There are few variables that matter more in dealing with a weight issue than the almighty MOTIVATION.  Successfully losing weight is a function of 1) starting and 2) sticking with it.  At some very basic level, it’s really not much more complicated than this.  Of course, motivation is an easy word to toss around, but it’s not such an easy quality to summon and keep with us.  Motivation has a nasty habit of not being there when it’s most needed.  It also has a bad habit of becoming suddenly shy and receding into the dark corners of our minds.

All of this begs the question about how exactly to find motivation and how to make it stick around.  It’s obvious to state that motivation is much easier to find when we are, well, motivated.  When something truly matters to us, it’s easier to stay motivated.  When we have a goal that we truly desire, we can stay motivated.  If there is someone pushing us, it can help maintain motivation.  Given this, there must certainly be external aids that help us find motivation and then keep it around.

Over the past few years, I’ve had the opportunity to be exposed to a fascinating little corner of the world of health, known as healthcare economics.  A big part of healthcare economics centers around the notion of how money and incentives can help nudge us into doing things that we might not otherwise be fully motivated to do.  This is hardly an alien concept in the world we live in.  We work hard with the hopes of making money.  We save with the hopes of keeping our money.  We invest with the hopes of making our money bigger.  It may sound mercenary and shallow, but there is no avoiding the magnetic forces of financial incentives.

Maybe a Fat Cat isn’t the exact right example of financial incentives for weight loss…

There are a group of folks that are dedicated (at least partially) to the study of how incentives can influence behaviors when it comes to health.  One particular group of these researchers that I’ve had the opportunity to get to know pretty well belong to a research group at the University of Pennsylvania Medical School, called the Center for Health Incentives and Behavioral Economics.  It’s a joint effort between academics and researchers at U Penn and Carnegie Mellon.  Some of their notable members include Kevin Volpp, George Lowenstein, Scott Halpern among others.  They are an interesting group in that they are all at once practicing physicians and psychologists as well as being economists.  They study the application of incentives to areas such as smoking cessation, obesity and others.  They are crazy smart, but also incredibly nice guys who are trying to make a positive impact in the world — no matter how scary the subject matter can sound (!).

Kevin Volpp asked me to write a piece on the subject of health incentives to weight loss, and I agreed.  It then occurred to me that it might be an interesting subject for a blog post.  So here you go!  For all you fellow Mathletes (yes, I was one, so please don’t give me a wedgie), put on your seat belts.

Back to motivation…  How could finance incentives be potentially used as a weapon in our arsenal to make this very difficult change in our life?  It’s a big wide open topic that I could never hope to do full justice in a brief(ish) piece, but allow me to take a brief crack at it.

Let’s start with a discussion about where motivation is needed.  In my last magazine column, I summoned my inner-nerd (maybe it’s outer too) by referencing a principle of physics:  the force required to set an object into motion is greater than the force required to keep an object in motion.  The reason force is required at all is for the simple reason that there is friction all around us.  It is what keeps us from sliding across the floor, and it is the force that causes a refrigerator to sit still even when you try to push it.  The greater the friction, the greater the force required to create motion.  Because friction is always around, objects have a tendency to revert to a point of rest.

It’s easy to see how this applies to the process of becoming healthy.  In the case of weight issues, friction can come in the form of ingrained habits that are hard to dispel.  Friction can be the powerful wants in our brains for foods that aren’t particularly good for us.  A huge source of friction for many of us is procrastination, rivaled by the friction of boredom.  These forces seem perfectly oriented to keep us from getting started or making progress.

So if we need to overcome these frictions, what are forces we can use to push past them?  Can want for money be used in a constructive way?  To test the theory, let’s break the problem into two areas:

1:  Getting started

The cards in the obesity deck are frankly stacked against us.  As much as we’d all like to  weigh less and be healthier, we all know that it takes work.  We all recognize we will have to give up some of the things (at least in quantity) that gave us our weight problem in the first place.  We know that there is no easy fix and that it will require effort.  Worse, we also know that most of the health issues associated with a weight condition are years down the line, yet that damnable blueberry muffin is right in front of us.  Hence, there are few things easier on Earth than procrastinating the process of changing our lifestyle and habits and becoming healthier.  Seriously, can’t it wait?

The inherent issue with procrastination is that it reflects the basic challenge of long term benefit vs short term indulgence.  We are all human, and the short term indulgence wins the race more frequently than we can count.  However, what if the the long term benefit suddenly became a right now benefit?  This is where a financial tool could come into play.  If someone were to tell me that I could have a million dollars if I lost a pound, I’d take that deal.  More practically, I’ve seen people use the specter of a life insurance exam to get their head into the game and lose weight.  Other examples could include:

• Agreeing to lower your health insurance premium if you agree to reach a goal
• Giving you the chance to win a lottery if you hit a certain goal
• Giving you a monetary award up front, but allowing you to keep it only if you reach your goal
• Doing the above with a group of people

2:  Keeping going

For many of us, the big challenge in keeping a weight loss effort going is having it matter week after week.  It’s one thing to pull together the energy and resolve to get started, but it’s all too easy to see this early vigor fade away.  How might we use money rewards or penalties to keep our heads in the game?

• One that’s become increasingly popular is to form a challenge where the winning team to win a pot of money at the end if they do the best
• Weight loss bets are a time-honored tradition among guys losing weight.  At the beginning of the challenge, everyone puts money in the pot.  Those that don’t meet their goal, lose their money while those that do get to split all the money left in the pot.
• One website, stickk.com, uses a novel approach in which you put money in upfront, and if you don’t reach your goal, the cash gets sent to the charity of your choice.
• There are increasing examples of companies that will set up rewards programs, like frequent flier, that allow you to win prizes, gifts and cash the more you participate and achieve

There is a lot of research behind all of the above.  One thread of work shows that we humans would rather not lose money vs. winning money.  It’s called loss aversion — this is the theory behind the program at stikk.com.  There is other research showing the promise of team efforts and lotteries.

For me personally, I used a weight loss bet with four of my colleagues to jump start the weight loss effort that finally got me to my goal.  Ironically, I didn’t get to my goal by the end of the bet, but it got me most of the way there.  I think I still owe my friend Mike about a hundred bucks (he was too nice a guy to collect from the losers).

Research is showing that all of the above can have a pretty positive effect in helping to stimulate and motive change in our behavior.  Keeping engagement going and having a weapon to fight off procrastination can give us the nudges we need to be successful.  However, I also have misgivings.  A carrot for one person can turn into a stick for someone else, and I firmly believe that obesity should never be punished.  Getting a reward for achieving a goal can be something positive if done the right way for the right reasons.  It’s a pretty slippery slope, but I’ve seen it done well.

Thank you for suffering through a particularly long post.  Since you’ve gotten this far, I would love to hear from any of you that have used money to push your weight loss effort along.  Think of it as your contribution to research!

Cheers,

Dave

It’s been almost a year to the day since the hardback edition of my book, Weight Loss Boss, was published and let loose on an unsuspecting and defenseless public.  One year later, the paperback is now in the wild.

This seems as good a time as any to reflect on what I’ve learned about myself over this past year, and possibly what I might say differently if I were writing the book today.

To put this past year in context, allow me to provide the briefest of refresher on my weight loss experience:

• 2000-2009:  the almost losing weight years.  These were my nine years in the wilderness, sometimes losing weight and then watching it come back.  I never returned to my worst point, but I never got to my goal weight either.  As I’ve said on numerous occasions, please don’t judge my nine years to get to goal:  it’s not nice to pick on slow people.  
• 2009:  GOAL!!!!!!  LIFETIME MEMBER!!!!!
• 2009-2012:  These were my three years as an @ goal, Lifetime Member (Free Lifetime for those familiar with WW membership parlance).  2009 also marked the point of beginning to write this blog.  Weight Loss Boss was published in early May 2012.
• mid-2012 to present…

I am now a bit more than four years at goal weight, a fact that I do not take for granted. The past year has been particularly interesting in that it happened after I published my book.  One might reasonably ask why the publication of a book has anything to do with my weight loss status.  For me, the book was the culmination of sharing everything I knew about the process of losing weight and keeping it off.  There was something about the process of writing it that it somehow felt that a conclusion had been reached.  ”And then Dave jumped on his trusty horse Trigger and rode off into the sunset, never to be seen again.”

What if Dave ate Trigger instead?  Well, I’d have to be European for that to be true, so fear not, no horses were hurt in the production of my story. Nonetheless, it’s a fair question, because in fact, I had to continue living in the world after the book was published.  There is no sunset in the process of adopting a healthy lifestyle.  There is no concluding point.  There is no epilogue.  Life goes on, and staying healthy always remains a process.

Over the past year, I’ve had some ups and downs.  If anything, I’ve found that this past year has been a bit more challenging in keeping my focus. There have been more than a few times where I let myself fall into Superman-mode, thinking that I cannot be harmed by mortal man or his junk food. During these times, I could feel the weight slowly start to creep back on while I could feel my hard won habits slightly slip away.

In truth, I’ve met very few people on maintenance who haven’t gone through what I’ve described many, many times.  Maintenance is tough because we are constantly surrounded by temptation, and periodically our defenses lower.  Fortunately, the worst I have gotten has been about 6-7 pounds over my goal weight.  At this point, you might now ask the questions:  ”Are you serious?  Are you actually self-flagellating about 7 pounds?  Go get yourself a quarter and call me when you have a real weight regain problem!”  I would of course reply back:  ”You are very mean and insensitive.”

Even when I was feeling the most at risk, I had a couple of advantages that kept me going way over the edge of weight control:

• Working out:  even when I’m slacking a little bit, over these past 12 months, I really have not missed many days of exercise.  My workouts may have gotten less intense from time-to-time, but I have kept going.  I cannot stress how important this has been to me.  Exercise covers a lot of sins.  It’s incredibly hard to maintain a weight loss without becoming much more active.  
• Course correction:  when I’ve crashed spectacularly, my saving grace has been to be honest with myself pretty quickly.  If I’ve had a gross food week, I usually find myself in a Sunday night session of self loathing followed by a Monday morning of redemption.  The self-inflicted psychological warfare may not be a good mental health practice, but being honest with myself has been incredibly important.  The trouble really starts when denial sets in, and we start telling ourselves that it’s all fine.  I’ve also forced myself to stand on the scale even when I knew it would make me terribly sad.  Every painful weight in was like a shot of horrendously bad tasting medicine that ultimately made me much healthier.  
• Lightening up:  seemingly inconsistent with the point on course correction above, I’ve also found myself getting more and more comfortable with my new fangled healthy life.  I’ve grown more confident that when I do fall off the wagon that I can get right back up.  This has allowed me to be somewhat of a less neurotic, tightly wound mess about the whole thing.  
• Honoring my healthier habits:  all the while, I have held onto certain go-to routines such as my standard breakfasts and lunches.  

Interestingly, over the past month, I have found myself becoming a little more intense and disciplined about my health.  I’ve upped my workout intensity a decent amount, mostly by adding extra cardio into my mix.  I’ve become much more disciplined about planning before going on trips after a spectacular wipe-out this past Spring Break.  I’ve also gotten back into the habit of not cleaning my plate and more quickly turning back mindless calories when offered.

The folks that run research at Weight Watchers would tell you that this is pretty typical.  We all go through periods of being heavily engaged and focused followed by periods of being a little more slack.  For most people, this is pretty much standard operating procedure and is to be expected.  The standard of success is NOT perfect behavior all the time.  If it was, we would all fail spectacularly.  The trick for me has been to not go over the deep end when I’m being intense as well as to not let everything fall to pieces for too long when I’m being a slacker.  Over time, it’s been about finding my middle path and trying to stay within a healthy zone.

So what would I say differently in a book if I were to write it now?  In truth, not much.  I was prescient enough in the book to acknowledge that the process of staying healthy is an unending one that will require effort and focus forever.  I’ve lived that this year, and I have no regrets.  I’m still healthier and happier by far, and it’s been more than worth all of the effort.

On a separate note, I am greatly pleased with the new cover of the book.  I’ve long been read to retire the guy with the constipated face holding the ice cream in favor of a cartoon.

And don’t forget!  For those who haven’t read it, all the proceeds (as always) go to Share Our Strength (not greedy me).  For those who have read the book, THANK YOU!

Cheers,

Dave

I have been known to be impulsive…

When last I wrote, I was owning up to a rash of irresponsible and dangerous vacation eating behavior.  I spent the better part of a week equipped with loose health morals and having lots of unprotected relations with food.  I was an unrestrained food trollop, and I subsequently spent many days wondering where my moral nutrition compass went so terribly wrong.  As is always the case in times like this, the underlying source of my sins was the same:  I was unprotected and unprepared.  I did not have a plan.

It’s always pretty easy for me to get back on plan when I get home as the routines and patterns of my life, heavily built over these past ten years, quickly come back to me.  Despite a 25^th college reunion, which resurfaced any range of suspect consumption choices, I have survived and recovered back to my puritan food eating ways.

However, my work travel has now accelerated back into overdrive.  I was in Philadelphia and DC last week, followed by a 24 hour layover at home (sad that I would see it that way) leading directly into a flight to London.  I now write this post from Heathrow where I am waiting to get on my 8 PM flight back to New York.  It’s in times like this that well meaning young men get into trouble.  Lots of jet lag, much socializing and plenty of private (secret) eating opportunities abound.

My new BFFL, Evernote

Through serendipity, I discovered a little app that has helped me to change my sinning ways.  I might be one of the last harried people on Earth to do this, but I finally opened up the Evernote application on my iPad that I had downloaded months and months ago.  I have never been a big one for to-do lists, but I was finding it increasingly difficult to make sense of my scribbled meeting notes spread over countless notebooks with no hope of ever being read again.  This was my impetus, beginning this weekend, to finally go fully electronic in organizing my work life.

To make my days ever so slightly more productive while I was in London sitting through many, many meetings, I decided to try out a new routine.  I started using Evernote to write my plan for the day, laying out what I wanted to learn and achieve in each of my meetings upcoming over the course of the day.  While I was doing it this daily plan, it occurred to me that I could do the very same with my food occasions over the course of the day.  Good intentions in hand and before I went down to the hotel lobby for breakfast, I mapped out a quick & dirty plan for my health.  It went something like this:

• Breakfast:  try not to molest the buffet.  Stick to cereal and skim milk, yogurt and fruit (they do not have oatmeal, sadly).
• Lunch:  small plate, no seconds, mostly fruit and green things
• Snacks:  fruit only (seriously!)
• Dinner:  one beer and some kind of ocean dwelling meat substance
• After-dinner:  There is no after-dinner!  Get your hands off the mini-bar.  NO SNACKS!

OK, it’s a little odd to talk to myself like this, but I decided to give it a go.  Here’s the weird thing.  It totally worked.  Completely and 100%.  It is as though the mere act of writing down my simple little plan bound me to obedience and gave me the strength to withstand temptation.  I stuck with the plan without even feeling a pull.

Some time ago, I had a chance to talk to my NY Times friend, Charles Duhigg (Oh my gosh, I just dropped a name!  Oooops!).  He told me about a researcher at NYU (I think) who had done experiments showing that people who wrote down a plan before encountering a situation were MUCH more likely to be adherent (i.e., behave).

It’s also quite similar to the research of Carnegie Mellon behavior mod superstar George Lowenstein, of the Hot State/Cold State fame, originally applied to risky sexual behavior and then applied to risky eating behavior.  Basically, his research shows that we can make calm, rational decisions when temptation is not staring us in the face (cold states).  However, in the heat of the moment (hot states) and without a plan, we do crazy stuff.  In my case, I was writing my plans in a cold state and it helped me manage what would have been hot states.

Before you accuse me of being an OCD freak-of-nature, which may be true in some parts of my life, know that I am not naturally wired to write lots of lists.  In Myers-Brigg parlance I am a P(erceiving), not a J(udgement).  For those not familiar, J’s are known for writing to-do lists on their days off while we P’s like to follow the Grateful Dead.  So, here I am as P finding religion in a simple little eating plan to start each day.

The big question for me is this:  can I stick with it?  Well, the key in creating any new habit is to make it pretty easy, make it worthwhile and do it long enough so that it starts to stick.  My plan is to keep my list VERY simple (not much longer than a Haiku – in fact that might be an excellent art form for it).  The “worth it” part is how unbelievably great I feel being in control in a known trouble spot, travel.

Will let you know how it goes!

Oh.  One more thing.  Evernote ROCKS!

Cheers,

Dave