The psychology of weight loss: Finding the middle ground

I was recently talking to a patient who needs to take off a significant amount of weight. He was contemplating having the LapBand surgery but wanted to give good old fashioned diet and exercise one more try first. He's yo-yoed for years, trying various diets that have worked for short periods of time but always regained the weight and more. Each time, his efforts involved a weight loss program where you have to buy prepackaged meals or cut out whole food groups and he said it just got boring after a while so he always went back to old eating habits. Once we started delving into why he gravitated toward those programs and talked about why they haven't worked over the long haul, it became clear that his underlying state of mind plays a huge role in his weight. While it wasn't that surprising to me, as psychology plays a huge role in just about anyone's weight problem, it was certainly an aha moment for him. Talking it out for over an hour and half I came to understand what might be going on and how we might start to address his issues. He's very much an all or nothing kind of dieter. He either eats bacon double cheeseburgers with fries or he has a salad with no dressing. There's really no middle ground in his eating habits. And over the past several years, he has just decided, consciously or subconsciously, that he'll eat what he wants and worry about it another day. But the added pounds have been weighing on his mind and he's starting to physically feel the effects of the weight. So, we started talking about finding that middle ground -- you know, the place where you can be comfortable eating for the long haul and take care of your health without feeling deprived. After a number of suggestions, such as ordering the grilled chicken sandwich with barbecue sauce rather than the one with melted cheese and bacon, he seemed confident that he could make some healthy changes that he could live with for the long term. I'm anxious to see his food diary next week. Hopefully we've taken a baby step toward the middle ground. I'll keep you posted.