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Relapse

Cut the Waist: A Follow-up Open Letter to Rob Ford, Mayor of Toronto

What can we learn when we fail to meet a goal--when we relapse?

Dear Mayor Ford,

I wrote to you in February, shortly after you had made a public commitment to lose 50 pounds in five months. Then, I shared some thoughts about goal setting, information derived largely from sport psychology. Thank you for acknowledging my note.

Now that you’ve decided not to continue—at least publicly—with your goal, I’m writing you to make some suggestions concerning discontinuation, discouragement, and relapse. You are certainly not alone. For just about any goal that people set—whether it’s taking a prescribed medicine or going to the gym or sticking with a diet, 50 percent of people end up not adhering to their plan.

As a psychologist specializing in sport and performance psychology, I’d like to offer some thoughts about where you might decide to go from here.

You were very public about your plan, and for a number of months you maintained a weekly public weigh in. I am hoping that your decision to discontinue your weight loss goal is an opportunity to pause, reflect, and recalibrate, rather than a decision to discontinue your attention to weight and health. A relapse isn’t the same as giving up altogether. I would hope that you can see this setback as what it is: a relapse from which you can learn, not an “I give up.”

When I work with athletes at any level of skill and competition, I encourage them to ask themselves two questions, following each practice and each competition:

• What went well?

• What could I do differently next time?

I hope that the past number of months have been an opportunity for learning on your part, so that you can reflect on these questions more specifically:

• What did I learn?

• How can I make use of that learning when I again decide to lose weight?

More specifically, here are some things that you might want to consider:

• What did I enjoy about the process of weight loss?

• What form(s) of monitoring did I use—and how useful were they for me?

• How was my weight loss reinforced or supported? What did I find truly helpful? (With all due respect, I have difficulty imagining that when an older brother competes with you and teases you in public, it actually feels very supportive.)

• What methods were effective initially; when and why did they become less effective?

• What weight loss advice would I give to someone else in a similar circumstance?

• Given a highly stressful job, how would I go about handling the challenges of weight loss in the future?

You have, at least in the public record, lost about 17 pounds. I know that’s lots less than the 50 that you pledged, but it’s a substantial start. Most people only lose about 10 pounds, ultimately, when they diet. So one very important question is: Can you maintain that weight loss? Do you have some plans in place so that you won’t regain the weight that you did lose? A step-wise plan of weight loss often makes the most sense anyway. Why not build on that?

There’s an excellent book—one of those oldies but goodies—on the process of change: Changing for Good, by psychologists James Prochaska, John Norcross, and Carlo DiClemente. They developed a model, sometimes called the Transtheoretical Model or the Stage of Change Theory, based on research about how people go about changing their behavior. In brief, they suggest that people change through a five step process: Pre-contemplation (not even thinking about changing), Contemplation (considering change), Preparation (a kind of back-and-forth getting ready), Action (making the change, consistently), and Maintenance (sustaining the action over at least a six month period).

Even though you might think that the “Action” stage is the most important, spending sufficient time thoroughly exploring the Contemplation and Preparation stages allows you to commit more completely to Action. I wonder if, in fact, you were really at the Preparation stage, but once you announced your plan in a public way, you then had to try to live up to it, before you were really ready. Dr. Prochaska and his colleagues call this “premature action.”

Like any good theory that is concerned with “stages,” this one recognizes that the changes don’t always go in a straight line but instead, sometimes loop around. Considering your recent actions and public decision, you may shift back to just giving up, that is, pre-contemplation.

But I’d like to encourage you to learn from this relapse, so that when you again decide to lose weight, you will be able to do so in a more systematic way. Changing for Good suggests ten really useful lessons we can all learn from, when we relapse:

1. Few people overcome a problem the first time around. Only 20% of people permanently change long-standing problems the first time out.

2. Trial and error is inefficient. Guided learning works much better.

3. Change costs more than you “budgeted”. This refers to money, of course—but also and as importantly, time and energy.

4. Don’t expect sheer “willpower” to carry you through. Change is a matter of systematic application of supportive techniques that will let you make the change.

5. Be prepared for complications. Specific processes, such as tension management, physical activity, assertiveness (not aggressiveness), and challenging negative beliefs can all be useful in managing the complexities of change.

6. The path to change is rarely linear.

7. A lapse is not a relapse. Catching yourself reverting to former behaviors, and changing immediately, can re-direct you toward your goal.

8. Mini-decisions lead to maxi-decisions. In his work on relapse prevention, psychologist Alan Marlatt labeled this issue SUDs—Seemingly Unimportant Decisions—or SUBTLE: Seemingly Unimportant Behaviors That Lead to Errors. Sometimes an initial small decision snowballs into a “slippery slope” with negative behavioral consequences.

9. Distress precipitates relapse. In fact, distress and social pressure tend to trigger the majority of relapses.

10. Learning translates into action. The more that we understand about ourselves, the more opportunity to make use of that knowledge in our behavioral change actions.

I hope, Mayor Ford, that you will understand the optimism that underlies this letter. Learning from adversity can be empowering, liberating, and exciting. I am encouraged that within the space of a day you re-thought your initial announcement to abandon your plan—and that you will do a final public weigh in on June 18. Perhaps, less in the spotlight, you will be able to re-engage in this weight loss work.

In another context, Ira Progoff spoke about “This solitary work that we cannot do alone.” I hope you will make good use of the positive social supports that are available to you, whether family, friends, or professionals. In particular, developing a plan with a dietitian and a personal trainer may be very helpful. And if you wish to engage an expert in behavioral change, you can find me at www.theperformingedge.com. Our contact would, of course, be entirely confidential.

Sincerely,

Dr. Kate F. Hays, Ph.D., C.Psych., CC-AASP

A follow-up for readers of this blog: On June 18, 2012, Mayor Ford did his final weigh-in on this 5-month project. End result was a net weight loss of 17 pounds. In and of itself, that number is no mean feat. The question will be: Now what?

If you’re interested in this specific story, check out http://www.thestar.com/news/cityhallpolitics/article/1212955--mayor-rob-ford-has-final-cut-the-waist-weigh-in-at-noon-monday

where you will also have the opportunity to see the video of the weigh in and observe the complex relationship between the mayor and his older brother.

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