News from Shape Up America!
September 2006
Shape Up America! Newsletter


Ready? Get Set! Go!
Part III: Listening Your Way to Weight Loss
by Barbara J. Moore, PhD
A physician who authored an article that appeared in The New York Times made the provocative statement that "volumes of data attest to the power of coercion in shaping behavior."1 Sometimes coercive circumstances can force weight loss, even in patients who have been resistant. One example is a truck driver with type 2 diabetes who faced losing his job if his condition worsened to the point of requiring insulin injections. After many months of dieting without success, the threatened job loss precipitated a 30 pound weight loss and dramatic improvements in his blood sugar levels. Another example is overweight military personnel who face forced separation from the military and loss of benefits if they fail to lose weight. This threat occasionally, but not always, produces weight loss. But under ordinary circumstances, we do not condone the use of coercion in overcoming resistance or motivating people to lose weight. In the cases described above, the leverage or coercive power did not lie with the health care professional facilitating the weight loss.

Motivating people to lose weight is a lengthy process that requires skillful negotiation and well-honed listening skills. The use of coercion to effect behavioral change will quickly be met with resistance. There is evidence that advice from a physician or other influential health care professional can stimulate the behavioral change process.2 The person receiving the advice can then move the process forward with the support of a properly trained health care professional, or occasionally on his own.3

In parts I and II of this series, we provided a current model for behavioral change and included ways in which this model can be tailored specifically for weight loss. In part III, we will discuss RESISTANCE to change. The bottom line is that the way to avoid resistance to change is to recognize that your client — let’s call him or her "Terry" — is in charge of the decision to change. Your job as advisor is to "make the case" for a specific behavioral change, but Terry makes the decision. This respect for Terry’s sovereignty is fundamental to avoiding resistance.

Listen for the Buts

Resistance is like the tango — it takes two. Resistance is the unhappy result of an interpersonal exchange that has gone awry, which, in this case, centers around Terry’s unwillingness to change. It is natural for most people to stay the same rather than change. That is understandable, since changing behavior requires work and expects us to abandon familiar habits and venture into the unknown.

In your discussion with Terry, resistance is manifested by the word "but" as in, "Yes, but..."or "I want to do that, but..." If you are trying to guide Terry toward weight loss and are frustrated from hearing excuses, you can remedy the situation by steering the discussion in a new direction. Consider this checklist to avoid resistance or address it once it has emerged:

  • Rapport: Take a time-out to establish or re-establish a rapport with Terry. (For example, "I’m a little confused. Let’s step back a bit and see if you can help me understand...")
  • Context: Ask questions about what is going on with Terry. ("Since I saw you last, what’s been happening? Has anything changed that I should know about?")
  • Readiness: For a specific behavioral change that Terry has selected to address (for example, cutting back on desserts from every day to every other day), reassess confidence and/or importance on a scale of 1 to 10 and thoroughly discuss the rankings with Terry before moving forward (see Parts I and II of this series).
  • Tone: Ask questions in a respectful manner that indicates a genuine curiosity and concern about the answers.
  • Engaged Listening: Employ active listening skills to seek clarity and to summarize Terry’s answers, to be certain you have heard and understood correctly. ("Let me make sure I understood what you just said. I think I heard you say you want X and feel ready to do Y, but a special circumstance Z has come up, so right now you feel you have more than you can manage. Do I have that right?")

The emergence of resistance signals a breakdown in rapport with Terry that must be mended in order to make progress. To re-establish rapport, ask an open question that shows you realize there has been a misstep and that you earnestly want to learn what is happening. For example:

  • I feel I may have misunderstood something. Help me understand how you feel about X at this time. Is this a good time to make a change?
  • Perhaps I misunderstood. How important is X at this time? (reassess importance)
  • Perhaps I misjudged your confidence. How confident are you that you can do X at this time? (reassess confidence)

Avoid the Shoulds

A signal that you need to back off is the word "should." If you hear yourself saying, "You should do X," you have overstepped a boundary and are inviting trouble. Rather than giving Terry unwanted advice, your job is to:
  • Discover why weight management is important to Terry’s health and well-being.
  • Build Terry’s confidence to make a specific change that Terry has selected.
  • Provide relevant expert information on weight management, in general, and on the specific change under consideration, in particular.
  • Help Terry build necessary weight management skills as needed.
  • Guide the process.
  • Help Terry set the agenda.
  • Provide ongoing support.
  • Affirm with Terry that the decision to change is Terry’s alone.

You may learn about fears you did not know existed or about a new stressful circumstance that must be addressed first. By far, the most important way to avoid resistance is to remember that Terry is in charge of change. From an ethical, as well as a practical perspective, the decision to change is Terry’s, since Terry must live with the change. For a wealth of valuable information and guidance on health behavior change, see Rollnick, et al.4

Part IV will address issues relating to stress, since stress undermines efforts to change behavior.

Another Nail: The Case Against Sugar-Sweetened Beverages
by Barbara J. Moore, PhD
A landmark study of sugar-sweetened beverages and weight gain was published in The American Journal of Clinical Nutrition.1 Because of the momentous importance of this study, I reviewed it below, but encourage interested readers to obtain a copy for themselves. The study was a qualitative "systematic review" of the published literature on sugar-sweetened beverages, meaning only studies that met strict criteria were included in the analysis. Thirty studies met the inclusion criteria:
  • 15 cross sectional studies – which are "snapshots" of a population taken at a moment in time seeking to identify associations between weight change, for example, and a factor, such as sugar-sweetened beverage intake.
  • 10 prospective cohort studies – which are more like "videos" that follow people over a period of time to identify associations between weight change, for example, and a factor that is suspected as contributory.
  • 5 clinical trial/intervention studies – which manipulate a single variable, such as sugar-sweetened beverage intake, and examine the results of that manipulation on weight change, for example, over a long enough time period to detect an effect.

The relevant details of each of the 30 studies are summarized in three tables in the published study.

The 15 cross-sectional studies were of varying design and statistical power. Two well-designed studies—Growing Up Today (GUT)2 and an NHANES study3—involved extremely large numbers of children. Both of these studies implicated sugar-sweetened beverages as a significant contributor to excessive weight gain. Several other, but not all, cross-sectional studies were consistent with this finding.

Of the 10 prospective studies, only three failed to show any association between sugar-sweetened beverages and weight gain.4–6 Of those three, one was quite small—only 166 subjects—and may have lacked sufficient statistical power.4 The second was larger, but did not study children.5 The third study was large—1345 children—but the follow up period was short (less than 1 year) and may not have been of sufficient duration to detect an effect.6 Of the positive studies that did find an effect, four were very large, involving many thousands of participants.2,7–9

Of the five clinical trial/intervention studies, 10–14 all five implicated sugar-sweetened beverages as contributing to weight gain, including two studies in children. The authors conclude that for weight management "sufficient evidence exists for public health strategies to discourage consumption of sugary drinks..."

The bottom line is that cutting back on consumption of sugar-sweetened beverages may help you lose weight or prevent weight gain in the first place. Limiting sugary beverages may also help prevent or treat overweight in children.

Getting Started: How to Begin Building Leg Strength
by Michael Roussell
The exercise featured in the July Shape Up America! newsletter was designed to help people begin to strengthen their arms and shoulders from the seated position. This month, we continue with the beginner theme and look at an exercise that can be used by those with limited strength in their leg muscles due to disuse, disease or disability.

When first starting out with bodyweight exercises, a bodyweight squat may seem like a daunting task. It is a movement that requires a certain level of strength AND flexibility throughout the whole lower body. It is important not to shy away from this exercise due to its perceived difficulty. The key is to begin with similar easier movements that will allow you to build strength and flexibility in your lower body as you work up to a full bodyweight squat.

The exercise that will allow you to do this is a partial wall squat. To complete this movement, you won’t need any exercise equipment, just a wall and perhaps a chair (if you need extra help with balance). To start, stand with your back against the wall, your feet slightly wider than shoulder width apart, and your heels 6-12 inches away from the wall. If you use a chair for support, place it to one side of your body and grasp it with one hand. To start the movement, slide your back down the wall with your knees straight out in front and in line with your toes. Remember, this movement is called a partial squat, so you should only squat down about 6 inches. Make sure your back stays in contact with the wall. When you reach the bottom of the movement, pause, push through your heels and straighten up. You have now completed 1 rep.

Ideally, you want to work up to 3 sets of 10 reps. But when you first start out, it is fine to only do 1 set of 5 reps. Listen to your body as you work, so you don’t over do it. Add just a couple more reps each week. Once you can complete 3 sets of 10 reps, try going down 1 or 2 inches deeper. After several weeks, you may go even deeper. Proceed incrementally to increase the depth of your squat until you reach the full squat, meaning your thighs are parallel with the ground. (Note: As you increase the depth of your squat, you may need to move your heels further from the wall). With consistent work, you will surely develop leg strength and flexibility that will improve your health and quality of life.

Healthy Eating Hits the Greens!
The Ladies Professional Golf Association (LPGA) and Canyon Ranch have teamed up to create The LPGA Cooks with Canyon Ranch, a delicious collection of your favorite players’ recipes, along with some of the most popular dishes from the Canyon Ranch kitchens.

From entrees and side dishes to snacks and desserts, these recipes are great-tasting and nutritious! In addition to sharing some of their own world renowned dishes, the Canyon Ranch chefs took the LPGA stars’ recipes one step further and made sure they met the healthy standards for which Canyon Ranch cuisine is famous. As a plus, each recipe includes a nutritional analysis.

Here’s a taste of what’s you’ll find from these LPGA Tour & World Golf Hall of Fame Members and the kitchens of Canyon Ranch:

Avocado, Mango & Walnut Salad (Karrie Webb)
Warm Quinoa, Spinach & Shiitake Salad (Amy Alcott)
Turkey Chili (Nancy Lopez)
Dijon Chicken (Beth Daniel)
Mexican Salad (Judy Rankin)
Fresh Marinara Sauce (Canyon Ranch)
Roasted Cranberry Pumpkin Crunch (Canyon Ranch)
Double Chocolate Chip Cookies (Canyon Ranch)
And much more...

Order copies for yourself, family, friends and business associates. It makes a great gift! And as an extra'll be supporting a great cause. Proceeds of the sale of this colorful 60-page booklet ($10 plus S&H) will benefit the Shape Up America! childhood obesity campaign. To order online, go to:

Recipe of the Month
This chili recipe is a favorite of LPGA Tour & World Golf Hall of Fame Member, Nancy Lopez. You’ll find this recipe and many more delicious dishes in The LPGA Cooks with Canyon Ranch.

Makes 5 (1-cup) servings


  • 1 Tbsp. olive oil
  • 1 cup chopped sweet onions
  • 1 Tbsp. minced garlic
  • ¼ cup chopped yellow bell peppers
  • 1 lb. ground turkey
  • 1 28-oz. can crushed organic tomatoes, undrained
  • 1 16-oz. can red kidney beans, drained and rinsed
  • 1 Tbsp. chill powder
  • 1 Tbsp. sugar
  • 2 cups low-sodium chicken stock
  • ½ tsp. garlic powder
  • 1 tsp. Tabasco sauce
  • 1½ tsp. sea salt
  • 1 tsp. dried basil
  • ½ tsp. dried oregano


  1. In a large skillet, sauté onions, garlic and bell peppers in olive oil over medium heat until onions are translucent. Add ground turkey and cook until browned.
  2. Add remaining ingredients and stir well to combine. Reduce heat to low and simmer for 1 hour, stirring occasionally.

Nutritional analysis per serving: 280 calories, 27 grams carbohydrate, 4 grams fat, 73 milligrams cholesterol, 33 grams protein, 395 milligrams sodium, 8 grams fiber.

Source: The LPGA Cooks with Canyon Ranch, LPGA and Canyon Ranch, 2006.

phone: 406-686-4844

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Editor: Adrienne Forman, MS, RD

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