I wanted to share some recent research that may
be helpful. It has been a privilege to be with
you on your journey, and as a continuing
commitment on my part, I keep trying to learn
more that can help you maintain your success or
help you further if you get stuck.

There has been many areas of research into
obesity over the last few years, more than ever
before. Some are looking at the fat cells and how
they play an active role in causing obesity.

Insulin resistance is another topic that people
are trying to get to grips with, as it leads
often toobesity before diabetes. Still others
are looking at the role of various gut hormones
in reversingobesity. However, as you are probably
aware by now, one of my main areas of interest
is the brain, and how this causes overeating.

When you came to see me, I explained about the
pleasure centre, and how this seemed to be
overly active in those struggling with their
weight, so that they were really fighting an
addiction to carbohydrates.

The ability of surgery to reverse this is
variable, and we are only just starting to
understand that surgery does, through still
undiscovered means, decrease the need to eat,
andwhy this can reverse in some patients around
the one year mark, so that cravings return.

Research has discovered that there is another
important area in the brain that is meant to
balance the urge and place it in the larger
context of life. It says: “If I do this now,
there will be consequences later!"

This area is in the prefrontal cortex, and we'll
call it the Control centre. It's job is really
to control impulses and delay gratification. It
matures in women at age 23 and men at 25.

By now you will have realised the importance
of this part of the brain - its the angel on
your right shoulder that says “You don!t need
that" (the Control centre) but it usually loses
out to the devil on your left shoulder that
says “But it looks sooo yummy!" (the pleasure
centre).

The interesting research that has come out in
the last few years relates to brain scanning
that has shown that this part of the brain is
very variable in its response to food, in
particular, chocolate.

Compared to "normal" people, the Control centre
is underactive in smokers and those with a high
BMI. It is also rapidly inhibited by alcohol-
which is why restaurants bring you the drinks
first, so you will order much more food than
you intended.

This means that bigger people actually do have
a problem with control (as many of you told me)
but it is neurophysiological, not a character
flaw.

We also know that it takes effort to maintain
the control, and if anything else gets in the
way of this effort i.e. other stresses, there
may not be enough ego strength left over to stop
eating.

The importance of realising that this part
of the brain may not be functioning normally
is that we have assumed that it is behaving
properly. We thought that if we did the surgery
and told you what to do, why of course you'd
do it!

The reality is that we can't rely on this to be
the case. For some people, the old inability
to turn down what is in front of them, calling
to them, becomes just as real again.

We don't know what reverts, but we do know that
there are strategies that can help fight it.

Nearly all these strategies are done best in
partnership with others, since we just said
that you can't rely on your own brain.

They also take time: set your alarm for 10
minutes earlier in the morning, and revise
yesterday and plan for today in the light of
what you are learning or want to try out.

Finally - these strategies don!t have to just
be about weight - they can be about anything in
your life that you want to change.

Strategies to stay on track:

1. Become aware of the risks and long term negative consequences of your behaviour. Learn from those that have gone before you - lost weight, and then regained it. Listen to their stories and what they think went wrong for them. Warn those around you to let you know if they see you going down the same track.

2. Tell people about your goals. We become what we say we are. If we tell people we have had surgery to lose weight, we will act like people losing weight and we will lose weight. If we hide the surgery and try to act like people not losing weight - guess what - we won!t lose weight!

3. Don!t look too far into the future. Live one day at a time. Create short term goals that are achievable, and revise as they are approaching achievement, to finally reach your long term goal.

4. Constantly remind yourself what you have already achieved, and look back at how far you have come. Take strength from this.

5. Develop practical solutions to tempting situations before they arise. Plan what you will eat at a party and then stick to it. Know that alcohol will lessen your resolve, therefore stick to no or low alcohol options. Pick your children up from the door at their friends parties. Identify the dangers and seek help to find solutions.

6. Replace old bad habits with good new ones. See the arrival home at the end of the day as the signal to reward yourself with a fun activity or relax with a book, rather than heading for the fridge. Automatically choose low alcohol options at restaurants. Plan with extra non-food treats if PMT triggers cravings.

7. Deliberately marry up temptations with bad images- chocolate reminds you of a traumatic event. Wine reminds you of embarrassing experiences. You can even create computer images that mix your favourite temptation with something you hate - this has been shown to help people resist temptation (we could have a competition on this one, but keep it in good taste!)

8. Avoid temptation rather than trying to fight it. If you can!t resist the candy at the supermarket checkout, buy your groceries online or send your partner to do the shopping. Shop at 10 a.m. when you are not hungry. Join the extended family for the Sunday gathering after they have eaten. Don!t have coffee with the jealous friend who will try and make you eat (“You!ve done so well, you can afford to have a little treat! Did they really say that you can!t eat this?").

9. Improve your working memory. Go online and do memory exercises. Train yourself to notice things around you. Learn new things - a language, a dance, a musical instrument. Try new hobbies. See if you enjoy using your hands to make things.

10. Realise that other things that sap your mental energy will lessen your resolve. Learn to cope with stress in safe useful ways. Meditation is useful here. Plan energy restoration breaks into your day (especially you mothers!).

We need accountability to keep on track. Rope in friends and family, as well. Use “other control" until you can develop new paths in your brain that are “self control."

Try it out and let me know how you get on.

Create your life.

David Schroeder