Weight Loss Solution: Alice and the Apple

Today is Thursday, the day I like to feature a client situation to see if you can relate to her story: maybe it will help you!
I had a client we'll call Alice, who was extremely overweight. She couldn't even weigh herself on her bathroom scale because it only went up to 300 pounds. She came to see me when I worked in the hospital as a registered dietitian. Her doctor had sent her to me to help her lose weight because of her many health problems.
The first thing I like to ask people who are trying to lose weight is to finish this sentence: "My problem is ____________".
Different people have different issues: one diet definitely does not fit all. Some people know their portions are too large; others skip meals and then gorge at dinner time; many find they snack at night while watching TV; still others eat to satisfy some emotional emptiness. Finding out what a client knows about his or her "problem" around eating gives us a starting place.
So, I asked Alice to finish the sentence. "My problem," she said, "is that I don't know what a medium sized apple looks like. I can't tell if I'm eating one that's too large".

Let me just say, "Wow!" This woman weighed over 300 pounds and believed it was because the apples she ate on occasion may have been too large? An extra 30 Calories on a few instances, and suddenly she was over 300 pounds?

No. What Alice was really saying was that she didn't know where to begin. There is too much information bombarding people who are trying to diet: There is no clue where to start. There are "good carbs" and "bad carbs"; "low fat diets" or "low calorie diets"; "fat burning" potions and "fat-blocking pills"; advocates of prepackaged meals, and six meals a day. Where does someone start when they weigh 300 pounds? For that matter, where do you start when you want to lose ten pounds?

Good question.
Start with what is reasonable.
1. Start by looking at what you eat. This will require keeping a food record. Before you say, "I don't want to--that's too boring/ time consuming/ annoying", let me just point out that the simple action of keeping a food log has been proven to promote weight loss in people trying to lose weight. The mere action of stopping to think, "I'll have to write this down" stops people from eating some foods! And the result is, they lose weight. Without 'going on a diet'. Try it.
2. Become aware of what you eat. Look for the obvious: Are you consuming multiple times what the label calls a portion? Are you eating a whole bag of chips or a whole box of cookies at one sitting? Things you know are extremely high in calories? Do you have a habit of having a milkshake every day, or a 2 liter bottle of soda (that's not diet), or cleaning your plate when you go out to a restaurant when you know the portions are unreasonably large? Try cutting back on the large portions; take a handful of snack food out of the package and sit down to eat it; take half of your dinner home when dining out. Nothing drastic; just sensible.
3. Check out the Food Guide Pyramid (at http://www.mypyramid.gov/) and see what the national nutrition experts recommend. Here you can calculate the number of calories you need, and how many servings from each food group you should be eating. Try establishing an eating pattern relating to what your body needs for a couple of weeks, instead of whatever your eyes or your mouth tell you they want, and see how that works for you.
4. Be reasonable. If you are snacking constantly throughout the day, or eating from the minute you leave the dinner table until the minute you retire to bed, you are consuming too many calories: find a way to change these behaviors.

So, Alice and I started with small and simple changes in her diet. We talked about what she ate, and we found places she could cut back a little. A smaller portion here, a lower calorie snack there, an awareness of eating when she was just bored. It wasn't going to be a drastic diet; it wasn't going to get her to lose six pounds a week. It was going to be a place where she could start. A strategy for her to establish new habits. One habit at a time, one week at a time, a few hundred calories a day. Now she is on her way to becoming a healthier person, at a healthier weight. Slowly, but surely.

I invite your comments: What is one thing you can change about your diet that can help you cut out a few hundred calories a day? What is reasonable? We can all help each other with tips!