To manage stress, it is helpful to consider the well known "Serenity Prayer" that is the opening lines of a prayer composed by Reinhold Niebuhr in 1943:

God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and the wisdom to know the difference.

Rollnick et al.¹ borrow their metaphor of a "stress bucket" from Powell and Enright² and use it to examine the causes, consequences and remedies for stress. Visualize a bucket with water taps flowing into it (the inflow represents the various causes of stress). The taps running from the bottom of the bucket represent the remedies that help to reduce your stress level. You can imagine that if there are lots of stressors, the water flowing into the bucket overwhelms the water flowing out, and the water level (i.e., the stress level) inside the bucket starts to rise dangerously. Or envision a balloon filling up with air, with the pressure inside the balloon rising until the balloon is in danger of bursting.

In the table below, I have adapted the framework of Rollnick to present the three components of the stress bucket—the causes, consequences and solutions. You’ll need to take out or add to this framework so that it reflects your own situation.

Causes of Stress (factors that increase your stress)	Symptoms of Stress (consequences of your high stress level)	Solutions (ways to relieve your stress)
Financial worries	Your heart races	Go for a walk
Marital difficulties	Inability to concentrate	Mediate, do yoga
Hostile work situation	Exhaustion	Take action (e.g., change jobs)
Parental difficulties	Relentless worry	Take a “time out” (e.g., enjoy a candlelit bath, massage, or weekend getaway)
A quarrel with a loved one	Restless behavior	Explore nature (e.g., gaze at birds or wildlife, go hiking)
Illness	Sleeplessness or disrupted sleep	Work out at the gym or work in the garden
Add other personal stressors here	Add your personal symptoms of stress here	Add your personal solutions/stress reducers here

Put together your personal stress bucket, and amend it as needed. You may discover that certain things that seemed highly stressful at one time may subside over time. Other unanticipated factors may enter your life and cause stress as you move forward on your weight loss journey. So revisit your stress bucket frequently.

Depending on the stress level in your own particular life, realize that there are indeed times when your stress level is so high, it is best to put your weight loss plans on hold. But, whether you are trying to lose weight or not, learning how to reduce stress is worthwhile because it will help you feel better.

Serenity Sets the Stage for Acceptance or Action
You may wonder how to get enough serenity to reduce the stress in your life. There are various types of yoga or other meditations that can help you breathe deeply, release stress, grow calmer and focus your attention. Start out by closing your eyes and taking a deep breath. Gently, but firmly focus your attention on the problem at hand. Take another deep breath as you focus. Now see if you can clearly describe what is causing you stress so that you can take the next steps described below.

It is critical to identify which stressors can be changed and which can not. That is why the Serenity Prayer can be helpful. It asks for enough serenity to think clearly about the stressors and to identify what you CANNOT change. This helps clarify your task because if you cannot change something, you must learn how to accept it. The Serenity Prayer does not tell you HOW to accept those things you cannot change. But you will experience relief that comes from knowing what the task is—accepting what you cannot change.

On the other hand, if change IS possible and it would reduce your stress, then the Serenity Prayer calls for courage to make the necessary change. Since making changes means abandoning the familiar and venturing into the unknown, it may, indeed, require courage. If stress is an important barrier to your weight loss success, then you must summon the courage and make the necessary change(s).

For weight loss, here are a few sample stressors that you may want to look for:

• Someone is pushing food on you (e.g., parent or spouse) and you don’t know how to resist without hurting your relationship. For more information on how to handle this situation, check out "Home for the Holidays."
• Your emotions are unsteady because of a home or work situation and you discover you are overeating, hoping that food will soothe your emotions.
• You feel your eating is out of control in some settings or you are bingeing on certain foods and don’t know how to stop. For more information see "If Food Binges Threaten, Don’t Fly Solo."
• Your spouse or significant other is unsupportive (or even sabotaging your efforts) and you are not sure what is more important—losing weight or preserving your relationship.
• You are feeling paralyzed by worry and can’t take on one more obligation to exercise or monitor your diet at this time.

We will tackle some of the above topics in future issues of this newsletter. If any of the above applies to you, it is time to get out the stress bucket to figure out what is causing the problem, how it is affecting you, and what steps you can take to remedy the situation. Remember that serenity comes to those who summon it.

The last line of the Serenity Prayer calls for the wisdom needed to discern those things you can change from those you cannot. It is helpful to realize that wisdom can sometimes be acquired through experience. You may try to change something, yet eventually come to learn that it cannot be changed. Or you may decide to seek the advice of a properly trained professional to help you with your concerns. As always, the choice is yours and yours alone.

This sounds like terrific news. Yet it is NOT the important take home lesson of the DPP. The group that did best of all in the DPP was the "diet and exercise" group — that is, the group that underwent lifestyle change. The New England Journal of Medicine (NEJM) recently confirmed our interpretation of the DPP — a whopping "58% reduction in the progression to diabetes in the group that underwent caloric reduction and regular exercise."⁴

It is wonderful that metformin is available to those at high risk for type 2 diabetes who are having a hard time changing their diet and exercise habits. But to fail to mention the even better strategy of lifestyle change — better because it is even more effective and less costly — does a disservice to the millions of people who are now at high risk for type 2 diabetes, the leading cause of blindness and amputation and a major contributor to nerve damage, kidney failure and heart disease. As stated in the NEJM article, "attention to diet and exercise remains our best hope for reducing the rising rate of diabetes."

Bottom Line: Lifestyle change remains the most effective way to stop Diabesity®.

NOTE: Diabesity® is a registered trademark of Shape Up America! Use of this term for any purpose is strictly forbidden without the express written consent of Shape Up America! For inquiries, please contact us at askshapeup@shapeup.org.

Take Advantage of Your Lunch Hour
In recent years, as people’s lives have become more demanding, lunch hour has become a prime time for exercising. Take advantage of this time. Going for a walk each day at lunch is not only a great way to increase your daily activity, but it can rejuvenate you for the second half of the work day, helping to prevent the midday energy slump.

To help you stay true to your commitment to exercise at lunch, find a work buddy to go with you and pack your lunch. Walking with friends or colleagues will create accountability. This is one of the "secrets" to exercise consistency and many successful weight loss programs. It is a lot harder to skip out on your lunchtime walk when three other people are counting on you to be there.

Packing a lunch is a great idea for two reasons: It puts you in charge of your food choices, so you can have a nutritious lunch each day. And you will save a lot of time by not having to travel to a deli or restaurant and wait for your order before you’re able to eat. By bringing a bag lunch, you’ll have more time to exercise (plus brown bagging your lunch is cheaper!)

Exercise at Your Desk at Home or On the Road
You don’t have to be at a gym or health club to exercise. Performing a couple sets of bodyweight exercises at a desk is a great way to fit activity into your daily schedule and give yourself an energy boost. Here are some sample exercises:

Desk Pushups: Stand at an angle with your hands on your desk, arms straight, shoulder-width apart. Keep your feet together with your weight on your toes, far enough from the edge of your desk so that you can keep your back straight for the entire pushup. Slowly bend your elbows and drop your body toward your desk. Pause, and then push through your hands until your arms are straight again. That is one complete desk push up. Work up over a period of weeks until you can complete 10-15 reps.

Wall Squats: Stand with your back against a wall. Place your feet far enough away from the wall so that you can lower yourself about 6 inches (or, if you are more advanced, lower yourself into a seated position) and hold for 30 seconds before pushing back up to a standing position again. Repeat 3 times.

Walk or Bike to Work
Consider walking or biking to work. As more employers learn about the increased productivity, reduced absenteeism and lower insurance costs of physically fit employees, workplaces are more receptive to promoting exercise by becoming activists for non-automotive forms of commuting. Some are setting up bike racks or installing gyms and showers at worksites. Become an advocate for worksite wellness.

Park Farther Away
Many people live too far from their place of employment to walk or bike to work. However, you can still add more physical activity to your daily commute by parking farther away from the entrance to your building. Look at it as a great opportunity to burn calories and exercise. Let’s say you intentionally park farther away and it takes you 7 minutes to get to your desk. At the end of the day you will have to walk back to your car, so that’s another 7 minutes. Plus if you get a walking group together for lunch and you walk 20 minutes during your lunch hour, you have now tallied up 34 minutes of extra physical activity. That’s huge! If you walk a 17 minute mile, you can cover two miles in those 34 minutes, which amounts to burning about 200 calories (the rule of thumb is 100 calories burned per mile). Combine that with the resistance exercises performed at your desk twice a day and it really adds up!

As you can see, the above strategies for adding physical activity to your daily schedule are easy and simple to implement. Reread the strategies above and think how you can apply them to your life, starting tomorrow. You have the tools to succeed; go out and make it happen.