, one year later, I received an email from her saying a position was coming open in the program and that she’d love for me to come interview. I ended up working there for 12 years!
This wound up being a great lesson in the incalculable value that networking brings. You truly never know when a connection might unlock a new opportunity in your life. Since then, I’ve made it a priority to always support others in my network as best as possible.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
My favorite quote is: “You’re always one decision away from a totally different life”. It hits me on both professional and personal levels; as a clinician, I frequently talk about the value of doing just one small thing each day. Changing behaviors and vices is hard! I, too, often get caught up in that all-or-nothing mentality where it feels like if I can’t do 100%, it’s not worth it and I shouldn’t bother doing it at all. Which, of course, isn’t true. This quote always reminds me how seemingly small choices in a moment can add up to significant gains over time.
What are some of the most interesting or exciting projects you are working on now? How do you think they might help people?
The COVID-19 pandemic opened my eyes to a whole new world of possibility within the online service sectors. I recently launched an educational website, www.pastparentfuture.com, which provides the same services that parents receive from me at the hospital but in a quick, universally accessible virtual format. It’s my sincere hope that this will help parents who simply can’t feasibly go to a hospital-based obesity or weight-management program get the resources they need to help their children at a fraction of the cost and inconvenience.
For the benefit of our readers, can you briefly let us know why you are an authority in the fitness and wellness field?
I have been an Attending Psychologist in a weight management program at Boston Children’s Hospital since 2008, and I’ve worked with thousands of children and their parents, using evidence-based behavioral approaches to help them achieve a healthy weight and lifestyle.
OK, thank you for all of that. Let’s now shift to the main focus of our interview about achieving a healthy body weight. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define a “Healthy Body Weight”?
There’s a lot of disagreement in the field regarding whether BMI (or other similar charts) is really an accurate measurement of a healthy body weight. Personally, I think that’s the wrong question to ask and I’d advise people to think about lifestyle as equal to, if not more important than, a number on a scale. For example, what if we looked at two different women who both had the exact same BMI…but one of them exercises regularly and eats healthy, while the other doesn’t exercise, smokes cigarettes, eats excessive amounts of sugar and drinks a ton of alcohol; does their BMI really matter at that point? What if the person making healthier choices was 20 pounds heavier? Is that a true indicator of their health? There are much better metrics than the scale to determine well-being for people deemed “overweight” by the masses; a few examples would be blood tests for insulin resistance, cholesterol levels and markers for fatty liver.
How can an individual learn what is a healthy body weight for them? How can we discern what is “too overweight” or what is “too underweight”?
Simple — focus on other markers and metrics as I mentioned above. If you have high cholesterol and insulin resistance, you’ll need to make some behavioral changes to resolve those, such as exercising regularly and cutting back on high glycemic foods and beverages. Subsequently, you’ll likely lose weight…but you’ll be coming at it from the significantly healthier and more important perspective of reducing those aforementioned other health risks.
And then, of course, there’s the psychological factor — many people struggle with body dysmorphia, which is an obsessive thought that there’s something seriously wrong with one’s body even if it’s not real or how other people see you in the slightest. Unfortunately, some people simply feel too heavy or too thin regardless of what the scale says or how they actually look. That’s why repositioning how we talk about weight and our bodies is so important.
This might be intuitive to you, but it will be instructive to expressly articulate this. Can you please share a few reasons why being over your healthy body weight, or under your healthy body weight, can be harmful to your health?
People with obesity are at increased risk for severe medical issues such as high blood pressure, high cholesterol, Type 2 diabetes and heart disease. But this seems like the perfect time to reiterate that lifestyle changes can and do make a difference here! Just being overweight isn’t in-and-of-itself a precursor for these issues, but many people who struggle with their weight also don’t exercise enough, or they regularly eat overly sugary foods. But this isn’t true for all people, as I mentioned earlier — and whether you’re overweight or underweight, you’ll be putting yourself in a better position to avoid major health problems if you change your eating patterns and ramp up your physical activity.
In contrast, can you help articulate a few examples of how a person who achieves and maintains a healthy body weight will feel better and perform better in many areas of life?
Well, for one, eating healthfully and regularly staying active generally leads to increased immunity — something we can all use right about now. So if you get a cold or a virus, you may be more likely to have a shortened or less severe course of illness. Additionally, exercise has been shown to improve mental health and reduce stress and anxiety, and a healthier diet generally leads to increased energy and productivity.
Ok, fantastic. Here is the main question of our discussion. Can you please share your “5 Things You Need To Do To Achieve a Healthy Body Weight And Keep It Permanently?”. If you can, please share a story or an example for each.
- EAT ALL MEALS AND SNACKS AT A TABLE, ON A PLATE AND WITHOUT SCREENS PRESENT:
When we eat standing up or while we’re on our phones, our body doesn’t recognize that we’re eating and we tend to overeat or not feel full when we actually are. When we eat mindfully and pay attention to our food, we feel much more satisfied with our snack or meal. So if you’re hungry, ask yourself if you’re willing to stop what you’re doing, put your food on a plate and eat at a table without your phone. If the answer is no and you’d planned to eat standing up, right out of a bag or box or on the couch (or the bedroom), don’t do it. You’ll thank yourself later. (Bonus tip — try not to eat in the car if it can be avoided.)
2. GET OUT OF THE DIET MINDSET:
When we’re on a strict diet and eat something that’s not technically an approved food, we call it “cheating.” Get that word out of your system; all it does is make us feel terrible about ourselves and to continue eating poorly, feeling that we’ve already ruined the diet so why bother anymore? A healthier mindset allows for treats on occasion because you live a healthy lifestyle most of the time. Balance is a much better approach to wellness than restricting a particular food entirely.
3. AVOID KEEPING TRIGGERS IN THE HOME:
If you pick up a box of cookies at the grocery store and find yourself thinking, “If I buy these, they’ll disappear in five minutes,” do not buy them. Avoid keeping foods in the home that make it challenging to control portion sizes in the way you’d like to. For instance, it’s much better to have one ice cream cone when you’re out on a walk than to have a gallon of ice cream waiting in your freezer for whenever the craving strikes you.
4. SET AN EXPECTATION AND SCHEDULE FOR EXERCISE:
If you make movement part of your daily routine — i.e. scheduling it like it’s a work meeting or an important appointment — you’re much more likely to prioritize it and ultimately get it done. Exercise classes and sports are excellent options for this, as they’re fun and social while easily fitting into a specific time slot that forces you to plan around it. (Also, try to avoid leisurely/mindless screen time until the physical activity has been completed.)
5. MAKE HEALTHY CHANGES AS A FAMILY:
Adults who properly model healthy behavior and set achievable goals as a family are more likely to have kids who grow up with healthy habits. Your children will struggle a lot less later on if they learn these habits now. Plus, working together as a team makes it so much easier to make lifestyle changes! Even if you live alone, it’s helpful to find a buddy — or even an online support group — to help you achieve the lifestyle changes you want. Accountability partners are really valuable and can help you fight through the inevitable ups and downs.
The emphasis of this series is how to maintain an ideal weight for the long term, and how to avoid yo-yo dieting. Specifically, how does a person who loses weight maintain that permanently and sustainably?
The only way to avoid yo-yo dieting is to stop dieting. Instead, make sustainable changes to your habits and mindset and stick to them for extended periods. If diets worked as people sometimes think they do, we’d only have to go on one diet in our lifetime to reach our goals and that would be the end of it.
It’s important to focus on changes that are both achievable and realistic. Daily movement, limiting high-glycemic food and sugary beverages most of the time, eating mindfully…these things will have a huge impact on your health and overall well-being. Will you lose 10 pounds in a week? Probably not. But the gains that you make will last and you’ll have implemented a new way of thinking about your health that will lead you to a much better physical and mental place as your mindset adjusts to your new normal.
What are a few of the most common mistakes you have seen people make when they try to lose weight? What errors cause people to just snap back to their old unhealthy selves? What can they do to avoid those mistakes?
Focusing on the short-term. People frequently make dramatic changes that might lead to initial success (maybe even losing five pounds the first week), but that’s an overly restrictive approach that’s simply not sustainable for the long haul. Because much more often than not, these people quickly find themselves starving and miserable and not losing weight as fast as they want before going off the wagon, “cheating” as mentioned above (ditch the word!) and ultimately give up entirely. Or, perhaps, old habits slowly creep back into their norms because they tried to change everything at once instead of patiently making adjustments that can be long-lasting and improve their physical and mental health the right way.
Also, an over-reliance on the scale tends to derail people quickly. For example, suppose you do really well on your eating and exercise plan for the week, hop on the scale with high expectations and find that you GAINED weight. What might happen? Well, you’ll probably feel that your efforts weren’t worth it and subsequently give up entirely…when in reality, you may just be retaining water or weighing yourself at a time when you’re naturally heavier. Sustainable fat loss just doesn’t occur as rapidly as we’d like, and we need to be okay with that!
(Alternatively, some people reward themselves when losing a pound; like, “Hey, I lost a pound! NOW I can have that ice cream!”). That mentality both takes you off track and puts an emotional reward context on food that can lead to emotional eating.)
How do we take all this information and integrate it into our actual lives? The truth is that we all know that it’s important to eat more vegetables, eat less sugar, etc. But while we know it intellectually, it’s difficult to put it into practice and make it a part of our daily habits. In your opinion what are the main blockages that prevent us from taking the information that we all know, and integrating it into our lives?
The main blockage is when we make things too hard or overwhelming. If it feels like it’s too much, we’re wired to avoid it and we have to reconfigure those wires. Start very small. Make one little change a day — maybe cutting down on sugary beverages first before changing your entire diet, or have one less high-glycemic food a day. If you usually order a burrito for lunch, try getting it in a bowl instead of a tortilla. If you’ve never exercised much, don’t jump into a crazy gym routine or go for a long run; start by taking regular walks. In all likelihood, if you go too hard too fast, you’ll quickly feel exhausted and sore and then convince yourself that you can’t do it at all.
I always say that doing something is better than doing nothing. Even if that’s just a walk 10 minutes a day, you’re still exercising for over an hour more per week than you would be otherwise. One small thing! And slowly build from there.
On the flip side, how can we prevent these ideas from just being trapped in a rarified, theoretical ideal that never gets put into practice? What specific habits can we develop to take these intellectual ideas and integrate them into our normal routine?
Set yourself up for success by minimizing the obstacles. What are your personal obstacles? Do you get to the end of the day and feel too tired to work out? Then schedule your exercise for the morning to avoid built-in excuses in the evening. Do you fight to eat healthy all day, only to find yourself starving at night and succumbing to that salty bag of chips? Don’t buy chips! Don’t keep anything in your house that can serve as triggers when you’re stressed, upset or hungry. Plan ahead for your meals and snacks. We’re more likely to order take-out or eat something processed if we don’t have healthy meals prepared in advance; as a single mother working full-time, I try to make meals in large batches and then freeze individual portions for easy access on busier nights.
Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
I believe that if parents put as much emphasis on health and wellness as they do on their children’s academic accomplishments, we’d see a substantial decrease in the child obesity pandemic. For this to happen, schools have to implement more physical education and wellness hours in a week, rather than squeezing in some extra math. I speak to so many kids who say they don’t have time to go for walk because they have too much homework, tutoring, etc…we need to make physical activity an absolute priority for children, not an optional activity.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂
Reese Witherspoon has had, and continues to have, such a positive and tremendous influence on women and mothers alike, especially those who grew up with her as my generation did. She also posts photos of herself on social media where she’s eating real food, drinking wine, and spreading body positivity messages to an enormous audience. She shares her successes and failures as a mother in a real way, and that helps the world realize that nobody’s perfect and we’re all just doing the best we can.
How can our readers further follow your work online?
Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success.