1. TOOLS FOR A BALANCED LIFESTYLE STRATEGIES FOR SUCCESS IN WEIGHT MANAGEMENT GOING FOR THE 3 INCREASES: INCREASE IN HEALTH, INCREASE IN HAPPINESS & INCREASE IN ENERGY Jim Messina, Ph.D., CMHC, NCC, DMHCS Troy University Tampa Bay Campus Website for Program: http://www.coping.us/balancedlifestyle.html

2. Who is this Program aimed at? ■People who need to work on improving their relationship with food ■People who need to improve their body image ■People who allow their weight issues interfere in their daily functioning ■People who consistently yoyo Diet ■People who have not made exercise a regular part of their lives

3. Goals of the Program 1.Develop a healthy relationship with food 2.Develop a healthy exercise program 3.Reduce the strength of triggers for relapse 4.Creation of new self-scripts which keep you targeted and reduce stress and anxiety 5.Letting go of need for approval and focus on personal health as rationale for new lifestyle 6.Improved Body Image 7.Reduced compulsive behaviors

4. Support System in Program ■Peer support of the weekly group meetings ■One to one support outside of meetings with fellow group members ■Support by email during week with program facilitator ■Ongoing communications bulletin board on website for program at www.jamesjmessina.com

5. Program Design ■Can be a year long continuing program or can begin with 14 weekly meetings of 1 1/4 hour in length and the decision to continue ■Same day of week, hour of day, location ■Daily Progress Reporting by email to program facilitator ■Weekly homework assignments off of Tools for Balanced Lifestyles and Tools for Coping which are on www,coping.us at: http://www.coping.us/balancedlifestyle.html

6. What is expected during Program ■Participant will follow a Intuitive Eating Model which is suited to person’s personality, attitudes, temperament, motivation, and lifestyle ■Participant will develop and follow an exercise program which is suited to person’s personality, attitudes, temperament, motivation, and lifestyle ■Participant will participate in group and outside of group support sharing ■Participant will participate in the accountability of daily reporting while in program

7. Principles of the Balanced Lifestyles Program 1. This is a lifestyle change program to modify your relationship with food, exercise and body weight 2. This program requires accountability with daily reporting by Email or Text 3. Success in program is not dependent on how much weight lost but rather on how well you manage to change your lifestyle into the Intuitive Eater Model

8. Principles: 4. You are not asked to compare your success with others in program 5. You are expected to follow Intuitive Eater program which meets your needs 6. By end of 14 week program you will be fully engaged in a planned program of exercise 7. This is a guilt free program, we do not use guilt to motivate your new relationship with food or exercise

9. Principles: 8. You are only to enter this program because you want to, not to please someone else, or to gain the approval of someone else. 9. Do tell others you are involved with this program so that they can assist you to stay on your new programs of relating to food, exercise and weight management 10. Set realistic goals for yourself in program 11. Be realistic in your expectations of yourself in this program

10. Principles: 12. You are in this program for yourself, do not try to fix or change anyone else in program 13. Keep an open mind to all suggestions offered in program, try to get rid of the “yes…but” knee jerk response to new ideas offered. 14. Let go of critical, judgmental, and controlling attitudes so you can hear messages of hope, encouragement and support offered.

11. Accountability in Program ■Daily Fax or Email Facilitator ■Daily reporting on level of: ■Honoring Hunger of eating only with hungry ■Honoring Fullness by stopping eating when full ■Experiencing Pleasure & Satisfaction from Eating ■Experiencing Pleasure & Satisfaction from Exercising ■Dealing with Emotional Triggers

12. Why Accountability? ■Insures your personal commitment ■Identifies patterns or cycles which may be unconscious and not easily self-identified ■Encourages facilitator to identify what is working or not working for you ■Individualizes the program to fit your personal needs ■Encourages personal recommendations which will address your specific concerns

13. 4 Topics to be covered in Weekly Programs ■Part 1: Overcoming Triggers to Relapse ■Part 2: Developing New Relationship to Food ■Part 3: Developing a Healthy Exercise Program ■Part 4: Personal Testimonies and Sharing Time

14. Personal Testimonies and Sharing ■Sharing success stories from past week or from your current program ■Sharing concerns and issues which have come up over the past week ■Sharing strategies you have found which help keep you on track with Intuitive Eating, exercise etc… ■New ideas, articles, program, you have found which you think all could benefit from

15. Part 1: Overcoming Triggers to Relapse ■What are triggers to relapse ■The many faces of triggers which derail us ■How to identify them when they are happening ■What to do to overcome such triggers ■How to insure that triggers lose their power to derail in the future

16. 1. Possible Triggers while in program ■Disillusionment with the program ■Fear that complete change will never come ■Anger at the slowness of change ■Discouragement at the size of change (amount of weight loss, rate of weight loss, etc.) ■Disbelief that to sustain the changed behavior requires a change in lifestyle ■Use of excessive rationalization as to why it is impossible for you to implement the full program at this point in your life ■Claims that you have no time to work on the necessary changes

17. 2. Possible Triggers while in program ■Feeling as if you are facing a life of deprivation rather than feeling good about how full your life will be once you have implemented the lifestyle change ■Feeling that this takes too much effort, time, and money for the results ■Lacking in motivation to continue in your program of change ■Wanting to abandon your time-management schedule because it feels too demanding and intrusive ■Wishing you had never started this program of change

18. 3. Possible Triggers while in program ■Faultfinding with the professional staff and fellow members in the program ■Looking for something wrong with the program, fellow members, or staff to justify your quitting ■Feeling bored or overwhelmed with the efforts needed to make the change in your life ■Not liking the "new'' you; feeling that the "old'' you wasn't so bad, was easier to live with, was happier, was funnier, etc.

19. 4. Possible Triggers While in Program ■Fearful of others' newly found interest in you when before they ignored, shunned, or barely tolerated you ■Not really convinced of a need for change in your life ■Just wanting to achieve an end goal of change (healthy relationship with food, weight management and exercise program), and not wanting to change your lifestyle for full recovery ■Resentment that lifestyle changes require so much restructuring of your time, social support, and personal habits

20. Some Sources of Triggers ■Personal feelings and emotions at any time of day or night ■Times of days: on scale, meal times, work, driving etc… ■Times of year: vacations, holidays, anniversaries ■Words or attitudes of self or others ■Advertisements on TV, Radio, Billboards, Stores related to your trigger issues ■TV, Movies, Radio, Songs, Shows, with story lines related to your trigger issues

21. Watch Out for Emotional Triggers: ■Lack of commitment to change ■Lack of motivation ■Depression over the difficulty ■Boredom over the repetitious monotony ■Denial ■Discouragement ■Anger ■Suspicion ■Overwhelmed ■Resentful

22. Be on the Look out for Other Sources of Triggers ■Emotional Status ■Irrational Belief System ■Habitual Ways of Acting and Believing ■Value System ■Peer Pressure ■Overabundance of Choices ■Sense of Prosperity ■Propaganda ■Conspicuous Consumption

23. Part 2: Developing New Relationship with Food ■Identifying a Food Plan which is suited for you ■Identifying a Food Plan which can be implemented easily and fit into your current lifestyle ■Eating to Live not Living to Eat ■Eating to be stay healthy, not eating to stuff emotions ■Eating plan which works while eating out ■Understanding the Nutrition of Food ■Keeping up on What is new in the Food arena

24. 1. Overcoming Myths Related to Weight and Food Myth 1: Being overweight is due to bad metabolism - its your behaviors not metabolism Myth 2: Being overweight is due to bad genes – its your behaviors not your genes Myth 3: Being overweight is due a thyroid problem - its your behaviors not your thyroid Myth 4: Fat-free and low-fat foods are good for my food program - fat- free is not calorie free

25. 2. Overcoming Myths Related to Weight and Food Myth 5: Some people just can’t lose weight – it takes a lifestyle change which anyone can do Myth 6: Fat people are fit – there are health problems which stem from obesity such as diabetes, arthritis, heart disease, stroke, cancer Myth 7: Bodies plateau and it is impossible to lose weight after that – efforts to lose weight plateau not bodies

26. 3. Overcoming Myths Related to Weight and Food Myth 8: Bodies want to be the weight they get to – bodies do not want to be overweight Myth 9: Big Boned People are overweight due to their Bones – skeletal size of average man or woman does not differ much Myth 10: Obesity can be result of being too muscular – that weight could be marbleized fat Myth 11: How can I be gaining weight, since I do not eat? – increased body weight come from increased eating

27. 4. Overcoming Myths Related to Weight and Food Myth 12: It is not good to weigh yourself – the scale does not lie and is not in denial Myth 13: Dieting five days a week is a good plan – weight loss comes from a caloric deficit and requires a 7 day a week effort REMEMBER: Weight loss = calories in minus calories out

28. Part 3: Developing a Healthy Exercise Program ■Identify Benefits ■Combat Myths about exercising ■Combat Roadblocks to exercising ■Identify and overcome: Triggers to avoid, ignore, or stop exercising ■Look at what is new in exercise offerings

29. Benefits of Healthy Exercise ■Compensates for fat accumulation by burning calories ■Provides a "natural high'' by the release of endorphins ■Strengthens the cardiovascular and respiratory systems if aerobic type exercise sustained for at least fifteen minutes on a regular basis. ■Keeps the muscular system supple ■Keeps the circulatory system operating at its best ■Builds bone mass to combat osteoporosis.

30. 1. Myths about Exercise 1. Exercise makes you tired. Because heart rate and respiration is increased, a person becomes energized, alert, and awake after a period of strenuous exercise. 2. Exercise increases your appetite. The immediate effect of exercise is a decrease in appetite 3. Exercise is boring. Rigorous exercise results in the production of hormones called endorphins which give a feeling of well-being, a "natural high

31. 2. Myths about Exercise 4. With exercise you can reduce certain spots on your body. Where people lose weight is determined by their hormones. With proper exercise people can increase muscle tone in certain areas and can speed along the general loss of fat, which helps overall appearance but not necessarily in specific areas. 5. You have to have athletic ability to get the most out of an exercise program. A complicated program of sophisticated athletic activities is unnecessary. Simply walking a 1/2 hour to hour a day during time when you normally would have been sedentary is enough exercise to provide some balance in your life.

32. 3. Myths about Exercise 6. A health spa or gym is the best place to exercise. Health spas and gyms can be useful if you need a social atmosphere in which to exercise. However, the type of exercise needed for lifestyle change can be done effectively with no expense. 7. Exercise takes a lot of time and expensive equipment. You need only 30- 45 minutes of consecutive, brisk, full-body movement a day to gain the full benefit of exercise. You can do this in your home with your own equipment (e.g., stationary cycle, rebound trampoline, or rowing machine), or you can do it without equipment by walking, jump roping, etc...

33. Roadblocks to Exercise ■Not enough time; my schedule is already so full ■Implementing a program of exercise takes exceptional effort and planning ■The health club is too far away. It is not "on my way'' to anywhere ■An exercise program costs a lot of money. ■It is unpleasant to get all sweaty when you exercise ■Exercise can be so boring ■Exercise makes your body sore

34. Time for Exercise ■Make the exercise session a priority of the day ■schedule a regular, specific time of day for exercise. ■Choose a convenient time. ■Exercise in the morning before breakfast, in the afternoon before lunch, or in the evening after getting home from work, but before dinner.

35. Place for Exercise ■Choose an exercise easily performed around the house, e.g., treadmill, stationary cycle, rowing machine, jumping rope, rebound trampoline, jumping jacks, walking, running, biking, swimming. ■Perform exercises that can be done in an air-conditioned environment (stationary cycle, rowing machine, or rebound trampoline). Profuse sweating is not necessary for exercise to be worthwhile.

36. Reduce Costs of Exercise ■Choose an exercise which doesn't involve the purchase of equipment or club memberships, e.g., walking, running, jumping rope, etc.

37. Keep Exercise Interesting ■Try indoor exercise in front of a TV or while listening to motivational tapes or energizing music. ■Try outdoor exercise in tree-lined or park-like settings with interesting scenery and use a portable radio or tape player ■For either type of exercise, get a partner or group of people to exercise with; make it a social experience that will provide mutual motivation and encouragement

38. Start out Slow to Protect Your Body from Being Strained ■Slowly phase an exercise program in; help your body adjust to the increased activity ■Use warm-up and cool-down exercises to avoid muscle strain ■Wear the proper clothing and shoes to avoid body strain or injury

39. Estimated calories expended per hour Person weighing Person weighing 120lbs 180 lbs washing dishes 110 153 making beds 180 270 walking the dog (2MPH) 180 288 raking leaves 186 240 mopping 210 252 gardening 220 300 scrubbing (walls, tubs) 240 300 mowing lawn (push mower) 275 350 shoveling snow 530 768

40. Estimated calories expended per hour Person weighing Person weighing 120lbs 180 lbs aerobic dance 289 391 tennis (singles) 357 483 bowling 176 240 golf (carrying clubs) 212 288 running (10MPH) 765 1035

41. Why does aerobic exercise have minimal effect in accelerating weight loss when combined with a low-calorie diet? ■Many overweight/overfat individuals are unable to perform high amounts of exercise without subjecting their bodies to an undue level of orthopedic stress-thereby incurring an injury. High amounts of exercise are needed to promote weight loss, but the risk of orthopedic injury limits the amount of exercise that can be safely performed by many overweight/overfat individuals. ■Some individuals who exercise tend to reward themselves by resting and relaxing more after their workouts are over. As a result, the net change in their total 24-hour caloric expenditure levels may be virtually unchanged.

42. Why does aerobic exercise have minimal effect in accelerating weight loss when combined with a low-calorie diet? ■The "net caloric expenditure" of moderate aerobic workouts is relatively small. The net calorie cost of exercise is equal to the number of calories expended during an exercise routine that are used beyond the number of calories expended by an individual's resting metabolism (RMR) and other activities that the individual might have engaged in had he/she otherwise not been exercising

43. Net Caloric Expenditure for 4-Mile Walk in 1 Hour by a 150 lb. Person Variable Calories Expended Gross Caloric Expenditure for a 4-Mile Walk320 Resting Metabolic Rate for 1 Hour -70 Caloric Expenditure for Mild Physical Activity the Person Might Have Engaged in Had He/She Not Been Formally Walking-70 Net Caloric Expenditure of a 4-Mile Walk*180 *Note: One pound equals 3,500 calories.

44. Why to do aerobic exercise even if it does not increase rate of weight loss ■Improved aerobic capacity. - All other factors being equal, an individual with a high aerobic capacity will have a high physical working capacity ■Reduced risk of developing obesity-related diseases - such as diabetes, coronary heart disease, and hypertension ■Improved blood lipid-lipoprotein profile - specifically decreased triglycerides, and increased high density lipoprotein cholesterol (HDLC) - the "good" form

45. Why to do aerobic exercise even if it does not increase rate of weight loss ■Improved psychological status, particularly enhanced self-esteem, general well-being, and decreased anxiety and depression. a Increased fat loss to weight loss ratio (i.e., more of the weight lost is fat) ■Enhanced long-term weight management. Regular exercise is the most powerful predictor of long-term weight loss success. It helps to ensure that individuals not only lose weight, but also keep it off

46. It takes 2 types of exercise to lose weight and keep it off: 1. to burn a high number of calories (aerobic-type exercise), 2. to build and preserve muscle tissue (strength- training exercise). ■Muscle tissue enables you to lose weight and keep it off because it helps you maintain your resting metabolic rate, thereby allowing you to burn a greater number of calories when you're at rest.

47. It takes 2 types of exercise to lose weight and keep it off: ■An analysis of the available data indicates that, in general, the combination of a conventional aerobic exercise program with a severely calorie-restricted diet does little (if anything) to help preserve lean body mass during weight reduction.

48. It takes 2 types of exercise to lose weight and keep it off: ■It is important to keep in mind that the less lean body mass you have, the lower your resting metabolic rate will be. As a result, it is more likely that you will regain some or all of the weight loss you may have achieved. On the other hand, if you engage in exercise designed to improve your muscular fitness level at the same time you are losing weight, you will enhance the likelihood that you will be able to maintain your level of lean body mass.

49. It takes 2 types of exercise to lose weight and keep it off: ■As a consequence, the optimal exercise prescription for sound weight management is one that combines aerobic conditioning and strength training.

50. Part 4: Personal Testimonies and Sharing ■Sharing success stories from past week or from your current program ■Sharing concerns and issues which have come up over the past week ■Sharing strategies you have found which help keep you on track with food, exercise etc… ■New ideas, articles, program, you have found which you think all could benefit from

51. Who needs to be on your Social Support Team? ■Your spouse or significant other ■Family members ■Relatives, including aunts, uncles, cousins, etc. ■Close friends ■Co-workers ■Social contacts ■Neighbors ■Members at church, synagogue, or temple ■Other ____________ (fill in the blank)

52. What is a Social Support Team? A team of people you have put together to provide you: ■Positive feedback ■Encouragement ■Understanding ■Healthy Confrontation & emotional support and understanding as you struggle with the lifestyle changes necessary to make you successful in getting and keeping your weight off

53. What is Helpful Confrontation? It consists of ■compliments on your success ■reminders when you deviate ■understanding when you are discouraged and hurting

54. What does a Social Support Team do? ■Accept no excuses from you why you can’t do this lifestyle change for yourself ■Help you to maintain your motivation and commitment to this lifestyle change ■Try to do nothing which would try to give you a TRIGGER or lead you into a RELAPSE situation ■Assist you to restructure your home, work site, and social life to be more conducive to your lifestyle change

55. Why you need a Social Support Team? You need positive social support so you will not: ■Lose interest in your efforts & feel like your efforts are meaningless ■Feel like your efforts go un-rewarded ■Lose the motivation to change ■Forget the reason for changing ■Feel discouraged when you have hit a plateau where your changes are less apparent ■Feel depressed because the changes require too much effort & your work is un-rewarded ■Want to give up since there is no visible change in your life or in the ways others react to you

56. Tasks for you need to delegate to your Social Support Team: 1.Give open and honest feedback concerning your progress and efforts to change your lifestyle 2.Positively reinforce you for your efforts to change rather than just reinforce the changes which you make 3.Assist you in monitoring your efforts to change 4.Listen and be understanding when you are depressed over an apparent lack of progress

57. Tasks for you need to delegate to your Social Support Team: 5.Kick you in the butt when needed to keep you on track 6.Accept you in your new lifestyle and to continue to reinforce you in these changes 7.Point out needed alterations in your lifestyle without nagging, harping, complaining, or criticizing

58. Steps to make your group members of your support team: 1.Share your concerns, fears, hopes and insights with one another 2.Share telephone numbers & email addresses 3.Maintain and encourage a sense of humor during the re-adjustment time of lifestyle change 4.Call or write one another during the week to reinforce each other's efforts 5.Call or write one another when you are discouraged 6.Celebrate each other's progress and efforts

59. Steps to make your group members members of your support team: 7.Encourage one another to stick to the program of lifestyle change 8.Take each other seriously and provide support when discouraged or weakening 9.Be tough with one another so that when the going gets rough you can confront each other to stay on track 10.Reward each other's attendance at group meetings and recognize that just being there is a sign of wanting to change

60. Steps to make your group members members of your support team: 11.Openly admit to one another how hard it is to change one's lifestyle 12.Brainstorm and share tips on what works in getting through the rough stages and plateaus in the weight loss process 13.Share insights and information to make the weight loss and lifestyle change process more palatable 14.Give permission to confront each other in order to re-focus on the serious and difficult task of lifestyle change and weight loss

61. Get rid of these crazy messages about seeking out support: ■I should be able to do this on my own. ■It is a sign of my weakness to ask others for support ■I am embarrassed to let others know of my personal weaknesses ■I should never burden anyone else with my feelings, personal concerns or problems ■If I let others know what I am trying to do, they will always be on my back ■I hate to be reminded of things I know I need to be doing for myself

62. This Program Works as long as You Work the Program! Best of Luck in your Efforts