Your Hand Guide for Permanent Weight Loss

Are you ready to go?

I want to guide you to your perfect weight but I want to do it in a way that you will never need me again (after you reach your perfect weight).  I think you will find something new that will encourage you and make you successful.  I won’t try to force you into a mold.  Some principles apply to everyone but the art of weight loss lies in knowing when to do what in such a way that you can tiptoe up to your perfect weight without a lot of pain but in a way that the loss will be permanent.

In order to do this, I would like for you to learn a few simple ideas that will make the journey much easier. 

 The first and most important principle to learn is that you probably already have all the will power that you need.  Most people who suffer with obesity will come to me and say, “I already know what to do.   I just need to exercise more and eat less.  I know that I need to do these two things, I just need a little more will power.”  They’ve been beating themselves up over a lack of will power (and sometimes think that they’ll find will power in a pill) but what they usually lack is skill power.

 You may say, “I know what to do.  I’ve lost weight before.”  But, if you lost weight before and now you’ve gained it back, then at least just for a few days consider the idea that you might could learn some new skills that will make it possible for you to comfortably keep your new perfect weight for the rest of your life.  I hope that you will find that there are many skills and strategies that you can use so that you need less will power and rely more on skill power.[1] 

I’ve had many people lose weight with me, but it still brings me much joy when someone finally realizes that she doesn’t have to go hungry and that she can actually feel better with less pain while losing weight (not just later when she finally reaches her goal weight and can go back to “living normally again.”)

Forget the idea of normal.  In the USA, two out of three adults (60-70%) suffer with obesity.  So, if you plan on reaching your normal weight, then you plan on being in the minority in this country.  If you develop a healthy, lean body, then you will be abnormal in this country.  This is important:  if you want a body that is abnormally healthy (in this country) then you must learn to act abnormally (different than most of the people around you).  So, you will learn to do some things that are different from most of the people around you.  But, soon, healthy skills and habits will start to feel “normal” to you.

The following list outlines a few skills and principles that I want you to learn while we coach your body to its new weight.  Some of them may already make sense to you and may represent current habits in your life.  But many of these skills introduce new ways that may only make sense after you test them under my direction.  

After being involved in fitness for the past 30 years (I started hanging out at the YMCA when I was 13 and have seen much come and go), hopefully I will have some experience other than what was gleaned from medical school to offer you.  I’ve worked as a research chemist, ER physician, Internist (primary care physician), and of course in weight loss.  I participate in clinical research now in endocrinology and other fields.  I try to stay trim and try out various diet plans on myself (yep, I’ve fasted, done Atkins, Protein Power, Sugar Busters, HMR, lived at a Seventh Day Adventist Retreat, studied under the Zone organization, traveled to classes at Harvard, Puerto Rico, San Francisco, New York, New Orleans, Las Vegas, Atlanta, and others…all so that I might hopefully help you find the combination that works for you.  So….

1. Read through this list of tips at least once a day for the next week and then once a week until you reach goal weight.  Every tip is important to your successful weight loss.  Just reviewing them and keeping them in the front of your mind will go far toward keeping you on track.
2. Each time we meet I will listen to you and search for the thing most needed to help you travel toward and to cement your body to its new weight.  Everyone has a little different schedule, a little variation in what tempts him or her most, and what stresses them most.  You may be making wonderful progress and I may seem concerned (because I sense an impending setback and weight gain).  Please listen to me and please allow me to listen to what’s going on with you.  I’ve coached many people into a new body and may see a big bump in the road and offer you a way around it.  Or, I might see a way to speed your progress.  So…
3. Expect me to make small changes in your program occasionally to help you avoid plateaus and weight gain and to keep your body’s momentum going.  The body seems to quickly adapt to the same routine and surprise in new and healthy regimens will keep you going.  I hope to draw from a variety of tools and strategies but this may involve occasional changes. 
4. When I make a suggestion, I will purposefully try to make it seem so simple and easy that you may be tempted to ignore it.  Please do not.  I’m trying to take you in tiptoe steps to a destination; but you will not be ready for the next step unless you take the one offered.  And though you may lose weight, you may not be building a secure base on which to rest your newfound body.  Although I expect people to regain weight, my goal with every person is that eventually they do not need me to keep their weight down (a goal that I’ve seen come true in the lives of hundreds of patients).
5. Bad News:  If someone tells you that you can maintain a healthy weight without exercise, they’re mistaken (about most people).  There are certain numbers that are programmed into most of the human bodies.  For example most people need about 7 hours sleep per night.  Most people are somewhere around 5 to 6 feet tall.  A few people can make it on 4 hours sleep per night, but most will eventually become tired.  A few people grow to 7 feet tall, but most do not.  A few people will not be overweight even with no exercise; but most people will be overweight if they do not get a specific amount of exercise.  Most people can tell you, “I need 6 hours sleep to feel well.”  Maybe, for you the number is 7 hours, or 9, or 4…I don’t know.  But do you know the amount of exercise your body needs to stay at normal weight and the least painful way to work that much exercise into your life?   For most people, the number programmed is 2000:  most people need to expend somewhere around 2000 calories (per week) in physical activity in order to keep their weight at the best level.  Some can get by with a level somewhere between 1500 and 2000 calories in a week.  Most people will regain at least ½ of the weight lost (no matter how it’s lost) within 6 months if they do not expend over 1000 calories per week in physical activity.   My job is to help you find out exactly what the number is for you and how to put this much exercise in your life (what to do and when to do it).
6. Good News:  Exercise can be simple and painless and I can help you learn how to exercise and have more time in your day and more energy.  I will also help you determine the kind of exercise you should do, when, and how much for your body.  I will help you learn how to do your exercise in a painless way.
7. Do less exercise than you want to do.  I will help you plan your activities but try to never break this rule.  It is better to be consistent and daily with your exercise than to do more than you want and then learn to dread the activity (or worse, suffer injury).  I prefer that you do less than what you wish to do so that you finish feeling like the session was easy and so look forward to the next day’s exercise.  Do much less than you want, but
8. Do exercise 6 or 7 days per week.  It’s much better to do less every day than to be inconsistent with more.  By being persistent with a small amount, your body will adapt with less risk of injury and fatigue.  After adaptation happens, then you will naturally find yourself doing more without any extra effort.  But the main principal to follow is to be persistent with a small amount at least 6 days per week and to guard this exercise time as you would the most important thing you have to do in a day.
9. For most people, the best exercise is walking.  Walking (once you make it to a certain level) does more to decrease your risk of heart attack than does any medication on the market at this time (more than any diabetes tablet, or hypertension, or cholesterol medication). [2]
10. Almost everyone tells me that they do not eat a lot of food.  Usually, that is true IF YOU MEASURE THE FOOD BY VOLUME (OR HOW BIG IT LOOKS ON THE PLATE).   But, if you measure the number of calories in the food, everyone who is overweight is getting more calories than needed.  Usually, the extra calories are much less than people think.  For example, a woman who is 60 pounds overweight is only getting about 660 calories per day more than she needs.  Many studies show that most people are very poorly skilled at estimating the actual number of calories being eaten.  (Almost every patient tells me that they eat very little and they eat almost nothing until late afternoon and evening).
11. I want you to learn how to EAT MORE FOOD (MEASURED IN VOLUME) but make the foods you eat lower in calories.  Two pieces of cake has the same number of calories as 11 cups of corn and the same number of calories as 22 tomatoes.  I can eat 2 pieces of cake after dinner but I can’t eat 22 tomatoes (and neither can you).  So,
12. Learn to make food your diet medication by eating lots of fruits and vegetables (at least 5 servings per day).  The more of these foods you eat, the less hunger you will have for other things and so the less of the other high calorie foods you will eat and so the more weight you will lose.  Did you hear that?  I just said that the more you eat the more you will lose.  You probably don’t believe me but I challenge you to try me.  If you want to lose more weight, try eating more fruits and vegetables.  Even if you eat the wrong thing, don’t try to make up for it by skipping the fruit and vegetables (would you skip taking a diet pill because you ate the wrong thing?)  Instead take more of your diet “medication” and eat more fruits and vegetables because your resolve will be down most after eating off the diet and eating fruits and vegetables will help keep you full so you get back on track (instead of bottoming out your blood sugar an hour later and then tanking up on sugar again).  If you regain your weight or if you reach a plateau, instead of quitting, just eat a banana and come see me.  Because…
13. I don’t expect perfect and neither should you.  Not one person who lost more than 20 pounds with me displayed a perfect performance.  Every person who lost more than a few pounds had weeks where they got off the plan and weeks where they gained weight.  You should not expect perfection.  Just try for close monitoring and a continually improving performance.  My job is to help you find a way back on track without letting you lose your enthusiasm.  Would your tennis coach quit on you or berate you if you missed the ball occasionally.  I consider our task a development of new skills (which I continue to try to implement in my own life) and so by presenting to you a continuum of new things to learn, I expect to see you stumble.  That’s when you need most to come back to me and to not quit.
14. If you want the easiest way I know to eat 1000 calories per day...then find a good quality, whey protein shake that's nutritionally sound enough to provide most of your nutrition for the day.  Then eat 4 shakes per day and two pieces of fruit.  Go here and order two boxes of the meal replacement shakes for the best tasting most nutritionally complete shakes that I know of.  A typical day would be shake for breakfast, fruit for mid-morning snack, shake for lunch, fruit in the afternoon, shake for supper, and shake at bedtime.
15. After making it to your goal weight, use two shakes per day as a way to keep your appetite in check.
16. Avoid sugar like the plague that it is.[3]
17. Avoid bread and pasta until you reach goal weight (eat baked potatoes and beans instead).  Both bread and pasta often cause large insulin spikes that result in fat storage.
18. Try to include 2 quick protein snacks in your daily routine to “ruin your appetite” for extra calories.  Eating about 150 to 200 calories mid morning and mid afternoon helps you control your appetite for lunch and dinner.  Make sure you put into your environment (work, car, and home) plenty of such snacks so that you never get ravenously hungry and eat the wrong things.  Good choices are Zone Bars, Balance Bars, and U-Turn Bars.  Replacing breakfast and/or lunch with a protein shake of about 300 calories is also a good practice that will help you along to your goal weight and help you stay there.  Even though you may feel like this adds calories to your day, this practice actually allows you to eat a much smaller lunch and dinner without going hungry (so you wind up with a total of less calories for the day).  Also, by spreading your calories out evenly over the day (eating only as many calories as you’ll need over about 2 to 3 hours) you avoid large insulin spikes which lead to fatigue and fat storage (you burn the calories at almost the same rate you eat them).  For more information on this, read the book Mastering the Zone by Barry Sears.
19. Until you reach your goal weight, drink no drinks with calories unless you're drinking a protein shake as a meal replacement (every coke or glass of juice you drink per day is worth about an extra 10 pounds). [4] Ask me to do the math if you don’t believe me. More people die from heart disease than HIV and much of heart disease is caused by sugar rich foods.    But, don’t ever give up a habit.  No one ever quits a habit.  We just trade one for another.  So, for example, if your favorite food is chocolate candy then please keep experimenting with different recipes and fruits until you can find a low calorie substitute (for most people the best substitute for chocolate candy cravings is one of the low calorie chocolate milkshakes).  One of my jobs is to
20. Teach you some low calorie substitutes for the things you like now.  Interesting isn’t it that we physicians spend months learning about the medications for Malaria (which I’ve only diagnosed twice) and yet we spend very little time learning nutrition (and all of my patients eat food)?  When I was in medical school, only two of the medical schools in the country offered a class in nutrition.  I’ll stay knowledgeable about various products and recipe books and help you find substitutes and teach you how to work them into your life.
21. With every weight-loss pill known you will regain the weight you lose when you stop the pill…. if you do not learn new skills and habits to practice when you stop the pill.  Weight loss pills serve as a tool to use while you learn new skills.  I do prescribe weight loss pills to some people.  If I prescribe them to you, then I will continually point out their purpose and help you to identify the skills needed for a healthy and permanent weight loss.
22. Do not allow your self to get hungry if possible.  If you do feel hungry, then eat immediately (but eat low calorie fruits and vegetables before you eat other things).  We’ll talk in more detail specifically about when and what you should eat but try to follow this basic principle:  eat every 2 ½ to 3 hours and eat only enough calories to cover your activities for the upcoming 2 ½ to 3 hours.  This way you do not store fat and instead will burn fat (because I’ll teach you to eat a little less than what you need until you reach your goal weight).
23. To be successful, you may need to have some hormonal abnormalities corrected.  Get your primary care physician to check the following:  free T3, free T4, TSH, IGF-1, DHEA, free and total testosterone, and estradiol.
24. If you snore, you must get a sleep study done.  Untreated sleep apnea may make it impossible for you to lose weight.  Talk to me about a referral for this test if you think it’s needed.  You may make much progress without this test.  But, with untreated sleep apnea you will have much trouble making it to your goal weight and will not stay at your goal weight.  You will also suffer unnecessarily with fatigue.
25. Make a schedule for when you plan to take care of your body.  Do this every week without fail.  Then show it to your family and ask them to support you.  Tell them that you can take better care of them if you will be allowed to take care of yourself.  I’ve included a form for this purpose. 
26. Start educating yourself about your body and about new methods by reading recommended books and websites listed at http://runels.com and at http://alabamaweightloss.net
27. In everything, use the principle of letting the good crowd out the bad.  If you walk, you will have less time for other things…let something harmful go.  If you eat vegetables you will have less room for pizza.  If you put tomatoes in your refrigerator you will have less room for pie.  So try not to give up anything until you’ve put something in its place.  Using this principle,
28. Fill your car, work place, and home with healthy foods.  Then throw out everything that’s not supportive of your weight loss.  Ask your family to cooperate (by eating their treats somewhere else or hiding them from you).
29. Keep a simple record of your progress.  Just the act of keeping a record of any activity automatically causes it to improve.  I will describe how to use a record easily and what to record when we visit together.  I will not ask you to record everything you eat or to count calories eaten in each meal.  As an X research chemist, I like math…but I don’t like doing math every time I eat.  So, I won’t ask you to do math when you eat.  But, I would like for you to count 3 things for me:  Number of fruits and vegetables eaten per day, what exercise you did, and number of protein snacks per day (more about this when we talk in person).
30. Please bring your record with you when we visit.  If it’s incomplete or displays that you did not reach your goals, then that’s exactly what I expect (your tennis coach doesn’t expect you to play perfectly or you’d be on TV instead of taking lessons).  So, just bring the record with you and let’s talk about how to make improvements.  Without the record, neither of us will do our jobs as effectively.  I CANNOT STRESS ENOUGH HOW IMPORTANT RECORD KEEPING IS.  TO TRY TO LOSE WEIGHT WITHOUT A RECORD IS LIKE TRYING TO RUN A BUSINESS WITHOUT KEEPING TRACK OF WHERE THE MONEY GOES.  Good records help build new habits. And, anything recorded will automatically improve.
31. Learn one new dish or food per week.  You may simply try a new protein bar.  Or you may prepare a dish from one of the books I recommend.  You may try a new recipe for a protein shake.  No matter how simple or interesting, try a food or recipe once a week.  By learning new tools (low calorie foods that kill your appetite without causing weight gain) you will be able to eat without boredom.  You know lots of high calorie foods; you must learn even more low calorie foods that you like.
32. Bring this note book with you every week so that I can make notes and we can both have a common record of what you’re attempting to do each week and what results you see.
33. Find someone much healthier than you to hang out with.  Easiest way to do this is to just go to the YMCA or other health club regularly.  Or go to a local track where people walk.  Just get to know some people who are healthier than you and hang out with them. 
34. Drop from your life everything that’s not important.  Most of us need to constantly learn to simplify our lives if we wish to preserve time for what’s important.  Most people only have room for 3 or 4 important priorities in life.
35. List the 4 things most important to you: 
1. Health 
2. ___________________________________________
3. ___________________________________________

            d. _____________________________________________

34. Show this list to the people you love and remind them that you cannot see to items b, c, and d if you do not take care of item a. (Health).  Ask them to support you in your weight loss efforts.
35. If you have to remember just three things:  1.  Eat 5 fruits or vegetables every day.  2.  Eat 2 protein snacks (about 200 calories) between meals every day.  3.  Work up to 2000 calories of exercise per week.

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 Good luck with your efforts.  You may email me if you wish.  You may call me if you want—just don’t quit.  

 Peace and Health,

Charles Runels, MD

 http://runels.com          

charles@runels.com     

http://alabamaweightloss.net

251-625-2612  (to speak with me personally)

251-343-5115   (Appointment Alabama Weight Loss)