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A Novel Diet

CHAPTER TWO

Today, Cheryl finally had her first doctor’s appointment with the new family doctor that Tina had recommended. She was both eager and apprehensive—eager to get started on a new diet, and apprehensive about what the doctor might find.

Locating the office had not been easy. Although it was only four or five blocks from work, she’d walked by it twice. It was on the lower level of a town house, with the entryway below eye level, half a flight down from the sidewalk.

The waiting room, when she found it, was very welcoming. The comfortable-looking chairs and prints on the wall gave it an atmosphere more like a  living room than an office, and the scattered magazines seemed to add a lived-in feeling.

Two women sat at the front desk. The one Cheryl dealt with was very professional, but seemed a little standoffish. Or perhaps Cheryl was projecting her own discomfort. The woman asked her for her insurance card and co-pay, then gave her a bunch of papers on a clipboard to complete—all without a smile, but admittedly she was quite busy.

Cheryl took a seat and began completing the forms. Other patients came and went; the more she waited, the more anxious she became. Her mind drifted, wondering if she was doing the right thing.

She was brought out of her trance by a voice calling her name.  

“Could you please follow me,” said the small black woman as she led Cheryl from the waiting room into a long, carpeted hall opening up into several exam rooms. “Please step on the scale.” Cheryl really didn’t want to, but she did.

“Do I have to look?” she managed to blurt out, embarrassed and ashamed at what she knew wouldn’t be a pretty number.

“No, that’s fine. I’ll just record it for the doctor.” Cheryl really didn’t want to look, but in the end, she opened her eyes just enough to steal a peek. Egads—235. She had gained another five pounds since scheduling the appointment. She knew that she had really been overindulging. Ever since deciding to try dieting again, she had been on a relentless mission to consume all her favorite foods before putting herself in diet prison. This was sort of like the condemned man’s last meal, she had told herself—only her last meal had lasted about two months.

She wished she hadn’t had to wait so long for the appointment. First, she had had to change her primary-care physician through her HMO; she could only do that on the first of the month. Then, it was recommended that she schedule a physical because she was a new patient. She had to wait another month before she could be seen. She hoped she liked this doctor after all she’d been through.

The exam room was small, but fortunately, not overly clinical. One wall was a burned orange color with a Picasso print of similar hues hanging in the middle. The exam table cover was a royal blue, picking up the small slashes of blue contained in the print. A large brochure holder hung on the opposite wall, displaying pamphlets for what seemed like every disease known to mankind. Then again, Cheryl didn’t spot any brochures on dieting.

Cheryl sat nervously, waiting for the doctor. As if hospital gowns weren’t embarrassing enough, the one they had given her was too small. Or, she realized with a wince, maybe she was too large. She was already sweating, despite the cool breeze provided by air-conditioning. Her discomfort compounded when the medical assistant had to go in search of a larger blood pressure cuff because her arm was too big for the regular one. At least her blood pressure was 130/85—not as high it was the last time she had gone to the doctor six months ago. Her previous doctor had told her that it was borderline, but hadn’t put her on any medication. She had breathed a sigh of relief at the time; she hated to take pills. He had just told her to decrease the salt in her diet and try to lose some weight. Yeah, she thought, that really worked well.

The doctor suddenly appeared with a knock on the door. “Good morning—I’m Nikki Lang,” she said, extending her hand to offer a firm grip.

Cheryl was nonplussed. The doctor standing before her wore jeans and Docksider loafers. She did have a white coat and a name tag, but she didn’t exactly look like a doctor. Her hair was long and streaked with gray. Cheryl really couldn’t tell how old she was.

Cheryl hoped the doctor hadn’t noticed the sweat on her palm.

“I see you’re here for a routine physical. Are there any particular problems you wanted to discuss?” Dr. Lang settled down on a stool and flipped through Cheryl’s medical chart, reviewing the history form Cheryl had completed while in the waiting room. Cheryl had been pretty healthy, so her medical history was actually rather boring.

Finally, Cheryl got up the nerve to speak. “I wanted to know if I could get some diet pills or something. A co-worker of mine told me about a patient of yours who had done really well with your help—plays ice hockey all the time now—and I wanted to know if you could do the same with me. You know, put me on a diet.”

“I don’t believe in diets,” was the doctor’s reply as she looked up at Cheryl.

The abruptness of the comment stunned Cheryl. Tears welled in Cheryl’s eyes. Finding a suitable diet had been the whole point of this visit. She had finally gotten up enough courage to ask about pills, only to be shot down. She had half a mind to walk right out of the office and demand her $20 co-pay back. The only thing that stopped her was the fact that she was buck naked under a thin hospital gown.

“If you go on a diet, you’ll go off a diet, so what’s the point?” Dr. Lang continued. “What you have to do is change your eating habits.”

By this time, Cheryl was hardly listening to anything Dr. Lang was saying; she was so angry that she had wasted her morning.

“If you’re really interested in losing some weight, I’m willing to help you,” Dr. Lang continued. “But you need to be willing to work at it.”

The tears began trickling down Cheryl’s cheeks.

Dr. Lang handed her some tissues without pausing. “I’m sure you’ve been on diets before. Did they work?’

“Well,” Cheryl sniffed, “the one diet that really worked well for me was the Atkins Diet. I lost nearly fifty pounds!”

“But it didn’t work, did it?”

“What do you mean? I lost fifty pounds.”

“So, how much did you weigh after that?”

“One hundred and seventy pounds.”

“And how much do you weigh now?”

“Two hundred and thirty-five.”

“Look … Cheryl,” Dr. Lang said after quickly checking her name on the chart. “I can tell that you really want to lose some weight. And I’ll do what I can to help you. I truly wish there was a magic pill I could give you or a failsafe program I could recommend. But there isn’t. Take the Atkins Diet: you lost the weight, but then gained it all back … and then some. So I ask you again: did the diet work?”

Cheryl began to get the doctor’s point. Yes, she had lost weight. But not only had she put the fifty pounds back on after stopping, she had even added another ten.

“I guess it really didn’t.”

“Exactly,” Dr. Lang said more sympathetically. “Diets don’t work. You have to change your eating habits, and changing habits takes a long time. What’s a habit anyway?”

“I guess it’s something you do that’s not good, like smoking.”

“Well, yes, that’s a bad habit. But what’s a good habit?”

“I don’t know.” Cheryl thought she was beginning to understand. “Maybe like not eating junk food?”

“Yes, that would be a good habit. So is turning off a light when you walk out of the room, or saying ‘thank you’ when someone does something nice for you. So, I’ll ask again. What’s a habit?’

“Something you do all the time?”

“Exactly! Something you do without thinking.” Cheryl felt like a student being grilled by her teacher. But at that moment, Dr. Lang smiled, dispelling that impression.

“Yes,” Dr. Lang continued, nodding, “it happens almost automatically without effort. So how long do you think it takes to establish a habit—or, for that matter, get rid of a bad habit?”

“I dunno … a few weeks, maybe?”

“I see here on your history sheet that your mother suffers from lung disease and heart failure. Is she a smoker?”

Cheryl nodded in the affirmative.

“Do you think if she stopped smoking for three or four weeks, she would have licked the habit?”

Cheryl shook her head.

“You’re right. Habits take anywhere from six to nine months to make or break—some maybe less time, some more. The point that I’m making is that changing your eating habits takes a lot longer than a few weeks. If you go on a diet for a few weeks or even a few months, how much headway have you made in changing your eating habits?”

Cheryl felt as if she were beginning to comprehend what the doctor was saying. But at the same time, her sense of hopelessness had not lifted. She knew that she just didn’t have the willpower or the patience to do something for nine whole months.

“It’s not just all the individual foods you eat,” the doctor went on. “It’s how you shop, what you keep in the house, how you store food, how often you eat out, how many times a day you eat, or if you eat when you’re angry or sad. The list goes on and on.”

Cheryl was really wondering why she’d bothered coming here. She had thought that this doctor was going to have some new way to help her lose weight. Now, she was feeling even more frustrated than before. The task seemed more daunting than ever.

Suddenly, the doctor paused and looked up at Cheryl in a way that made her feel exposed by more than just her ill-fitting gown—as if her thoughts were an open book. It somehow didn’t surprise Cheryl when Dr. Lang abruptly changed gears. .

“Cheryl, I see that you’re a dental assistant. I presume that you brush your teeth every morning and night?”

“Of course, but I don’t see your point,” she said through gritted teeth, beginning to get angry.

“Did you always brush your teeth regularly, even though your mother had told you to?”

Cheryl remembered letting herself go after Joy died. She’d stopped doing her hair and her makeup. Half the time, she hadn’t bothered getting dressed. What was the point? She had even stopped brushing her teeth. As a matter of fact, she’d gotten the idea of becoming a dental assistant when she’d gotten several painful cavities fixed. It was all that junk food, she knew. The cavities had reminded her that it wasn’t all about appearances. Brushing was a good idea. By the time she was taking dental tech classes, she was flossing regularly.

Returning to the doctor’s question, Cheryl shook her head as her anger faded.

“Do you find it a great effort to brush your teeth every day?”

“No, in fact, I even floss every day.”

“So that’s precisely what I’m talking about. Once you establish a new habit, it sticks, and you don’t have to think about it anymore. That’s what you have to do with eating habits. Do it slowly, only addressing a couple habits at a time.” Dr. Lang took a breath and continued. “The real problem, I find, is that you have to know which important habits to establish first as you work toward your goal. It’s really amazing to me that so many people go about the very important job of learning to eat healthily with so little knowledge. How proficient would you be as a dental assistant if you’d read one book on dental care and then tried to be good at your job?”

“Not so good.”

“Learning to eat right for your health might be one of the most important jobs in your life. Don’t you think it might be worthwhile to educate yourself about doing it right?”

Cheryl nodded in agreement. But she still wasn’t really sure she could do it.

“Look, Cheryl, let’s start with one habit. What fluids do you drink during the day?”

“Black coffee with two sugars, Pepsi, and fruit juice.”

“How many fruit juices, and how many Pepsis?’

“Two or three.”

“Of each or both?”

“Probably three combined a day.”

“Do you have any idea how many calories that represents?”

“A hundred or two?”

“Minimally, 450 calories, and that depends on what fruit juice and how many ounces. If it’s one of those sixteen-ounce bottles, then it’s more than 550 calories. Take a guess at how many pounds that represents in one year.”

“I dunno … ten, maybe?”

“If you changed nothing else in your diet, but stopped drinking your calories, you could lose anywhere from forty-five to fifty-five pounds in one year!”

“Really? But what do I drink?”

“Diet drinks.”

“But they taste terrible; I can’t stand them.”

“Look, Cheryl: here are a couple of pages that I’m writing on the topic of acquired taste from my diet book—or, should I say, healthy eating book. Why don’t you read them, and when you come back in a month, we’ll talk about it again. As a matter of fact, you might want to pick up the other two of the first three chapters of the book at the front desk, which will review what we’ve already discussed today.”

Dr. Lang finished taking Cheryl’s history, then did the physical. When she was finished, she told Cheryl to schedule her next appointment, so they could review her lab work at that time and continue their discussion.

The pleasant medical assistant returned to take Cheryl’s blood and give her a tetanus shot that was due.

Cheryl left the office unsure of how she felt. She wasn’t angry anymore, but she also wasn’t very happy. She had thought that she would walk out of the office with a pill in hand ready to change her life, and instead she was actually a bit disheartened. As she walked to the deli to meet Teresa for lunch, she thought about all that Dr. Lang had told her.

***

Teresa managed a retail shoe store on South Street, so she was able to skip out for forty-five minutes for lunch. When Cheryl met her at the deli, Teresa was full of questions about the doctor visit.

“It didn’t go so well,” Cheryl responded. “I thought I’d get some great diet, but all she talked about was changing habits—how hard it is, how long it takes, and how much knowledge is required to eat right. Basically, I think it was a great big flop.”

“Didn’t she ask you to do anything at all?”

“Well, she said I should drink diet instead of regular soda and fruit juice and put Splenda in my coffee. She said I could lose up to forty-five or fifty-five pounds in a year even if I did nothing else.”

“Wow, forty-five or fifty-five pounds. You know, I drink diet soda.”

“Yeah, but you like it. I hate it. It’s disgusting!”

“Cheryl, you look like you’re about to burst into tears. Was it really that bad?”

“Oh, Teresa, I’m just so frustrated. I really had my hopes up. I wanted to do it this time, but it just seems so … impossible. You know how hard I’ve tried in the past, but nothing ever seems to really work.” Tears started trickling down Cheryl’s cheeks yet again.

Teresa grabbed her friend’s hand and squeezed it. “Is there anything I can do?”

“What can you do? I mean, geez, it’s up to me, isn’t it?”

“Well, I dunno. Maybe there’s something I can help with. Tell me what else the doctor talked about. Maybe I can learn something.”

“You’re thin. What do you need to learn?”

“Maybe about how not to get fat. You’ve seen my mother. Is that what I have to look forward to?”

Cheryl smiled. She couldn’t imagine Teresa looking like her mom, who was nearly as large as Cheryl, but had bony knees and small boobs. Teresa smiled with her. “You know, my mother was once my size. I really don’t want to become my mother, so help me out here.”

Cheryl dried her tears and recounted what she had learned. “She said I need to start by changing just a few small habits at a time, not to actually go on a diet. That it takes a while to establish habits, but once you do, they stick. She used my daily flossing as an example.”

Teresa looked at her watch. Their food still hadn’t arrived. “If our food doesn’t come soon, I’m going to have to take mine with me back to the shop.”

“Yeah, you and me both!”

“Getting back to what the doctor said … does it make any sense to you?”

“It all makes sense,” Cheryl replied. “It’s just that … that … I dunno.”

“It’s just what, Cheryl?” Teresa prodded.

“It just seems like it will take forever. I mean, nine months to establish one stinky habit?”

“Yeah, but remember what the doctor said about you and flossing. Once you learn a habit, it sticks. God knows you certainly bug me about it enough!”

Cheryl grinned. She could be really annoying about getting other people to floss. “I know, but it just seems like it will take eons to lose any weight.”

“What have you got to lose? Why not at least try? If you don’t try, you’re still going to be the same size a year from now.”

“I’ll think about it,” she said, not very convincingly. “Oh, look our food is finally coming.”

Just as their food arrived, Cheryl noticed a few of the papers that Dr. Lang had given her sticking out of her purse. “I almost forgot these,” she said as she extricated the papers from her purse’s innards. “Dr. Lang gave me some chapters from the book she’s writing. These are the first few on habits … and something about taste.” She looked at the title. “‘Acquired Taste’—that’s it. Maybe you’d like to read them?” She handed the pages to Teresa.

Teresa laid them down next to her plate and started reading while she ravenously took large bites of her sandwich. As she finished each page, she handed it back to Cheryl. Having nothing better to do, Cheryl read them too.

After finishing the short chapters, Teresa said, “Well, it kinda makes sense, don’t you think? I used to hate beer, but when I went to those wild frat parties on Penn Campus, I didn’t want to feel like a real loser, so I drank it anyway, and now I really like it. What about you?”

“Ugh, I can’t stand beer—never could. It tastes terrible.”

“Isn’t there anything that you eat or drink now that you didn’t like when you were younger?”

“No.”

Teresa sighed.

Cheryl could tell her friend was really frustrated with her. But Teresa didn’t understand. How could she? She’d never been overweight or even on a diet. She was as slim as she was in high school—and with her thick, dark hair and perfect skin, she was a guy magnet. How could she possible know how Cheryl felt?

Cheryl was happy when Teresa changed the subject. She didn’t want to talk about it anymore.

They finished their lunch with some momentary idle chatter about Wendy’s upcoming wedding. Cheryl told Teresa she would stop by her store at the end of the day, to find the new pair of shoes Cheryl had promised herself, and then they both went back to work.

Before moving on with our story, let's review the important points that Cheryl has learned thus far.

HOW TO GET STARTED!

STEP 1: Stop drinking your calories.

Calories that you drink do absolutely nothing toward satisfying your appetite. If, for example, you drink a soda with your meal, do you eat less food than if you hadn’t had the soda? The answer, of course, is no. You’re still going to eat the same amount. Your meal then contains an additional 150 calories. If you do this at lunch and dinner every day, you are consuming an additional 300 calories without any further appetite satisfaction. You may be thinking, “But I like soda.” Over the next several chapters, we will discuss how your present likes and dislikes will factor into this plan, but for the moment, let’s put this thought on hold.

So here you are, drinking an extra 300 calories (in soda, fruit juice, or milk) without any further appetite suppression. Let’s review what that means in pounds. Since there are 365 days in a year, and there are 3,600 calories in one pound, then 10 calories a day times 365 equals 3,650 calories, or approximately 1 pound. Every additional 100 calories ingested per day for one year represents 10 pounds; therefore, an additional 300 calories daily equals 30 pounds in one year. (300 calories x 365 days in a year = 109,500 calories. 109,500 ÷ 3,600 calories = 30.42 pounds in a year.) Mind-boggling, isn’t it? For every 100 calories less per day ingested, you could lose as much as 10 whole pounds per year.

Very small changes over time can make huge differences.

So let’s address other things you might drink on any given day—coffee or tea, for example. If you drink your coffee or tea black, then you are drinking nothing more than flavored water (with regard to calories), so there are no calories to consider. However, if you use cream, sugar, or both, then you must count those calories. As an example, if you use 2 rounded teaspoons of sugar in 2 cups of coffee or tea per day, you have 2 tablespoons of sugar each day (3 flat teaspoons = 1 tablespoon). Each tablespoon of sugar contains 45 calories, which means that the 2 tablespoons of sugar equals 90 calories per day—or 9 pounds per year. By eliminating 2 sodas and 2 tablespoons of sugar (using artificial sweetener instead) each day, you could lose 39 pounds in one year.

Very small changes do add up!

Another interesting way to really appreciate small incremental changes is to create a warehouse in your mind that is going to house all the food you won’t eat for the next year. So, if you were to visit the part of your warehouse that housed the soda (or juice) that you didn’t drink in one year, at 2 sodas a day, it would presently contain 61 cases of soda. The shelf holding the sugar, if you abstained from 2 tablespoons a day, would have approximately 5 five-pound bags of sugar, and 1 two-pound bag of sugar. We will revisit this warehouse concept in the future, just to drive home the importance of small changes.

So Step 1 in this journey to eat better and be slimmer is to stop drinking your calories. We won’t address alcohol consumption at this point, except to say that fewer calories are better, light beer is superior to regular beer, and less is always an improvement.

ACQUIRED TASTE

What Is It and How Does It Work?

“Acquired taste” refers to the concept of learning to like something that you’ve never liked before. One of the simplest illustrations is that of the beer drinker. I’d be willing to bet that very few people liked beer the first time they tasted it … and yet today, millions of people love beer. Are they forcing themselves to drink it? Obviously not. They have learned to savor the taste in spite of their initial aversion. Why did they acquire a taste for beer? Well, maybe when they were younger, they thought it was cool. Or perhaps they just wanted to fit in with their peers. Or, although they didn’t particularly like the taste, they liked how it made them feel—they liked the buzz. Whatever the reason, they chose to drink beer, and by repeating the experience over and over, they learned to like what they initially thought was awful. They are no longer forcing themselves to drink it; they truly enjoy it, want it, and think it tastes great.

How does this happen?

Earlier, I mentioned that we human beings are not terribly fond of change and find it very difficult. Well, that “shortcoming” can also be an asset, depending on how we approach it. We love and crave what is familiar to us.

Anything that we do every day becomes desirable, comforting, or relaxing. Whether it’s taking off our tie or shoes at the end of a day, having our first cup of coffee in the morning, or engaging in grooming rituals like brushing our teeth or washing our hair, sameness breeds comfort.

Do you remember how much fun you had on your last vacation, but also how good it felt to be home in familiar surroundings? Well, the only way that something can become familiar and comfortable is through repeated exposure. The more we experience a particular activity, or food, or environment, the more comfortable it becomes, and generally the more we like it.

Acquired taste requires a great deal of repetition.

If you want to drink water or diet drinks instead of regular soda or juice, you need to learn to like water or diet drinks—or both.

Now, a few little tricks can ease the process. Our palates—that is to say, our taste buds—are also reluctant to change, so it’s often necessary to blindside them. Say you are a Pepsi drinker who has tried Diet Pepsi in the past and thought it was awful. Since your palate was expecting regular Pepsi, it reacted to the unfamiliar taste: “Yuck!” Similarly, just think how awful vodka or gin would taste if you were expecting natural spring water—double yuck! Expectation plays a very important role in how good something tastes.

To avoid that issue when switching to diet drinks, pick a flavor of soda that you rarely drink. Your taste buds will not hold a preconception of what it’s supposed to taste like. It may not taste great, but it will taste okay.

Continue to drink these other diet-flavored drinks for several months, and avoid all cola for at least three months. If you basically have a preference for cola, after a three-month hiatus, Diet Pepsi will taste pretty good. Continue to drink Diet Pepsi for the next three to four months (without ever drinking a regular Pepsi), and you will find by that time a regular Pepsi will not taste particularly good—in fact, it may actually taste too sweet!

You have now acquired a taste for diet soda. It has become your preference, and it actually tastes better to you than a regular Pepsi. Don’t believe me? Ask other diet-soda drinkers. Better yet, put this book down for the next several months and begin the experiment. Many of my patients over the years have reported back to me after our discussions that it was easier than they had expected to acquire a taste for new foods and drinks. Many who had already learned to drink diet soda, but had not yet applied the concept to food, agreed that they no longer even enjoyed regular soda.

Perhaps you too can begin to benefit from acquired taste. Stop digging in your heels and avoiding change. You have to open up to the idea that changing your taste buds may not be as difficult as it first seems—and it’s crucial to your future success.

ON ESTABLISHING HABITS

The dictionary defines “habit” as “a recurrent, often unconscious pattern of behavior that is acquired through frequent repetition.” Once you have acquired a taste for diet soda, you’ll have developed a good habit. Obviously, the concepts of habit and acquired taste overlap, but it is important to make some distinction. As Cheryl learned, many different habits (what, where, how, and when) are involved in eating.

So what do you do? How do you successfully change your eating habits? The simple answer, which I’m sure you’ve already figured out, is to address only a few habits at a time. Trying to change hundreds of habits simultaneously, as you do when you go on a diet, is totally unrealistic. The chances of success are minimal. So why not give yourself a fighting chance by gradually changing just a few habits at a time, instead of all of them all at once?

So, if your choice of beverages (Step 1) is the only habit that you try to change initially, you’ll still lose weight. By doing just this simple step, you will also learn the very important concept of acquired taste. You will learn what establishing a good habit is all about—and that, if you are patient and take it one step at a time, changing habits isn’t nearly as difficult as it first seems.

I don’t want to leave this discussion of habits just yet; some important aspects of habit changing still need to be reviewed.

Establishing a new habit, as we have said, requires repetition. The more often you do something, and the longer you do it, the sooner it will become an unconscious behavior. The good news: even if you don’t do it every single time without fail, you can still be well on the road to establishing that habit. The bad news: the more frequently you don’t do it, the longer it’s going to take.

Pavlov proved that dogs could learn to salivate at the ringing of a bell, once they had associated that bell with dinner. Sometime later Skinner came along and established the concept of intermittent reinforcement. Let me give you an example. He put a mouse in a cage with a simple lever that dispensed food. Every time the mouse stepped on the lever, it received a food pellet. After a while, he stopped giving the mouse any food. The mouse would continue to push on the lever, but after a relatively short time, when it consistently received nothing in return, it stopped stepping on the lever. Next, he did the same experiment, but instead of giving food every time the mouse stepped on the lever, he gave it food every third or fourth time. When he stopped giving the mouse food entirely, the behavior persisted far longer.

It works precisely the same way with negative reinforcement. If he had given the mouse small electric shocks every time it stepped on a certain grid of the cage, the mouse would have learned to avoid that grid much more quickly than if he only shocked the mouse every third or fourth time.

Let’s apply this to humans. Let’s say that you develop significant heartburn every time you have a cup of coffee. How long do you think it would take for you to stop drinking coffee? How much longer do you think it would take for you to stop if you only developed heartburn every third or fourth time you drank it?

So how does this apply to developing good eating habits? If, as I advise, you were to begin drinking diet sodas, but every fourth time you gave in to temptation and drank a regular soda, then a real habit change would take much longer. Likewise, if I were to advise you to eat breakfast every morning, and you were to only eat it some mornings, how much longer do you think it will take to establish that behavior as a habit?

The good news is, however, that it will still become a habit; all is not lost if you occasionally slip up. Just get back into the routine as soon as possible.

Remember, the repetition of any behavior adds up to change!

 

Let’s continue with our story and find out how Cheryl deals with change.

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