photo credit: ant.photos

This came hot on the heels of Wednesday night’s slump (Oh, I’m so tired — I can’t do more than 20 minutes of cardio…) and certainly has psychological and physical ties to Tuesday night, when I couldn’t fall asleep until about 2:00 a.m.

photo credit: krissikes

I’ll probably get into details leading up to the crisis, and the emotions involved (I am a therapist after all), but for now it’s enough to know that the crisis was diverted from becoming much bigger.

Here are the steps from my Preparation Stage that I drew upon to identify and head off the problem as soon as I was able:

• 1.4: Self-talk and visualization
• 1.5: Set my focus
• 1.7: Journaling
• 2.4: Sleep schedule
• 4.1: Select a few supportive friends to be my safety net (and reached out to them)

Active steps I took to prevent the problem from becoming bigger:

1. Mentioned my concerns to Supportive Female Friend, even though we didn’t have enough time to really talk about it.
2. Called Supportive Male Friend, left a message saying I needed him and to please call me back ASAP.
3. Reviewed my focus, my journal, and my visualizing.
4. Arranged to get an extra hour of sleep last night.

photo credit: jaxxon

Here are the results from the steps I took:

• Supportive Male Friend called back and let me open up, admit my mistakes, and express my fears and concerns. He talked about his experiences (he also exercises 2 hours/day — enjoys walking to and from work) with motivation and asked hard questions. I didn’t shy away from the questions, which I’m proud of, because they stung a bit. In the end, he was right. How much do I want this, anyway?
• Supportive Female Friend called this morning at 6:20 to offer support and make sure I was exercising. Even though we hadn’t had a chance to get into details about anything yesterday, she was still loving enough to follow up and show her support. That was pretty amazing.
• I set a new focus based on these conversations and then got back to work.

photo credit: margolove

What’s fascinating to me is that last night, for the first time, someone outside of my support network mentioned to me that I looked thin. Timing is everything.

It surprises me how little press this book has gotten, given the nation’s obsession with The Biggest Loser. NBC frequently pads their news, talk, and late-night programs with previews and follow-ups to The Biggest Loser drama. “Where are they now?” episodes and a market flooded with Biggest Loser powders and paraphernalia all give the impression that the public would at least be a little interested in the nuts and bolts of life on (and after) the Ranch.

Not so, though, which is why the relative silence surrounding Dr. Huizenga’s book is so curious. Seems that the moguls know they can make more money on Biggest Loser branded contraptions, video games, and more-or-less useless exercise books than by promoting the actual science behind the plan that these massive weight-losers undertake.

Where did all the fat go? is obviously not a product of the Biggest Loser marketing machine. If anything, it suffers from branding issues: the cover is unattractive, the title is long and confusing while still managing to be cheesy, and the website which was supposed to accompany the book seems to have never really made it off the ground.

However, this is a “diet book” that really appeals to me and I think it would appeal to many people in my basic demographic — 20- to 40-somethings who are morbidly obese, intelligent, and motivated to lose massive amounts of weight. Here’s why:

1. Dr. Huizenga does not coddle or condescend.He believes that obese people are capable of intense exercise and lifestyle changes. I find this very refreshing, in comparison to the Surgeon General’s recommendations that obese people begin with 10 minutes of moderate walking and work up to two hours of light exercise per week. Research seems to show that this level of exercise may have cardiac benefits, but will make very little impact on weight loss.
2. He utilizes the principles of scientific study and research to demonstrate his thesis — that moderate calorie restriction paired with intense and vigorous exercise can result in a 1.5-2% body weight loss per week in obese and morbidly obese individuals. He employs research methodologies that ring true with my academic experience and reports them in a way that appeals to my logical/practical side.
3. The plan is all-natural, rejecting severe calorie restriction, diet pills, surgeries, and supplements. The goal is to lose fat, not water, muscle, bone, or other “lean” structures in the body. He has measured this with state-of-the-art medical equipment in Biggest Loser participants and verified that lean body composition (including bone density in hard-to-affect places like the spine) actually increases — something previously unheard-of in weight-loss research.
4. Although the program is designed for dramatic weight loss, there is no crowing about quick or easy fixes. This regimen is hard and requires intense sacrifices. It is not for the faint of heart or the dabbler, even without the screaming trainers. The results of this program are comparable with results from weight loss surgeries.
5. This plan has been tested and tried with hundreds of obese and morbidly obese participants under strict medical observation. In short, Dr. Huizenga knows obesity. He has seen people just like me follow this program and have success. He knows what to expect, how to overcome the obstacles, and he tries to prepare you for roadbumps along the way — touching on everything from how to deal with joint pain to how to manage excess skin and how to shop for produce with minimal waste.

What this book is not:

1. An exposé on The Biggest Loser. There are a few mentions of Ranch contestants and game-play involved with losing weight on the Ranch and the behind-the-scenes stuff that occurred in board rooms and conference calls. But, the majority of the book focuses on people who never made it to the Ranch, and/or what happens once they are kicked off. He basically compares the “boot camp” environment of the Ranch with the at-home version that he’s suggesting for the rest of us. The weight-loss results are surprisingly similar.
2. A psychological or emotional exploration. Pretty much, this book is about science, research, and bullet points. If you need to get to the root of your issues with food or appreciate a touchy-feely, clever approach, you’ll need to look elsewhere.
3. Sexy, glamorous, or even enticing. Aside from a strange diversion into perceived changes in penis size after weight loss (c’mon…), there isn’t much to titillate, here. I wouldn’t even say this book is particularly well-edited. It’s fine, really. The errors and diversions aren’t totally distracting. But this seems to be the work of a small publisher and the overall feel is that Huizenga wanted to pack as much information into the book as possible, sometimes at the expense of organization and flow.

Okay. So what’s in the book? Three sections, lots of charts and graphs, and marching orders. 

Content

The first section contains background and basics. Huizenga is an MD specializing in sports medicine who has been team doctor for the Oakland Raiders among other jobs. He’s now on faculty at UCLA medical school and has the endorsement of many of his peers on the book’s cover. The Doc includes his own history with weight and sports (wrestling, bed of male eating disorders), the Hollywood ballyhoo that landed him on the show, and the nuts and bolts of the Wow!Rx and how it stacks up against other diet programs.

The second section is a collection of the weekly emails sent out to the 36 at-home contestants during Season 3, so you can follow their progress and compare it to your own. This is sort of cool because he answers questions that people sent in, which is surprisingly helpful, even though the emails were written years ago.

The third section is labeled supplementary and contains tips and hints for cooking, planning, buying food, etc. It ends with speeches given at the “graduation ceremony” for the 36 at-home contestants which, I have to say, is pretty moving since you follow their whole progress closely throughout the book.

1. Get With the Program — The ABC’s of the Rx
   1. The Biggest Loser: The Bumpy Road to Malibu
   2. Fat-loss Myths and Scientific Discoveries
   3. The WOW!Rx Home Fat Loss Team
   4. Getting Started
   5. The WOW!Rx Step-by-Step Guide
   6. Understanding Healthy Eating for Fat Loss
   7. Understanding Fat-Loss Exercise
   8. Push-Pull-Twist (PPT) Training — the Last Piece of the Fat-loss Puzzle
2. You are Not Alone — Follow the Losers
   1. The Wow!Rx: Week-by-Week Guide
3. Help is on the Way — Supplemental Material to Facilitate Your Journey
   1. The WOW!Rx Nutritional Plan
   2. Mind Over Matter
4. Appendix
   1. Biggest Loser Pre-participation Medical History Form
   2. Personal Physician Statement
   3. Medical Articles Written About Biggest Loser Contestants

The Basic Plan

Huizenga asks participants to get their body fat percentage measured in order to figure out their lean body mass. From these numbers, you calculate your personal calorie intake (he calls it “moderately restricted” and I have to agree) and your goal weight, based on appropriate body fat percentages. The objective, as he states over and over, is to lose fat, not weight.

Armed with this information, you then launch into a two-a-day exercise routine combining intense/vigorous cardio and strength training. This regimen runs 6 days a week, with the following approximate recommended durations:

• 2-3 months if you are overweight
• 4-8 months if you are obese
• 6-12 months if you are morbidly obese

The good doctor claims that if you follow this eating and exercise plan, you can lose 1.5-2.0% of your body weight per week (not the 1-2 pounds that is commonly accepted) and that nearly all (if not all) of that should be fat.

In addition to the restricted calorie intake, he recommends utilizing an old body-building trick and drinking “anabolic shakes” after each workout. Never fear, though. Although you can buy powders and supplements to accomplish this, he gives easy recipes that provide all of the carbs, sugars, and proteins you need from simple grocery store ingredients like fruit, milk, etc.

Because the plan itself is simple, the rest of the book is filled up with recommendations for carb-fat-protein ratios, a section on strength training illustrated with photos of the good doctor himself doing the exercises — all short and sweaty and mulleted — and those week-by-week updates on the at-home contestants’ progress.

Review

I really think one of the reasons this book has gotten so little airtime is that it takes a special kind of crazy to embark on this plan. Two-a-day exercise would be a breeze if you were in a boot camp environment such as the Biggest Loser Ranch. It’s do-able. Believe me, it’s do-able. But, you really have to re-structure your life and make major sacrifices. In the end, it depends on how important it is to you, and how much you believe in the science behind what he is suggesting.

The results are undeniable, if you’re able to stick to it. With success and recidivism rates almost equal to that of weight-loss surgery, it’s really a great option if you are obese or morbidly obese and already considering such a drastic step as surgery.And I do like that Dr. Huizenga doesn’t condescend or coddle. He knows the program is difficult, and he makes no apologies. The message is, “You can do it” — and I don’t mean that in a hippie, summer-camp, feel-good kind of way.

The book is an easy read, but has some tangents and diversions that I wish had been edited out — research on hot vs. cold beverages on hot vs. cold days and the resultant burn of a few extra calories, for instance, seem silly and out of place. Sure, they are researched effects, but they also feel a little game-y, which is exactly the kind of mindset the doctor is encouraging us not to adopt. Honestly, I’m also not sure how he expects us to weigh our water intake and output before/after exercise to make sure we are hydrating appropriately. I mean, c’mon. Like most scientists, Dr. H. can get a little lost in minutiae, and you have to afford him these diversions in favor of the bigger picture. 

At times, I feel he is posturing to adopt, say, Jillian’s hard-ass-ness. You have trouble waking up early in the morning? JUST WAKE UP! You don’t know how to cook? JUST LEARN TO COOK! You just had surgery? BUNDLE UP AND GET ON OUT THERE! Dr. Huizenga is a little short on motivation, but he gets the job done.

With so much information jammed into one book, you can’t expect it to be a work of literary genius. The tone is a bit enthusiastic at times (exclamation points!!!!!!!!!!!), and he sometimes over-simplifies away emotional issues in order to make his point. This is not prose. It’s a program.

With the exception of pointers and supplemental materials, there isn’t a lot of assistance on implementation of this plan. Basically, he lays it out there. He cites examples of other people (stay-at-home mothers, medical students, lawyers, clergy, and a dozen other people more busy than you) who have made it work. The basic message is, “Here’s what to do. Other people have done it. Now you go figure out how to make it happen.”

If you can, though, the results seem to be amazing.

Only one of these things is a repeat victory from previous weight-loss attempts. I was able to wear smaller clothes when I lost weight without exercising — when I became thinner but not fitter. Everything else is a first-time for me.

photo credit: sgatto

Here is a sampling:

1. I have significantly more energy for chores and daily tasks. You should see me motor through the laundry now. Seriously. I don’t fatigue at all! I fold like the wind, Grandmother. When I pick up my bins to cart them from the laundromat, I expect to grunt or wince but I don’t! It’s a little eerie — like I’m becoming bionic. Or a Stepford Wife!
2. I went from an average 20-minute mile to 17-minute mile. Look, I know this isn’t going to break any land-speed records, but still. Major progress.
3. I went from doing 4 sit-ups with difficulty to doing 12 sit-ups with ease. I think I could probably do closer to 30 now, but that’s not the Good Doctor’s program, so I don’t. Someday, if I get serious about something as vain as 6-pack abs, we’ll talk. For now, it’s enough to know that I’m making progress and strengthening my core.
4. I went from doing 2 squats with severe pain to doing 12 squats with some grunting. My poor arthritic knees are like snap crackle pop, man.
5. I grew out of my basic set of handweights. Holding two weights at a time is awkward, but it’ll have to do until I can afford a new set of adjustable dumbells.
6. The dogs annoy me a lot less now that they’re getting 1-2 short walks every day. I do a 10-minute warm-up walk outside before I exercise. The fringe benefit is that it tires them out so they’ll leave me alone while I exercise (they have very short legs so 10 minutes is all it takes). The only downside is that they sleep after their walk, and then by the time I’m ready to go to bed, they’re all revved up again and/or they wake me up in the middle of the night. Bad dogs!
7. I am doing activities I always wanted to do. The obvious addition to my repertoire is hiking. You know, I always thought I would be a person who would enjoy hiking (since I’m a dirty hippie and a nature nut) but now it’s a proven fact. I like hiking.
8. I feel my muscles working now, and it’s awesome. Sometimes I’ll be walking along and I’ll feel the muscles in my back doing their thing. I don’t know why my back muscles all of a sudden need to support my walk from the subway to my office, but I assume it has something to do with improved posture or more efficient movement. Whenever I notice my muscles at work, it’s unexpected and it feels so cool. Core strength is neat.
9. I’m getting back into the clothes I wore when I lost all that weight before my surgery. HOWEVER, you have no idea the wardrobe schemes I am cooking up in my head already. Things I am looking forward to wearing: boots, wide belts, skirts, a wedding ring. Okay. Got a little carried away there.
10. NEW. POSITIONS. Yup.

I give handmade holidays each year, so I knew there would be no way I could devote 2-2.5 hours of exercise a day until after Christmas. Handmade gifts are a personal priority of mine, and so I used the month of December to prepare myself as much as possible, with a commitment that I would begin 2-a-day exercises on December 26th.

photo credit: Dunechaser

So, December 2009 was my Preparation Stage. During this stage, I:

1. Prepared my mind
   1. Read, re-read, and re-re-read Dr. Huizenga’s book
   2. Took myself through the mental health questionnaire at the back of the book
   3. Had my body fat percentage measured so I could calculate personalized calorie counts and goal weight
   4. Did a lot of self talk and visualization
   5. Set my focus
   6. Figured out a daily schedule that would allow me to follow the program after the holidays were over
   7. Started journaling
2. Prepared my body
   1. Had a health screening and physical exam, discussed the plan with my doctor and got approval
   2. Started taking glucosamine and chondroitin (which need a few weeks to build up in your body to reach full effect) due to history of knee problems and anticipation of pain onset
   3. Revisited my old physical therapy routine to strengthen my knees before starting vigorous exercise
   4. Experimented with sleep schedules
3. Prepared my environment
   1. Altered my eating down to my personalized “moderately restricted” calorie count so that I could work out the kinks of the diet without the distraction of the exercise
   2. Dug out some equipment from storage and dusted everything off, tuned it up, got it ready
   3. Purchased some new equipment
   4. Asked for other equipment to be given to me as Christmas gifts
   5. Made a list (and a budget) for purchasing additional equipment
   6. Put together a binder to keep track of everything
   7. Rid my house of temptations
   8. Set up an exercise station in my living room
   9. Did a deep clean and organization/purge in my house, knowing that once I started exercising, I would have precious little time for cleaning
4. Prepared my social supports
   1. Selected a few supportive people to confide in
   2. Made a plan for informing other friends as time went on, once I proved myself capable
   3. Informed my parents, when they called to say they were going to visit in January, that I was beginning a new exercise program and it would have to take precedence during their stay
   4. Temporarily canceled my profiles for online dating sites
5. Took a week off of work

I’ll be elaborating on many of these steps over the next few weeks. It’s my hope that anyone who is considering embarking on this plan will find useful info in how I’ve made it work for me.

photo credit: nDevilTV

From the Happy Accidents Department: this season of The Biggest Loser actually started just after my first week on the Wow!Rx program. It’s a little extra Tuesday night motivation to feel like I’m going neck-and-neck with the contestants. I was hopeful that they would have at-home players this season, and they did!

Two pairs were sent home during the first episode, with the promise of returning 30 days later for a weigh-in and progress report. Awesome. An even better yardstick by which to measure my progress. At-home teams!

From everything I can tell, at-home contestants follow the Wow!Rx, except that those who can afford it do seem to hire trainers. Wow!Rx doesn’t require trainers (and in fact the first batch of at-home contestants were forbidden from using them). I also think that most of the contestants follow this plan after they get voted off and return home, giving us our beloved “transformation moment” at the end of each episode. This last episode (which Jen does a great job of recapping here) brought back the two expelled teams to see if the Blue team or the Yellow team would return as Ranch contestants.

Season 3 was the first time that at-home contestants followed the Wow!Rx and were given a chance to return to the Ranch. I’ll never forget watching  the episode from Season 3 when the top at-home contestants came back and weighed in. I shared the “Ranch” contestants’ reactions when the top 6 at-home contestants all clocked in with a weight loss percentage higher than the lowest Ranch contestant, and the two that were invited to stay in the house had the highest percentage of all contestants.

Jaron had lost 23.2%, Adrian had 23.3%, while Brian was the top Ranch dude and had lost 22.1%. The Ranch contestants moped around. “What are we even doing here, if people can follow a program at home and lose even MORE weight than we can!?”

Well, that wasn’t exactly repeated this week, but the blue team lost a respectable 9.92% and the yellow team lost 11.45%. Without the benefit of a male on my team, you’ll note that my first month percentage is closer to 9% but still. Not bad.

Soon, I’ll post a breakdown of the month because there were definitely some surprises.

More arguments for the importance of exercise — not just weight loss.

What matters is how healthy you are — how fit — not your dress size and not your BMI.

Also, check out this article about discrimination in the medical field against women who are as little as 13 pounds overweight. Incredible.

photo credit: DigiDragon

It didn’t take me long to know exactly what I wanted to do to bring about change. I knew about Dr. Huizenga’s book from my brushes with Biggest Loser auditioning. One of the things I like best about the Biggest Loser approach is that fat people aren’t treated as incapable or stupid. They are expected to work hard, and the overall attitude is that they can work hard. I ordered Dr. Huizenga’s book a few days after Thanksgiving, and read it through in about a day and a half.

Honestly, the biggest component of my contemplation phase was a self-searching, no-nonsense interview with myself. Could I really do this? What would happen if I tried and failed? What would happen if I did nothing at all? Is this the kind of all-or-nothing thinking that I generally try to avoid? Is fitness really the most important component of weight loss? Why not just make quiet, small-scale changes in hope of results? Am I crazy?

 
photo credit: Marco Bellucci

By the end of this interrogation, I was already beginning to formulate a plan. I could actually visualize myself carving out chunks of time to make this thing happen. I knew it would be hard. But I felt that I could do it.

I spent the entire month of December in the Contemplation and Preparation phases. I do not recommend that anyone embark on this program without adequate Preparation time. For me, it was really the key to success, and it took about 3-4 weeks and a few hundred dollars. Watch for that entry to come soon.

photo credit: serhio

Precontemplation is the stage before you are even thinking about making a change. Change isn’t on your radar. Maybe you aren’t even aware that a change needs to be made, or not willing to consider options for making change.

This is all just a nice, fancy way to say “denial.”

photo credit: Esther_G

When you’re in precontemplation, you sort of sail along. You may concoct workarounds for your problem — justify it, rationalize it, make allowances for it, whatever — but you don’t really think about actually changing anything.

In essence, you embrace the comb-over.

photo credit: Generation X-Ray

I documented snippets of my precontemplation (here, here, and here, as examples). Basically, I gave up the weight-loss fight after my complicated surgery. I just needed to recover. I rationalized that I should allow my body the energy it needed to heal and get better — rather than pushing or straining.

And then I let go, and I bobbed along that way for virtually an entire year. Sure, I’d notice from time to time that my clothes were getting tighter, that I was digging into my “fat stash” for something to wear on a Saturday night, and that Cold Stone Creamery had returned to my self-soothing repertoire. But, for whatever reason, it didn’t matter. I was pre-contemplating. In denial.

Sometime in the early fall, after I passed my licensing exam, my precontemplation ended. I remember the moment vividly. I was in and out of a Saturday afternoon nap on the couch, sandwiched between two sleeping dogs, when suddenly I slipped into a vision.

Okay, I don’t know if it was a vision per se. It was a daydream, or a half-dream, or an imagination run wild or whatever, but it felt very real.

I was walking down a street — like a pedestrian mall. I was window-shopping, and I remember coming to a store with a large front window that was dark on the inside. Standing there, I caught a glimpse of myself in the window’s reflection. There I was — definitely me — but thin. Thin! It felt so natural, so normal. There were my facial features, but more defined. My blue eyes blinked out of my own face. My clothes hung well, and they were clothes I would definitely wear. They were my style. My hair. My shoes.

photo credit: Joseph Robertson

I have never been thin. I don’t think I’ve ever even successfully imagined myself as thin. But, after all of these years of therapy and of resolving my food issues and accepting myself the way I am and working toward a general state of health, there remains deep within me the hope — the belief — of a thinner me. Some part of my brain can even conceptualize it. I’m here to tell you that it isn’t the everyday part of my brain that understands this concept. Even now, it’s difficult to re-conjure the image.

But the image was there. And for whatever reason, on a Saturday afternoon, I could believe in it. It felt good. Like I could inhabit that body. Like I could still be me and look that way. Like it would fit.

And that was the end of my precontemplation.

photo credit: Anna Gay

Unfortunately, we’re human and full of foibles and complications. Models and theories, no matter how well-researched, do not always take into consideration the many factors that play in to our day-to-day decisions.

Such is the case with a famous model called the “Stages of Change” model. It was developed in the 1970′s by some “transtheoretical” researchers who were trying to help people quit smoking. Although this model has been researched multiple times as a way to help bring about change, it does not seem to be an effective tool for that purpose.

What I do find helpful in this model, though, is the way that it describes processes that naturally occur. At least, I have seen this cycle in my own life. Whenever I have brought about a significant change, I can usually recognize these stages of change — but only in hindsight. I’ve never successfully been able to use them to go from zero to sixty in the change machine.

The stages are:

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
6. Relapse

I like how the model accounts for “relapse” (a substance-abuse term, to be sure, but one that can apply to any effort at positive change) and normalizes it so that when it happens, it doesn’t throw you entirely off track. At any moment, you may need to step back to a previous stage for strength and progress.

Looking back, I can see exactly how I worked through the first 3 stages to arrive at (and cycle through) stages 4/5/6, which is where I currently am in the process of the 2010 Experiment with Huizenga’s Wow!Rx.

photo credit: Ozyman

But, I didn’t want to publicize it much until I was pretty sure I could sustain the pace. Frankly, as I read the book and contemplated the life changes I’d have to make in order to exercise for 2-2.5 hours per day, I became increasingly convinced of one thing: I’d never be able to pull it off.

Through November and December 2009, I carried around an intense fear of failure. And, I mean, failure is one thing. With your run-of-the-mill failure, you can at least say, “Well, I tried.” More than that — I was reasonably convinced that I would never make it out of the starting gate of this plan. I worried about telling anyone about my new experiment, because I was pretty sure that my mind and body were incapable of pushing that hard.

photo credit: wine me up

In fact, for long stretches of time, the only thing that kept me going on this idea was the inspiration of The Biggest Loser. Thanks to the miracle of television, I have burned the images into my mind: people my size sweating it out, week after week, on national television. If they could do it, why can’t I?

Worse — if all of those people sent home from “the ranch” could manufacture their tremendous successes by following the at-home plan, then why couldn’t I?

photo credit: tiarescott

After all, like millions of annual applicants, I was willing to consider giving up 12-15 weeks of my life — losing my job, subleasing my apartment, boarding my dogs, and giving up contact with friends and family — to lose weight. What was keeping me from dedicating tremendous time and energy to this pursuit in a somewhat-less-dramatic (and certainly less-incentivized) fashion?

Here it is. As of tonight, I will have officially been following Dr. Huizenga’s nut-busting regimen for exactly one month. I can at least say this: I am capable of it.

photo credit: Maʝicdölphin

And I have a lot of tips and suggestions if you’re considering doing it, too.

I’ve been keeping notes all this time and writing about my experience. Now that my fear and trepidation is mostly past, that I have proven to myself that I am capable, I’m ready to start sharing more about how this journey has gone.

photo credit: c@rljones

I’ll start by talking about the “stages of change model“ and how I moved from Precontemplation to Contemplation, Preparation, and Action. And, if any of you decide to embark on this project, will you please let me know?

I like to think I’m not the only insane one.