Megan, wanted to share this with you. It's part of one of our lessons from the Precision Nutrition Lean Eating Program I'm participating in, but it's a habit that many of us could use. I know it hit home for me.... :)

The Okinawans are a simple people. They drink their water, they farm their lands, and they eat until 80% full. This last practice is known as "hara hachi bu." It's actually quite repulsive to do otherwise. Hara hachi bu is not a fad dietary suggestion, or about being a nutrition over-achiever, it's part of the culture. People who stuff themselves are gluttons. Many experts believe that this cultural practice, in conjunction with the traditional Okinawan diet rich in fruits and veggies, legumes, seafood, tea, and otherwise unprocessed foods, plays a major role in their leanness and well-being.

Hara hachi bu is an excellent practice for anyone who hopes to attain optimal health and body composition. Think of it as eating to a point where hunger is no longer present. This is compared to the North American way of eating until "full" or "stuffed."

When we eat until 80% full, we are ready to eat again in 2-4 hours (see previous meal frequency lesson). Not only that, but not stuffing ourselves allows the body to digest and process food without discomfort and bloating. Moreover, with a low level of hunger around at all times of the day, we know we are in fat burning mode. When hunger hits, and/or you aren't 100% full, don't think of it as an obstacle. Think of it as an opportunity. An opportunity to improve your health and body.

Eating until 80% full doesn't require a food scale, measuring cups or an encyclopedia of calorie counts. It simply requires YOU to figure out your hunger and fullness cues. It also requires that you pay attention to the food you eat at meals while allowing some time to elapse before drawing conclusions. If you've never paid attention to how you are feeling before and after eating, you have years of conditioning and circuits to re-wire. No time like the present.

At first, allow some wiggle room. It will take trial and error. Begin to understand the amount and types of food your body does well with. One of the most critical factors for eating until 80% full is allowing between 15 and 25 minutes to elapse after eating before deciding to eat more. If we eat a high volume of food in a short amount of time (say 6 minutes), we might get done and still have hunger sensations. This is because the signals from our gut haven't yet reached our brain to say, "slow the food cramming session!"

So pace yourself and understand that if you are truly less than 80% full in 20 minutes, you can eat more real food. It's about how YOU feel.

Another caveat with hara hachi bu is this. Real, unprocessed, whole foods tend to elicit the 80% full sensation better than processed stuff. You might be able to eat an entire bag of potato chips before you feel 80% full, which could set you back about 1500 empty calories. Meanwhile, a bowl of beans and broccoli could get you 80% full, which would contribute a controlled level of calories and lots of nutrients. When our options include completely natural foods, and we acknowledge hunger cues, overeating and gaining excessive body fat is extremely unlikely.

Think about the major signals you notice when you're no longer hungry and when you are hungry. They are different for everyone and we all have them. Our minds are actually designed with receptive machinery for optimal hunger and thirst regulation.

When you are hungry, you might notice shakiness, borborygmus (growling stomach), headache, an "empty" feeling, irritability, a craving for real food (e.g., veggies, lean proteins, and so on), etc.

When you are no longer hungry and have reached 80% fullness, you might notice a fuller sensation in your gut, no desire to eat real foods, contentment, minimal cravings, a good level of energy, alertness, etc.

Now, when we eat at home or when we bring meals with us, our food intake is under tight control. We simply bring the amount of food we do well with and then make adjustments as necessary.

However, at restaurants we need to think ahead. Take a look around at the portion sizes being served and ask the wait staff. Don't be afraid to start with a smaller order, as we can always get more. If the sizes are massive and you know that eating an entire plate would push you beyond 80% fullness, order a half serving. Or, simply order a full serving and box up half for a future feeding. You save money and get leaner. It's a win-win. And when you get your food, check in with yourself throughout the meal. How are you feeling? When you approach 80% fullness, don't be afraid to leave some food on your plate. Just because your friend, spouse or business associate ate a certain amount of food doesn't mean you have to as well.

Once our clients get the hang of this habit, they're astounded at how little food they actually need to feel good and meet their goals. Once you take up this habit, you'll feel much better during the day, have more productive workouts, sleep better, and get/stay lean. It's not always easy to eat the hara hachi way, since some cultures promote and advertise excessive consumption.

To make the "80% full" message a bit more appetizing, consider that quality may have a bearing on quantity. We know that at PN, the better the quality of the food we eat, the less of it we need to feel satisfied.

I do annoyed that insurance companies for the most part are not concerned with prevention or maintenance of health. It took passing laws in most states for insurance companies to cover the cost of mammograms, and even now ours covers the actual test, but not the cost of the radiologist to read it! :shrug: I have worked places where the employer - not the insurance company - provided gym membership at a reduced "corporate" rate, and deducted it from your paycheck (if you wanted). My sister has a lap band, and that surgery was covered, along with all the counseling and support that goes along with, and of course her regular doctor visits, medications and her c-pap machine. Me, I pay for my gym membership, for any nutritional counseling I might want.... Grrr. BUt, it's worth it to me to go into my later years as a healthy active person.

I t will be interesting to see how and if insurance companies cover WLS in the future as this surgery becomes more and more popular.This is an elective procedure.And with its increase in popularity we are seeing more and more complications post-op in the hospital I work at.Just admitted a patient on Friday that has been admitted 6 times in the last 6 months with intestinal obstructions and her surgery was 7 years ago.Have seen many WLS complications this summer.So I imagine that insurances will begin to evaluate this over the next few years.

A couple things:
1) A comment about food
2) My meeting today with a nutritionist
3) Public Awareness Campaign Plan

Food:
I think it's so interesting about the very big change I've gone through over the years. I remember a key moment: when someone said they 'ate alot at lunch and would eat light at dinner'. It was a massive "who'd have thunk it?" for me. I never knew there was anything I could do. That was maybe ten years ago. Slowly over the years I have learned a lot about food and fitness, cut out poor nutrition behaviours, and added good nutritional behaviors.

Yesterday at a local pizza/sub shop, the kids and I ordered small subs with lots of veges. I asked for may on the side (pretty sure I wouldn't bother with the teaspoon scrapping--mostly as totally inadequate and not worth the effort). The guy have my a half cup of mayo on the side.

On the menu board, here's one of their very popular items: Seafood Platter with fried clams, fried shrimps, fried scallops & fried haddock, french fries, cole slaw, fried onion rings, tartar sauce, bread & butter. I felt like dying of a heart attack just reading it.

Nutritionist:
I made an appointment with a nutritionist through my PCP five months ago. I was thinking I'd need support near the middle or back end of my "diet" and want to check with a specialist. So, today's meeting was kind of weird. She was very nice but clearly puzzled after a few minutes when she realized I have a very good idea of my successful strategy so far and am near the end. What's the need? I was totally looking forward to this meeting because I wanted some kind of innoculation against gaining this weight back. I really had a secret wish that she might give something I can walk off with.

In the end, I just got a very nice pat on the back and a "keep at it" thumbs up. I did tell her about 3fatchicks.com, public policy support for maintenance programming, and Meg's post about that doctor who thinks surgery's the only answer. She raised her eyebrows and agreed surgery seems to be way too supported.

She asked if I'd be willing to speak with people about my success story. I said it's a bit early for me to grab a megaphone. I would be willing to sit on a panel with more experienced maintainers for:
1) sharing info to folks who are trying to lose weight
2) connect with other local maintainers for an evening
3) support past weight loss people who've regained
4) inform the friends, family and co-workers of maintainers (about NOT being a freak-of-nature, fanatic; why gifts of food are not appropriate; how to support; ways to enjoy this new maintainer and healthy life; etc.)

Policy:
I want to open a new thread for folks interested to promote maintainance. It will be housed within the maintainance forums. Interested people should watch for this. It will have discussion, action alerts, and information on current policies/practises that either support maintainance or work against healthy weight loss and maintainance. (I'm going to research a couple things then start the thread).

As opposed to a doctor who has something to gain from the original statement, the following study found pretty much the opposite.

Lifestyle Changes As Effective As Surgery For Obesity
http://www.realjock.com/article/1302

That's a pretty good description of how I try to eat too. I think it's good stuff.

realCdn-great article.I really wish people would believe this more and make the lifestyle change and not go under the knife.Seriously, I have seen so many complications.I have never seen complications from a lifestyle change.

I don't think that obesity is always a compulsive disorder, but there are some very pertinent parallels between weight loss struggles and those of alcoholism, substance use, sex addiction, and other compulsive self-harming behaviors like compulsive shopping, gambling, and in extreme cases even OCD.

Treatments for each are often very similar, with similar success rates. However, medical insurance is most likely to cover treatment for alcohol or substance abuse, but less often for other compulsive disorders (especially those without a direct link to physical health problems. Compulsive shopping affects your pocket book, not necessarily your physical healthy). If it takes the form of illegal behavior (like shoplifting) insurance may cover it, IF it constitutes a mental health diagnosis.

In the past, some obese patients were given psych diagnoses in order FOR insurance to pay for treatment. When I was working in law-enforcement, in the 90's I found an in-patient obesity clinic that my insurance "might" have covered, but it would have required a diagnosis of severe clinical depression, personality disorder, or bi-polar disorder (effectively ending my career). The program was known for "finding" a disorder that would be covered by patients' insurances, but in most states it would prevent patients from ever owning a firearm, or being employed in law enforcement and some other fields. Basically, I had to admit (or pretend) that I was "crazy," and give up my career - and I seriously considered it.

I think that treatment options need to be explored. I realize that insurances can't afford to insure "everything," but the research dollars do exist in the weight loss field - right now though most of the weight loss research money is spent on wls and on dietary programs, not behavioral change plans.

It's difficult to study multi-faceted approaches BECAUSE of non-compliance and drop-out rates. Exercise may be part of the program studied, but subjects may lie about whether they're participating as directed. Measuring compliance can be difficult. With alcohol and substance abuse there are blood and urine tests that can detect non-compliance, but there's no blood test that will detect whether you're following a diet and exercise regimen.

I think there are signs that things are changing. Obesity is such a wide-spread problem that it is drawing attention of the medical and scientific community. I think our local areas weight management clinic is a sign of that. Even though insurance doesn't cover their program, it is able to support itself, people are willing to pay out-of-pocket. I also think they have a great multi-faceted approach. Monthly counseling with the doctor and the dietitian co-heading the program (the doctor heading the program lost nearly 100 lbs herself), there are group counseling sessions, and sessions with a personal trainer/physical therapist, and a discounted YMCA membership is available (the whole program is housed in a center that was co-funded by the hospital and the YMCA so the gym is also an accredited physical therapy center).

I'm saving for the program, because the $2500 for 18 months is pretty affordable in the scheme of things. They have a payment plan, but it's outside our budget.

It isn't that I think I can't lose weight without their program, but it does include everything that I would include in a program, if I were designing one.
If my insurance covered part of the cost, I would be be on board in a heartbeat.

Yeah, because with the easy, yummy, tasty, fast-food life that everyone else is enjoying come the big jeans with the elastic waist....the huge, shapeless tops with sofa-upholstery print (or kittens and sparkles). The chunky, swollen joints, the bad feelings ......yeah, I'll pass. I still do eat some fast food, I'll admit it, but NOTHING like I used to. Not the same quantity and definitely not the same frequency. Wendy's is a 1 time every 8-10 weeks now, not a weekly (or more) occurance.

You should be proud. We all should.

Shannon, this is so true. And I think that many people who say, "I don't eat that much!" truly believe it. Heck, I believed it when I said it, too! Because "All I had for lunch was a SALAD!". Yeah, but that was a gut-buster from a chain restaurant and had 1200 calories! Or "All I had for breakfast was 2 frozen waffles!" But I had them with a tablespoon of butter and 1/2 cup of syrup; the syrup alone was 450 calories!!!! So I think what they mean (and what I meant when I used to say it) was that I wasn't eating much VOLUME. I didn't feel full, but what I didn't realize was that I wasn't really getting any nutrients--it was all junk, so my body was still hungry. For FOOD!

If I could embrace this idea it would definitely help me, Pat. I have gotten rather caught up in the "this is a serving so I will eat a serving" - even if it's a properly portioned serving of vegetables or skinless chicken breast. If I don't eat the whole serving, I'll have an unever number of leftover servings, and all of my even numbers will be thrown off. This is what goes through the mind of an person with tendency towards OCD (not so bad that I've ever been diagnosed, but I definitely have a thing with numbers - need to have even portions of food, and for a long time I could only turn the volume on the TV up in 2 pushes of the button increments, little things like that).

I think this is a good idea, though. I need to remember not only to eat when I'm truly hungry, what is what I usually focus on, but also to stop in time (just as important!). Thanks for the idea.

I think that's very interesting b/c as I said above, in some ways I behave in an OCD-like fashion. The reason I had to turn the volume on the TV up in 2 push of the button increments was that if I sat there and the volume had only been pushed once, it would bother me. Long after the volume display disappeared from the screen. I knew it was "wrong". In a very similar way if there is cake or cookies in the kitchen it just bothers me. I absolutely do not forget about them until they're gone, which usually means I've eaten them all. Now I'm wondering if this is something that many problem eaters like me experience or if it's an OCD-like tendency.

Much as I hate to say it, and it goes against everything we've been taught from childhood - it is okay to throw food away! :lol: Really. I was always guilty of saving evey little bit of leftovers, letting them become science experiments in the fridge, and then throwing them away. Now I skip the middle step! It's liberating. I never know how much my DH will eat - some days a lot, others not so much, so we frequently have leftovers. If it's not enough for a lunch - which can be several small bits combined - out it goes.

And another thought, how about just making your portions smaller? You can do it by increments so you're not shocked by small servings all at once. ANd two other things that help me: using smaller plates (we usually have luncheon size unless there's something "large" on the menu, like corn on the cob); and serving the plates at the stove, not putting the food on the table. This makes seconds less easy. I will put the veggies on the table, but not meat or carbs. And we usually have a salad as well.

It's a hard animal to get your head around. Yet even though if you're eating the calories you aim for, if you're gaining, or not losing, something's not working. :) I've been there a long time as well. Now upping my exercise (which is still an effort for me) and eating whole foods pretty exclusively, and less carbs I'm seeing the scale and my clothing size moving down again.

Lifestyle changes, one way or another
 

Wow....just looked at your post, and feel like I found someone who is like me. I started with lifestyle changes last year, and took off 25 pounds. Then, this year, I started to really work out and took off another 30, at which point my husband decided he wanted a divorce. Change is so hard. Since then, I've taken off another 70 pounds, for a total weight loss this year of 100 pounds. I still have another 30 to go until I have body lift surgery, and I expect to loose about 10-15 through that. I became morbidly obese only after the birth of my daughter at 40 years of age, a little over 6 years ago. Prior to that, I was at an ideal weight in my 20s and early 30s and a little overweight in my late 30s. I have a thyroid condition which requires constant treatment, and after the death of my parents and brother in quick succession, I entered an emotionally abusive marriage and just blew up. When you're ready to get better, you do. I have just been writing down everything I eat, and trying to eat lean meat, fruits and vegetables and whole grains. I had 5 sessions with a dietician last year. I just learned how to do it. Then, I started walking...it was hard as I was amost 300 pounds. I got up to 3 miles, then I started to run/walk. Then I joined a gym. I'm not burning up the road, but I'm getting a lot of exercise. I hit a plateau this summer where I did not loose any weight for 6 weeks. But I am loosing again, thanks to morning and evening walk/runs. Loosing weight this way is so hard....but once you get momentum, you can really get going! I am afraid to tell people how much I have lost.....I went out with a minister friend for lunch today and she didn't know what to say when I gave her the numbers...and I'm feeling more and more like a sideshow attraction. The cosmetic surgeon I contacted for the body lift has almost no "diet and exercise" loosers of more than 100 pounds. People ask me breathlessly whether I think I can keep it off......and I just want to scream. This is what I am supposed to look like....the really large person I became for 6 years wasn't me. I feel like I have no one to talk to who knows where I've been. What I've done feels natural....there are more people like me out there.....right? I understand that weight loss surgery is a viable alternative....I would have asked for it by now if my lifestyle changes weren't working. And loosing this way is hard. But its not as rare and unheard of as people seem to think. Now, I just want to finish loosing, get rid of the extra skin through surgery and get back to who I was before all the weight gain.

nmflame, :wel3fc:

Wow, what a wonderful story of overcoming your weight in the face of so many obstacles! :bravo: I sure hope you'll stay around! You'll find lots of folks here know exactly what its like...

Jay

nmflame-Amazing story.Way to go girl!!!!

In relation to insurance, my husband's company has instituted a program where if the employee and spouse have a company physical and biometric analysis, they will reduce the amount we have to pay for our medical insurance by about $300 / year. They do counsel you at the end based on your risk factors, but don't penalize you if you are overweight, high bp, etc. They also have as a part of this program, we can earn $ to be put in a HCRA account if we do a number of "get healthy" programs, e.g. attend classes on stress management, get a yearly physical, quit smoking classes, manage diabetes classes, attend x number of (documented) sessions at a gym, etc. So at least they have made the connection if they help their employees learn to live healthier, their insurance costs may go down. (they do have a free gym for employees and families, but we live too far away -20 miles - to make it convenient for us - so I belong to a more local gym)