1

Lifestyle Patterns Approach

To Weight Control
 2

Faculty

• Robert Kushner, MD
– Professor of Medicine, Northwestern
University Feinberg School of Medicine
– Medical Director, Wellness Institute,
Northwestern Memorial Hospital
• Dawn Jackson Blatner, RD, LD
– Staff dietitian, Wellness Institute,
Northwestern Memorial Hospital
 3

Disclosures

• Dr. Kushner
– Author of Dr. Kushner’s Personality Type
Diet (St. Martin’s Griffin, 2004)
– Medical Director, diet.com
• Dawn Jackson Blatner
– Consultant diet.com
 4

Overall Goal

• Learn new weight management tool/resource

to use in addition to your current approach
 5

Learning Objectives

• Discuss the rationale and philosophy of using a

qualitative lifestyle patterns approach to weight
management
• List and define the 21 eating, exercise and coping
lifestyle patterns along with the targeted strategies for
the 7 eating patterns
• Using case-based studies, demonstrate how the
lifestyle patterns approach is used in clinical practice
• Become familiar with the online features and support
tools of the lifestyle patterns approach website:
www.diet.com
 6

Background Perspectives

• Perspective 1: Obesigenic. Weight gain is a result of

adapting to our environment.
• Perspective 2: Scaling Up. Each person gains/loses
weight for different reasons.
• Perspective 3: One Size Doesn’t Fit All. Each person
is different so they will need different/individualized
treatment plans.
• Perspective 4: Multidimensional. Addressing eating,
exercise, and coping is the key to weight management.
 7

Perspective 1

We live in an “obesigenic” society.

Becoming overweight and obese is a
consequence of ecology and
economics of modern society.
 8

Perspective 1 (con’t)

• People adapt to and harmonize with their environment

(ecology).
• People make decisions based on available resources
and allocation of available time (economics).
• Since we live in an environment where high calorie
food is available 24/7 and technology has essentially
engineered out the need for labor, a calorie imbalance
and weight gain can be expected.
• Thus, overweight, obesity and an unhealthy lifestyle
could be considered the norm rather than the
exception.
 The Effects of Food Pressures
Food Availability
Abundance
Snacking
Convenience Stores
Vending Machines
Should Eat Healthy Foods Processed Foods
Should Watch Portion Sizes Cooking Less
Should Cook More Eating Out More
Should Eat Only When Hungry Large Portions
Fast Food Choices
Value Meals
Food Courts
All You Can Eat Buffets

Healthy Choices Unhealthy Environment

 The Effects of Technological Advances
Elevators
Escalators
Telephones
Snow Blowers
Should Walk Up Stairs Remote Controls
Should Park Car Farther Away Cars, Buses, Trains
Should be More Active Computers
Should Watch TV less Email
Should Do Less Passive Activities Drive-Thru Society
Television
Cable Channels
Video Games
VCR’s: Home Movies

Healthy Choices Unhealthy Environment

 The Effects of Time Pressures

Living the Hurried Life

Always Rushing
Overscheduled
Overdoing It
Not Living in the Moment
Should Make Time to Exercise Working Longer Hours
Should Make Time to Eat Healthier Less Leisure Time
Should Make Time to Cook Family Stresses
Should Make Time to Relax Juggling Schedules
Juggling Roles
No Time for Family
No Time for Self

Healthy Choices Unhealthy Environment

 12

Perspective 2

The Scaling Up Syndrome

The constellation of life events--
biological, environmental, social &
cultural--that result in weight gain.
 13

Scaling Up Syndrome
 14

Scaling Up Syndrome
 15

Scaling Up Syndrome
 16

Scaling Up Syndrome
 17

Scaling Up Syndrome
 18

Perspective 3

“One size does not fit all”

People need an individualized
tailored approach that addresses
their own unique lifestyle &
personality.
 19

Different program examples

Why should a ...

• 52 year old traveling salesman who eats most

meals on the road and isn’t comfortable
exercising do well on the same program as a ..
• 35 year old mother of 3 who finishes her
children’s food, wants to exercise but can’t find
the time?
• These individuals have different lifestyles,
responsibilities, support systems and obstacles.
 20

Perspective 4

Treatment must be multi-dimensional

Weight loss and health aren’t just about the
ratio of carbs and protein on the plate, which
is the one –dimensional focus of many weight
loss programs.
Control of body weight and health must
include eating, exercise and coping lifestyle
patterns of behavior as well.
 21

What do People Want?

• A targeted, individualized and personalized

approach that is tailored to their lifestyle
addressing preferences, habits, time
availability, likes and dislikes, style, attitudes,
abilities, culture, etc.
 22

What do RD’s Want?

• A quick, easy, and effective tool to identify

the specific areas patients need help in
along with the strategies to achieve weight
control
 23
A New Theory to Treatment of
Overweight: An Overview
• Weight gain, overweight and obesity are expected
responses to our ‘obesigenic’ environment.
• Individuals have adapted to their environment by
developing unique and identifiable eating, exercise
and coping patterns. Unfortunately, many of these
patterns are maladaptive to body weight and health.
• Targeting treatment of these maladaptive lifestyle
patterns will lead to weight loss and improved
overall health.
 24

Lifestyle Personality Patterns

Eating Patterns Exercise Patterns Coping Patterns

Meal Skipper Couch Champion Emotional Eater

Nighttime Nibbler Uneasy Participant Self-Scrutinizer
Convenient Diner Fresh Starter Persistent Procrastinator
Fruitless Feaster All-or-Nothing Doer People Pleaser
Steady Snacker Set-Routine Repeater Fast Pacer
Hearty Portioner Tender Bender Doubtful Dieter
Swing Eater Rain Check Athlete Overreaching Achiever
 25

Lifestyle Patterns Approach to

Obesity Management

• Takes into consideration the known multi-

factorial etiology of obesity and reinforces the
importance of addressing diet, physical activity,
and cognitive (coping) behaviors during
treatment.
• By focusing on and changing one pattern at a
time, the patient gains control, builds
confidence, improves health, and remains
motivated.
 26

Symptom Pattern Approach is

Commonly Used in Medicine
• Problem: Asthma

• Goal: To reduce asthma symptoms such as

wheezing, coughing, or shortness of breath
• Implementation: What are the patient’s triggers
(patterns)?
• exercise
• laughing or crying
• environmental allergins
• cold air or tobacco
 27

Symptom Pattern Approach

for Obesity: Dietary Treatment
• Problem: Caloric intake exceeds energy
requirements
• Goal: To reduce caloric intake

• Implementation: What are the patient’s patterns?

• Eats large portions of food
• Skips meals
• Nibbling into the night
• Filling up on higher calorie foods instead of fruits
& vegetables
 28

Symptom Pattern Approach

for Obesity: Exercise Treatment
• Problem: Caloric expenditure less than energy
intake
• Goal: To increase physical activity

• Implementation: What are the patient’s patterns?

• Hates to move
• Wants to move but has no time
• Has medical concerns and restrictions
• Is embarrassed to exercise in front of others
 29

Symptom Pattern Approach

for Obesity: Coping Treatment
• Problem: Patient has difficulty focusing on &
sustaining weight management program
• Goal: Improve coping skills

• Implementation: What are the patient’s patterns?

• Procrastinates
• Puts self low on priority list
• Eating is triggered by emotions
• Has unrealistic goals
 30

Symptom Pattern Identification

Questionnaire
• Patients are asked to complete a 5-10 minute
questionnaire indicating their level of
agreement to 66 statements.
• Each statement is scored (0,1,2,3) based on
strength of agreement.
• Statement items are keyed into predetermined
patterns
• Percentile score is calculated for each pattern

(Kushner et al, AJCN, 2002)

 31

7 Eating Patterns

» Meal Skipper » Steady Snacker

» Nighttime Nibbler » Hearty Portioner

» Convenient Diner » Swing Eater

» Fruitless Feaster
 32

Food Pattern Profile

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Meal Skipper Nighttime Convenient Fruitless Steady Hearty Swing Eater
Nibbler Diner Feaster Snacker Portioner
 33

7 Exercise Patterns

» Couch Champion » Set-Routine

Repeater
» Uneasy
Participant » Tender Bender

» Fresh Starter » Rain check athlete

» All-or-Nothing
Doer
 34

Exercise Pattern Profile

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Couch Uneasy Fresh Starter All-or-nothing Set-Routine Tender Rain Check
Champion Participant Doer Repeater Bender Athlete
 35

7 Coping Patterns

» Emotional Stuffer » Fast Pacer

» Self-scrutinizer » Doubtful Dieter

» Persistent » Overreaching
Procrastinator Achiever
» People Pleaser
 36

100%
Coping Pattern Profile
90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Emotional Self Persistent People Fast Pacer Doubtful Overreaching
Eater Scrutinizer Procrastinator Pleaser Dieter Achiever
 37

The Importance of Coping

How patients’ view themselves, relate

to others, and deal with stress has a
major impact on their weight. For
many, learning better coping strategies
is the missing piece of their weight
loss puzzle
 38

Coping Patterns Predominate as Most

Prevalent Self-Identified Problems
• Personality Lifestyle Patterns Questionnaire was
administered to 335 obese adults in the Wellness
Institute at Northwestern Memorial
• Most prevalent set of patterns was related to the
coping symptoms; all 7 coping patterns endorsed by
over 50% of patients, compared to 5 eating and 3
exercise patterns
– People Pleaser
– Persistent Procrastinator
– Overreaching Achiever

(Kushner et al., Obes Res, 2003)

 39

Research Validation

• One year prospective study of 92 individuals treated

in a group format using the personality patterns
approach along with meal replacements, pedometers
and tracking of physical activity.
• Average starting BMI 35 kg/m2, age 45 yrs
• Average weight loss was 11 lbs or 5% of initial weight
at one year (last observation carried forward (LOCF)
analysis.

(Kushner et al. Obes Res, 2004)

 40

Lifestyle Patterns Treatment

Approach
• Four specific strategies have been developed
for each of the 21 symptom patterns.
• Patients self-select which patterns they want to
tackle and in which order.
– Start with highest scored patterns
– Start with highest self-efficacy
– Start with “linchpin” pattern, e.g. Persistent
Procrastinator
Lifestyle Patterns Treatment 41

Approach: Eating Patterns

• Nighttime Nibbler

• 4 strategies:
– Redistribute calories
– Calorie proof your home
– Plan 1 nightly snack that satisfies
– Reset your nighttime routine
 Lifestyle Patterns Treatment 42

Approach: Eating Patterns

• Steady Snacker

• 4 strategies:
– From mindless to conscious
– Quantify munching
– Refresh with healthier alternatives
– Tame your triggers
Lifestyle Patterns Treatment 43

Approach: Eating Patterns

• Hearty Portioner

• 4 strategies:
– Pace your mind and body
– Proportion your plate
– By savvy about servings
– Overcome portion traps
Lifestyle Patterns Treatment 44

Approach: Eating Patterns

• Couch Champion

• 4 strategies:
– Count all activity
– Energize your body and mind
– Find fun
– Buddy up
Lifestyle Patterns Treatment 45

Approach: Eating Patterns

• Rain Check Athlete

• 4 strategies:
– Add it naturally
– Make an appointment with self
– Multitask your exercise
– Ask for help
 Lifestyle Patterns Treatment 46

Approach: Eating Patterns

• Emotional Stuffer

• 4 strategies:
– Inventory food and mood
– Acknowledge your feelings
– Nurture emotions without food
– Strengthen mind-body connection
Lifestyle Patterns Treatment 47

Approach: Eating Patterns

• Persistent Procrastinator

• 4 strategies:
– Probe procrastination trait
– Prompt yourself
– Make it manageable
– Enjoy small successes
 48

Case Study 1

• S.O.

• 41 yr old high school teacher

• Married for 19 yrs, 2 children

• Medical problems:
- pains of weight bearing joints
- heartburn
- Elevated blood cholesterol
• Weight 201 lbs, 5’6” 1/2 in., BMI 32 kg/m2

• Waist circumference 85 in.

 49

S.O.’s Scaling up Graph

 50

S.O.’s Past Weight Loss Programs

Starting Ending Length of % Weight

Date Program Weight Weight Program Loss

1990 WW 160 120 6 mo 25%

1994 WW 190 175 5 mo 8%

1996 WW 195 187 3 mo 4%

1997 Redux 195 175 4 mo 10%

2000 WW 200 195 1 mo 2.5%

 33%
Fruitless Feaster
67%

Steady Snacker
67%

Hearty Portioner
67%
S.O.’s Baseline Eating Patterns

Swing Eater
44%
51
 Couch Champion

58%
Uneasy Participant

58%

Set Routine Repeater

42%
S.O.’s Baseline Exercise Patterns
52
 Self Scrutinizer
92%

Persistent Procrastinator
67%

Fast Pacer
67%

Doubtful Dieter
78%
S.O.’s Baseline Coping Patterns

Overreaching Achiever
44%
53
 54
Weight Loss Record, S.O.
aas

205
lbs.

200200

195

Patterns initiated
190
190
Weight (lbs)

8.3% loss
14% loss

185

180
180

175
170

170
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57
Months 1 2 3 4 5 6 7 8 Week
9 10 11 12 13 14
 55

S.O.’s 12 month Eating Patterns

Baseline
12 month

67% 67% 67%

Hearty Portioner
Fruitless Feaster

Steady Snacker
44%
 56

S.O.’s 12 month Exercise Patterns

Baseline
12 month

58% 58% 42%

Couch Champion

Uneasy Participant

Set Routine Repeater

 Self Scrutinizer
92%

Persistent Procrastinator
67%
Baseline
12 month

Fast Pacer
67%

Doubtful Diieter
78%
S.O.’s 12 month Coping Patterns
57
 58

Case Study 2

• L. M.

• 57 yr old catholic priest

• Lives in a residential community

• Medical problems:
- Obstructive sleep apnea
- Arthritis of feet, ankles, knees, low back
- prehypertension
• Weight 363 lbs, 5’11 1/2 in., Class III obesity, BMI 49.7
kg/m2
 59

L.M.’s Past Weight Loss Programs

• Multiple self-imposed diet-focused

attempts with weight losses ranging from
0 to 50 lbs., all non-sustained.
– OTC SlimFast
– Atkins
– Others
• No registered dietitian
 60

L.M.’s Scaling up Graph

 Meal Skipper

67%
Nighttime Nibbler

50%

Hearty Portioner
100%
L.M.’s Baseline Eating Patterns
61
 Couch Champion

58%
89%

Fresh Starter
89%

Set Routine Repeater

L.M.’s Baseline Exercise Patterns

Rain Check Athlete

67%
62
 63

L.M.’s Baseline Coping Patterns

People Pleaser
 64

Weight Loss Record, L.M.

370
360
350
Pounds

340 12.3%

330 14.3%

320
310
300
0 5 10 15 20
Months
 65

L.M.’s 12 month Eating Patterns

100%

Hearty Portioner
67%
Meal Skipper

50%

44%
Nighttime Nibbler
 Couch Champion

78%
89%

Fresh Starter

Tender Bender
50%
89%

Set Routine Repeater

L.M.’s 12 month Exercise Patterns
66
 People Pleaser
L.M.’s 12 month Coping Patterns

Overreaching Achiever
67
 68
Lifestyle Patterns Approach
to Weight Control
Online Support Website: Diet.com

• Exclusively offers this personalized approach

– Members take the validated quiz that pinpoints their DOMINANT
eating, exercise and coping patterns that cause weight gain
– Members get their own diet personality profile
– Members get weight loss strategies and a meal plan
personalized just for them
– Members are encouraged to retake the quiz monthly to keep
advancing their weight loss program
• Social Networking
– Personality specific discussion boards, online buddies, personal
cheerleaders, email access to medical experts, online and
offline support groups
• Can complement your office-based weight
management practice
 69

Diet.com Dietitian Partnership Program

Objective: Partner with dietitians to develop a robust

weight loss program that is personalized for each client.

Key elements of the program:

•Turn-key, personalized weight management program for your clients
•Free coaching from Dr. Kushner and Diet.com dietitians.
•Peer discussion boards for participating dietitians
•Up to 50 discounted premium accounts for clients (50% off)
•Private online coaching boards for your clients
•Welcome packet to help you and your clients get started
•Sign up today at www.diet.com/professional!
 70

“Most people underestimate their

power to change and grow. They
think that yesterday’s pattern must be
tomorrow’s.”

Dr. Nathaniel Brandon

The Six Pillars of Self-Esteem