Jean had more than her fair share of emotional, financial, and physiological stress. She was struggling to support herself and the three grandchildren who lived with her on her salary as a school cafeteria worker while dealing with her prediabetic medical condition: high blood pressure and knees that hurt badly when she walked. Because of her weight, her self-esteem was in the basement, and her confidence in her ability to lose weight was almost zero. "To be honest with you," she said, "I don't think you can help me. I've been dieting on and off since I was 12. I've tried every diet in the world. I've lost 10 pounds more times than I can count, but I've always gained them back—and more."
While empathizing with Jean, I also knew it was important to give her realistic hope. So I asked her whether anyone had ever taught her how to diet. She was puzzled. I gave her some examples: "Did anyone ever teach you how to motivate yourself every day? Or enjoy every bite you eat? Or give yourself credit every time you follow your plan? Or get right back on track when you make a mistake?"
When she replied that she hadn't ever learned, or even heard, of any of these skills, I said, "Good. That gives me hope for you. I think the problem has always been that you never learned how to diet. No wonder you've had trouble." I then gave her an analogy: "If you'd never tried to play the piano before, would you be surprised if you sat down one day, with a page of sheet music in front of you, and found you couldn't follow the notes at all, much less play a beautiful piece of music? Of course not. You'd know that to be a good pianist, you need someone to teach you how to read music and how to play, and then you'd have to practice your new piano skills, over and over. Pretty soon, playing the piano would become easier and eventually you would be able to play that piece of music. It's the same with dieting. You can't be successful until someone teaches you how."
She still wasn't convinced. "Well, I can see how that might help other people," she said hopelessly, "but I don't know if I can ever lose weight."
I repeated her idea aloud, "I can't ever lose weight," and jotted it down. "Well, it would be interesting to find out whether that thought is 100 percent true, 0 percent true, or someplace in between. Would you be willing to do an experiment?" I asked. "Would you like to work together for six weeks and see what happens? I have to warn you, though, that I don't expect you to lose much weight in six weeks. In fact, I don't want you to make major changes in your eating right away. It may take several weeks for you to learn the skills you need before you actually start a diet."
Jean looked startled. "I thought you'd tell me I have to eat, like, 1,000 calories a day, starting today."
"No," I said. "That's exactly what I don't want you to do. First, 1,000 calories is too low for almost anyone to keep up long term. You'd just be setting yourself up for failure—either now or in the future. I don't want you to make any changes in your eating that you can't keep up for life.
"Second, I don't want you to start a diet until you've learned the skills I mentioned before; until you know exactly what to do and what to say to yourself so you can get yourself to use good eating habits. I also want you to know exactly what to do to get right back on track when you eat something you're not supposed to."
Now she looked relieved. She let out a big sigh. "This does sound different," she acknowledged. "I've always just gone full steam ahead when I've started a diet." Jean agreed to work with me.