Bob Greene
Photo: Reggie Casagrande
From avoiding food triggers to managing stress, fitness expert and best-selling author Bob Greene weighs in with what he knows about relapse—and how to prevent it.
Oprah's struggle with her weight has become almost mythic—it's not just that she's been so open and honest about it but that millions of people share her story. The truth is, the majority of the American population either wants to be thinner or is actively trying to become so. Why do we have such a hard time controlling our eating and sticking to an exercise program? In the 25-plus years that I've been helping people slim down, I've noticed a few common traps that cause people to fall off the wagon. (Incidentally, they're similar to the reasons we fail to lose weight in the first place—and I'll tell you about them in my "Back to Business" Plan.) Science, too, is starting to help us understand why certain people may be wired to relapse.

That research has to do with the way we respond to pleasure. Food, sex, a glass of wine, certain drugs—they all raise levels of the reward chemical dopamine in our brain. Nora Volkow, MD, director of the National Institute on Drug Abuse, believes that for some people, eating cookies or french fries raises dopamine levels in a way that keeps them going back for more. In other words, these people can become as hooked on food as alcoholics are on booze and smokers are on nicotine, although even in the worst cases, a french fry never delivers the same kind of high.

One reason the craving to overeat may occur is that the brain is deficient in dopamine receptors. In someone like this, it would take more food than normal to get the same hit of satisfaction. According to Volkow, dopamine is also a major player in the frontal cortex, the area of the brain that puts the brakes on destructive behavior. So being low in dopamine hits your weight control efforts with a double whammy—you're driven to eat more and it's harder to stop once you start. That's why when you relapse, it's not with just a slice of pizza; it's with the entire pie.

At this point, there's no way to test your brain to determine whether it's dopamine deficient. But if you suspect that's the case, you should try adopting new sources of pleasure. Hanging out with people you enjoy, for example, is a great start. Also, exercise (I'm not making this up) appears to raise dopamine levels. And avoid foods you can't stop eating (ice cream, cookies, french fries) the way you would stay away from bars and happy hours if you were trying to quit drinking.

Recently, in fact, experts have started comparing the struggle to slim down with the difficulty of breaking an addictive habit. Research suggests that it often takes a number of attempts before people are able to kick cigarettes or give up alcohol for good; this might also be true for weight loss. The National Weight Control Registry is conducting an ongoing study of more than 5,000 men and women who have succeeded in maintaining an average loss of 66 pounds for more than five years—and among them, 91 percent had tried and failed before. The average total number of pounds lost (and relost) by a participant through various diets is a whopping 565!

So here's the good news: Instead of thinking, "I've failed over and over again, why bother trying again?" take your relapse in stride and stay positive no matter how many attempts it takes you. Each new effort brings you closer to the one that might really work. The key is to stick with it until you achieve your weight and health goals—that's my definition of a true success story.

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