Relapse/Maintenance - Stages of Change

Michelle Obama likes pie.  Michelle Obama likes cheeseburgers and french fries, especially when followed by a hot fudge sundae covered with peanuts.

And her mission as First Lady of the United States of America is to address the epidemic of childhood obesity.

She began this effort when her children's pediatrician noticed they were developing some issues.  That brought her own food issues to her attention.  So she changed the way her family eats.  Less fast food.  More fruits and veggies.

It wasn't about looking like a model, getting into that dress for the big event.  It wasn't a diet.  It was, and is about change, for the sake of health.

She still eats pie.  Just, not all the time.

Stages of Change

Here is the last of my series on the Stages of Change, a model for addressing the health crisis of people with mental illness, who lose 15-25 years of our lives to our illness, mostly due to obesity and its health complications.

The reasons we weigh more on average than the rest of the population are many, some simple, some complex. But the consequences are the same.  We have the lifespan of people who live in Sudan.  We don't get a lot, or any help with our weight issues.  We have to do this ourselves.

This is the road map.  One step at a time, changing thoughts, then behaviors, then thoughts to move from one stage at a time.

The goal is not a number, not a dress size, not an event.  It is a permanent change in the way we eat.

That is the first, last and most important takeaway from this series. That is why, once the action stage is over, (the time one is actively working on ceasing the old habits and developing new ones), we are not finished.

From Pre-contemplation Through Action

Most of this series has come down to breaking the addictive food cycle. David Kessler names names and spells out the science in his book, The End of Overeating: Taking Control of the Insatiable American Appetite

Here is my summary, explained in more detail in this earlier post:

You have to interrupt this cycle to regain control of your eating.  That last post supplies some tools.

But let's get back to that pie.


A piece of an 8" two crusted apple pie cut into six pieces is worth all the carbs and fats that I eat at lunch (my main meal of the day) to maintain a normal (healthy) Body/Mass Index.  (Great resources at that link there, by the way.)  Add four ounces of grilled tuna, broccoli and a salad with fat-free dressing, and I am good to go.

Except that's too much sugar, and I will be tired by mid afternoon.  Cut the pie into eight pieces.  Or choose pumpkin pie instead.  Then I can add a fourth cup of brown rice to even out the blood sugar levels.  And I am a happy camper, having splurged and still feeling good, and feeling good about myself.

I kept using the "bubbles" to track of my food intake for a couple years after I reached my goal, to reinforce the habit, to make sure I ate enough of the food groups I tend to short, and to help me calculate things like, how do I fit that piece of pie into the day's plan?

There is now structure, not chaos in my eating habits.  The bubbles have become more automatic.  I do them in my head, or go back to written form when I am traveling or eating out, when my behavior tends to wobble.

Maintenance thoughts:

  • I really did this!
  • I have beat the odds.  I will have a longer life-span than the average person in Sudan!
  • I better have a good financial plan, because I really am going to live longer than my mother!
  • What do I need to eat for lunch, given that we are going to that fancy dinner tonight?
  • I still want to eat the whole thing.  What tricks will help me stay on my plan?
  • If I mess up those three weeks while visiting my in-laws, I can (and will!) return to healthier eating when I get home.
  • I will feel (and sleep) better when I do return to my healthier eating.


Relapse is normal.  Relapse is as normal as falling off a bicycle when you are learning to ride.

The issue is, how far did that bike roll before you got back on.
  • If you decided it's hopeless, then you go back to contemplation.
  • If your old habits reclaimed you, but you are still in the game, then you go back to preparation.
  • After three weeks over Christmas at the in-laws, it was back to action.
  • Actually, I took the slow road back and simply returned to maintenance.  So it took four months to take off the four Christmas pounds, by eating the way I need to eat to maintain the weight I want to weigh.  That was fine by me.  I just wanted to stick with the program.
By the way, an occasional splurge is not a relapse.  There are some foods that have a particularly strong hold on me, and maybe some on you.  At the beginning of maintenance, you may have to stay away from them entirely, the way an alcoholic in recovery simply cannot say, Just one.  But once the new habits are established, you can accomodate, and even make up for an overdose over time.

Captain Obvious says, The sooner you get off your butt and chase down that rolling bike, the less far you will have to run.  And the sooner you can get back on.

It is important to identify which foods trigger relapse, and continue to avoid them.  Put a bowl of popcorn in front of me and I will empty it.  Baby bowl, Mama bowl, Daddy bowl, the Jolly Green Giant's bowl.  Doesn't matter.  I will empty it.  So I have to control the size of my bowl, and stay on the other side of the room from the bowl that was intended for the whole crowd.

Relapse thoughts:

  • What went wrong?
  • How can I do it differently next time?
  • Where do I reenter this process?

Never waste a good relapse.  It is an opportunity to examine the process, to remember why you wanted to make the change in the first place, to learn more about what motivates you and what you need to do to achieve and maintain your goal.

I have a very supportive sister-in-law, who now reminds the martini maker to give me the junior-sized glass.  It's still up to me not to go back for seconds.

What Next?

So that's enough about food for now.  I have a draft post with the title Sugar Makes You Depressed (And Stupid) -- more research studies, and the mean things that scientists do to poor little rats.  But I want to move on.

Some final thoughts -- This series has been about changing the brain, not dieting.  Did you catch that?  I have used food habits by way of illustration.  I could just as well have used exercise, smoking or sleep regulation.

In fact, those are the big four.  Control nutrition, exercise, smoking and sleep, and you will probably beat the Grim Reaper, who put your name on the short list when you came down with whatever sucky DSM diagnosis you have.  Your need for medication may also plummet.  Which will help you control those big four.  Now there's a cycle that works in your favor!

Just be kind to yourself.  One step at a time.

NAMI has a program called Hearts and Minds.  Follow that link for more tools and information on wellness.

Live long and prosper, my friends!

Note added 01/02/13 -- The following are links to the rest of the series:

No New Year's Resolutions - Change Your Life December 29, 2011 -- Overweight is a major health issue, the largest contributing factor to early death for people who have mental illness.
The Stages of Change and Weight Loss January 3, 2012 -- How do you change a habit?
My Food Autobiography and the Stages of Change March 8, 2012 -- Pre-contemplation and contemplation.
Changing Food Habits -- Contemplation and Preparation March 15, 2012 -- Reviews The End of Overeating by David Kessler and introduces the brain science of the sugar/salt/fat trifecta.
Dopamine -- Can't Live Without It March 23, 2012 -- The brain science behind habit formation and an experiment to try.

photos of Michelle Obama in the public domain
Stages of Change graphic by Todd Adkins and in the public domain
habit graphic by Willa Goodfellow and in the public domain
flair by
photo of broken bicycle by Giusto Cerutti, from the Dutch National Archive and in public domain
Hearts and Minds logo from

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