Shape Up America! Newsletter
Ready? Get Set! Go!
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.
Part III: Listening Your Way to 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
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
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
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
Tone: Ask questions in a respectful manner that
indicates a genuine curiosity and concern about the
Engaged Listening: Employ active listening
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
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
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
- 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
- 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
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
studiesGrowing Up Today (GUT)2 and an
NHANES study3involved 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.46 Of those
three, one was quite smallonly 166
have lacked sufficient statistical
power.4 The second was larger, but did
not study children.5 The third study was
large1345 childrenbut the follow up
short (less than 1 year) and may not have been of
duration to detect an effect.6 Of the
positive studies that did find an effect, four were
very large, involving many thousands of
Of the five clinical trial/intervention
studies, 1014 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
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
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
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
benefit...you'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!
campaign. To order online, go to: http://spiritretail.com/lpgacookbook/sp-bin/spirit
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,
- 1 16-oz. can red kidney beans, drained and
- 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
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
Add remaining ingredients and stir well to combine.
Reduce heat to low and simmer for 1 hour, stirring
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.
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Editor: Adrienne Forman, MS, RD