In the July newsletter, we first discussed the stages of behavioral change as applied to weight loss. I have specially tailored the following table to highlight the stages of change for physical activity. At each stage of change, this table summarizes just a few of the many issues, barriers and concerns that adults experience as they move from a sedentary to an active lifestyle. Note that the questions, needs and concerns of the individual differ dramatically depending on the stage. The strategy to move from one stage to the next must be tailored accordingly.

Most physical activity motivational experts believe that progress from one stage to the next is not linear.³ Some people take action to increase their physical activity but then return to a less active stage, and begin the process all over again.

Assess your current stage

To move from one stage of behavioral change to the next higher level, it helps to: (1) increase your awareness of the importance or value of a more active lifestyle and (2) increase your confidence that becoming more active is possible, fits with your lifestyle and can be done safely.⁴ Start out using a scale of 0 to 10 to rank how important physical activity is to your health (e.g., reduces diabetes risk, lowers cholesterol and glucose levels, improves insulin sensitivity).

Healthcare professionals can also use this ranking to learn what their patients know about the benefits of physical activity. To increase confidence, it helps to focus specifically on HOW individuals can move forward with incorporating physical activity into their lives. Discuss different types of exercise to learn what is most appealing and realistic. Starting to exercise may feel like a huge step, so break the process down into small steps that seem manageable. Consider a reward for mastering one or two steps in the process of becoming more active. If you think you may have identified a good strategy, you might conduct a reality check by asking: On a scale of 0 to 10, how confident are you that you can…? (e.g., walk for 10 minutes during your lunch break 3 days a week.)

Probing your attitudes and goals regarding physical activity is a complex undertaking that requires you to have an honest and constructive dialogue with yourself. Here are some questions you may want to ask yourself:

• Are you interested in becoming more active at this time? Why?
• Do you understand that physical activity yields large health benefits?
• Have you been physically active in the past? If yes, why did you stop?
• What is different at this time that may contribute to success?
• What factors may interfere with success at this time?
• Do you have a plan to address those factors?
• Is excess weight interfering with your ability to be physically active?
• Do you want to diet to take weight off your joints BEFORE becoming more active?
• Do you believe that becoming more active would make you feel better about yourself?
• Is your busy schedule interfering with becoming more active?
• Does your worksite have exercise facilities?
• Are you willing to commit the necessary time?
• Are you willing to commit the necessary resources?
• Are you comfortable going for a 10-minute walk to start?

The point of all of this is to elevate your (or your patient’s) appreciation of the importance and value of physical activity and to build confidence that there are activities you will enjoy doing on a regular basis. As a reminder: For good health, the goal is to accumulate at least 30 minutes of moderate-intensity physical activity on most (5 or more) days per week. For weight management, a more ambitious goal of 60 minutes or more may be required.

When setting up a workout to fit into your crazy holiday schedule, you’ll want your workouts to be brief, but effective. In previous issues of this newsletter, we introduced a training method called supersets. A superset is when you complete two exercises back to back without any rest. We are going to take this idea one step further and complete three or four exercises in a row without any rest in between. These are often called giant sets.

Here are some examples of workouts that you can use during the holiday season to increase your activity level without a huge time commitment. For many of the exercises, variations have been provided in previous articles. Please use the variation that best suits your level of fitness. Consult the illustrations below and the links to previous articles for more details.

Beginner
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 2

Inverted Row x 8
Push Ups (from knees) x 8
Rest & Repeat x 2

Intermediate
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 3

Inverted Row x 8
Push Ups (from knees, or, when you are ready, from toes) x 8
Rest & Repeat x 3

Advanced
Bodyweight Squats x 8
Abdominal Crunches x 8
Rest & Repeat x 4

Inverted Row x 8
Push Ups (from toes) x 8
Rest & Repeat x 4

You will find this series of exercises to be extremely time efficient and effective. So don’t let your busy holiday schedule get in the way of your weight loss or fitness goals. Plan ahead and try these workouts today so you are ready to beat the holiday weight gain!

I feel that the most important choice in this process is in the selection of a qualified, board-certified surgeon. It is important to research the surgeon thoroughly. Make an appointment to meet with him/her, and talk to his/her patients. Go to informational meetings and support groups before a decision is made. Surgery is not for everyone, and the risk of surgery vs. living with obesity must be weighed (no pun intended!). I enjoy food, but don't look to it for comfort, as many obese do. It is very important to ask how many of his/her patients have died after having this procedure. This number needs to be very, and I emphasize very low—much below the national average. The surgeon I chose had not lost any patients post-op. This shows not only his skill as a surgeon, but also the selection process of good candidates for this type of surgery. Everyone is not a candidate, even though a person may desire it and have insurance coverage for it. Also, it’s important to ask what is the probability that a second procedure will have to be done as a result of this surgery. This was also a large consideration on my part, directly related to the surgeon choice and type of surgery I opted for.

It is important to be able to visualize what life will be after surgery, and if you are up to that challenge. Exercise needs to be there, as well as control with food limitations and restrictions. I have found that my tastes and desires have changed dramatically, and I was not very hungry for the first 6–8 months after surgery. This is a huge benefit to weight loss, obviously. By the time my hunger and appetite did return, my tastes were different, and it was easier to choose foods to nourish my altered gastrointestinal system. Protein is now my priority, and needs to be part of every meal. If it isn't, I don't feel well and healthy.

I have lost about 80 pounds, and feel so much better. Activity and exercise are so much easier now that I don't have to carry the "other" person around with me. My family is thrilled and we are relieved of the health threats that obesity poses. And I love to buy new clothes, in any store that I want!