Learn THE secret that you have been missing to building a good healthy habit
This was a talk I gave for my patients in November 2018 at Scottsdale Weight Loss Center in Scottsdale, AZ 480-366-4400
Craig Primack MD
Craig Primack: How To Easily, I don’t know if easily is the right word, but, Easily Build Good Habits. It’s taken from a blog that I get a lot. if you want to write it down, it’s great. If you ever read anything by Malcolm Gladwell, Blink and all that. This guy is like a weekly Malcolm Gladwell. He’s great, Barking Up The Wrong Tree. So, examples of things that we should be doing. What aren’t we doing that we should be doing?
Craig Primack: Exercise?
Craig Primack: Cooking? Who cooks? Okay, not bad. Our society as a general rule doesn’t cook anymore (by the way). They eat out, they bring in, they microwave, because why? We don’t have time. How about oatmeal? If you’re actually cooking it on the stove, how long does it take? 30 minutes. It’s 30 minutes. It’s not two and half minutes in the microwave. The microwave stuff is actually precooked, and that’s why I don’t like it. Two and a half minutes. Sleep? Anyone heard me say sleep? If everyone is not raising their hand, we have a problem here. What else? What don’t we do that we should be doing? What do you want to do that you’re not doing?
Audience: Drink more water.
Craig Primack: Drinking more water? Absolutely. Anybody else?
Audience: Be more active?
Craig Primack: Be more active, so how to make these things happen more likely. Simple and painless, of course, right? Isn’t that what we all want? Simple and painless.
There are four steps. Step one, make it obvious, so going towards the drinking water, what does that mean? I want to drink more water, what does it mean?
Audience: It just means you got to take more water to stay well hydrated.
Craig Primack: How much is more?
Audience: Six to four ounces a day.
Craig Primack: So, that’s a great number, so now we have a specific. If you want to drink more, should it be 80 ounces? When should I drink it? Where should I drink it? How should I drink it? So, let’s start getting specific. I will at a time and the location. So I want to exercise tomorrow. What do I say I want to do? I’m going to go to the gym. That’s when am I going to go to the gym? What am I going to do there? How long am I going to do it for? So this is being very specific. Tomorrow I’m going to wake up at 5:30. I’m going to put on my running shoes, walk out my door and go two miles.
Craig Primack: If you say very specific, some of you came in the first day and we met and you said, I want to be healthier. And I said, what does that mean? We have to measure it. So this is on the track for that. SMART goals. Everyone…here is smart goals. Oh, it doesn’t show. Hold on. I think there are enough if they just did. So. The first thing is specific. Let’s be very specific. I want to walk tomorrow. It’s measurable. I’ll probably do it. I want to walk. How far do you want to walk?
Audience: Two miles.
Craig Primack: Is it attainable? Well, have I walked two miles before? Do I have a bad knee? Do I have shoes? Is it good outside? Is it relevant? So if my goal is weight loss, is this a relevant goal? We have a last one last one. Oh, time bound. When is it going to happen? Tomorrow? In the morning at 6:30. Habit stacking is another technique. Tie a new habit to an old habit. Who Watches Netflix? Anybody have a stationary bicycle or a treadmill at home?
Craig Primack: Put your treadmill in front of your TV? So I have a friend. I’ve told some people that story before. She does not watch TV unless she’s on her stationary bicycle with TV. I like bike, I might like, but I know I like TV. so every time I watch TV I get on the bike and her rule for that is “I just have to move”. I don’t have to go fast. I don’t have to go slow. Her only goal what she’s doing is moving. You watched a half an hour show, you just biked to half an hour. Watching an hour long show is you just biked an hour. It takes your mind off it too. So you don’t stare at the numbers. Oh my gosh, it’s been two minutes. It’s been four minutes. Who goes to the gym and stares at the treadmill number? Don’t. Put a towel over it.
Craig Primack: So after a current habit, I will do this habit. So it can be even simpler than that. When I wake up, I put on my shoes and I go for a walk. We’re just tying things together. Sometimes it’s the things had happened anyway, I get on the way home from work, I stop at the gym, so you have to start being specific about the things and putting goals on them.
Step two, so that’s step one, make it attractive. So actually this was the Premack’s Principle that spelled differently because this was a psychologist. He said more probable behaviors will reinforce less, probable behaviors. So that’s the things that you’re already doing. I have to wake up and then I exercise. I come home and I do that. I, personally, when I exercise in the morning, the night before, every single time my clothes are in a pile ready to go when I wake up in the morning and it becomes super routine. I wake up, I can tell you the contacts go in, the clothes, go on. I do a chocolate shake… still five years later and I’m out the door in a few more minutes. Right now I actually have to walk the dogs first. I come back and I do my own exercise.
Craig Primack: And if it doesn’t happen in that order, at that time when they were the closest you get out there, it’s probably not happening in the morning. Leverage sheep-like tendencies. People around you influence you more than you think. If all my friends go to happy hour on Friday, what am I going to do?
Audience: Go to happy Friday.
Craig Primack: I’m going to have happy hour on Friday. All my friends on Sunday morning or riding bikes, what am I going to do?
Audience: I’m going to ride. Going to happy hour.
Craig Primack: It’s going to happy hour [crosstalk 00:06:35]. So doing things with people that already do the things you want to do. Um, they’ve actually said your friends, when I look at this, your friends are actually better than your spouses or significant others when it comes to this because we’ve already kind of set up those relationships. Although it’s best if you do it with your spouse or significant other, we know that friends are really the ones that help us in this. I always joke if you go out to eat and you’re the fourth person or fifth person to order, and if someone goes cheeseburger, cheeseburger, cheeseburger, cheeseburger, are you going to be ordering a salad? No, but if it goes salad, salad, salad, salad, you’re probably not ordering a cheeseburger. It’s what other people are doing is what you do. So if you’re ordering with those kinds of people, order first truthfully and then you’re the one who sets the tone for the rest of us.
Craig Primack: Step three, make it easy. Find ways to make it easier. Commit to a small amount. I may have told some people, go to the gym and get on the treadmill for one minute. Why do I say one minute?
Audience: It’s a start.
Craig Primack: It’s a start. Do you think anyone is ever truly got on the treadmill and only went for one minute?
Craig Primack: Lisa Galper, who taught the class right before this, tells someone, go to the gym, sit in the parking lot in your gym clothes, and if you leave, you leave. Do it twice. I don’t think anyone has ever gone there twice and not gone to the gym? I don’t think so. I actually don’t think so. At least no one has ever told me they have. And so all the time I’ll say just, it’s always the first bit that’s hard. I’ve been a runner for since high school. I still hate the first mile. I still hate the first mile, but I know once I do it the second mile feels good and however else, it depends. Now it’s two miles probably a max. So yeah, make the first two minutes easy.
Craig Primack: Step four, make it satisfying. How do you reward yourself? Well, it used to be food, it’s not food anymore. So what is tied or we need short term goals or rewards or we need longterm rewards and all of them are different for all of us. What is immediately rewarded is repeated. So if you feel good and why do I say you have to do an exercise that you like? ‘Cause I want you to leave it feeling better than you did when you started. When I go for that mile walk and I’m done. The sun is out, the birds are singing in the, you know, we live in Arizona. It’s nice all the time. I can come back smiling, right?
Craig Primack: Also, what’s immediately punished is avoided. If we hated it, we’re not going to do it tomorrow. If you pick a trainer and that trainer beats you up for an hour the first time you meet with them, you don’t want to meet with them two days later when you’re scheduled again?
Craig Primack: That happens all the time. So many people get their trainer beats up on them way too much. So how do you maintain these good habits? Make them part of your identity. It becomes who you are. It’s no longer something that you do. I’m not just someone who’s going for a walk. I’m a walker. I met someone that goes to the gym, but I work out. That’s what I do. I’m a cook. I enjoy cooking. I’m a napper. I’m actually all four of these things by the way. So I’m a runner, I’m a cyclist, I’m a cook and I’m a napper and I keep doing them and all of this, some people say all the time how do you do it? And if I was out to dinner with you guys and people were ordering bad and I ordered good, you just go well, that’s Primack… he does weight. No, it’s because I do these things. Make it obvious, make it attractive, make it easy and make it satisfying. I put them on a little piece of paper.
Craig Primack: Questions. We have about 10 minutes in the hour. Sometimes I end with this, which is called AMA. Ask Me Anything. Questions, anything at all….
Audience: If you look back at all the years you’ve done this, what are some of the key successes that you see that have been consistent the people that have lost weight and kept it off all the time and yourself?
Craig Primack: So knowing … A couple of things, learning from what happens, we’re not all going to be the same. You hit your goal number and we say I’m never going to go off that goal number. There is going to be a range. I am still learning my triggers and the things that help me stay on my weight and the things that don’t. Ice cream doesn’t come to my house. I’ve told many people this story. Ice cream does not come in my house anymore. I can tell you the last few times I’ve bought ice cream in my home, October of last year, 2017. That’s when I realized I had a problem with ice cream and it wasn’t just, it was you sit down with a bowl and the thing in front of the TV, we all do it or can’t do it or, or we struggle with our weight. And so I didn’t buy an ice cream the whole year and I had a car accident this October. Itbwasn’t bad and my car is just three weeks in the shop, but I wasn’t hurt. He wasn’t hurt but I was on my way to the grocery store. What did I do? Want ice cream?
Craig Primack: I sat on the couch and I started eating again and when I got about halfway into it, I said, this has got to stop. And I stood up. This is where the willpower comes in. I stood up and I walked to the sink and I turned the water on and the ice cream was gone. And it’s not that I haven’t had ice cream between last October and this October, but it isn’t in my house. So the first thing is learning from things. If you go to certain restaurants, and you always overeat, it might not be the right restaurant for you. So that’s, I think that’s number one. And number two is having some kind of accountability, whether it’s coming in here on a regular basis or writing down your weight or tracking your food or something that shows you that you’re just looking at it regularly on a regular basis. And if you do fall off the wagon so to speak, you don’t beat yourself up.
Craig Primack: We know that in the all or none world, when you beat yourself up, you actually go the opposite. You go off the plan even more. And so yeah, it happened. It was a lapse. And I’m getting right back on. Today’s a new day. We talked about the dimmer switch sometimes. So and especially like this, it’s either on or off. If our diet is either on or off, there’s no middle ground, but if we had a dimmer, it starts out at 100%. Oops, I ate the little thing I wasn’t, but it’s still at 90%, it’s not at zero. But then I went for a walk, burned a little calories and also 95% again. I go to sleep I wake up tomorrow. It’s not where it was back at 100 a brand new day started again.
Craig Primack: So I think those. And then if the tools you’re using are working, don’t stop them. If you’re using some level of meal replacement if you’re using medicines, if you’re exercising, if you’re doing those things, just keep doing them, for the things that work for you. All of us are going to do a different combination of things. So as we find what works for you, just keep doing it. I think those are the biggest things I’ve learned.
Audience: Question back to obesity, maybe something I was wondering about from a disease perspective, what portion of that would you say or is there a difference between, is it hereditary? Is it genetic? Is it environmental?
Craig Primack: I believe it is a combination of, well, genetic and hereditary, I will call the same thing. And I think it’s the right genes in the right circumstances. The last time I talked about the Pima Indians, Pima Indians are based in southwestern United States. If you live in call it the US side as opposed to the Mexico side of the border and you eat in the normal American size way of eating 30, by the age of 35, 50% of them have diabetes. 50% of them have diabetes. So we’ve been able to study them as a science thing. If you live and the Mexico side and you’re still really, a farmer. And so they were farmers in the southwest and we live in the desert. So there wasn’t a lot of good farming that happened so they weren’t eating a lot.
Craig Primack: And so if you’re still working on your farm in the Mexico side, it’s 6% diabetes. This is the same genetic makeup in the same people. And it’s the different food that they’re eating. When we look at it, there’s probably what they’re going to say is 20, what they’ll call majorgenes. If you have any of these major genes, you’re going to have maybe slower metabolism, more uptake of calories or something, or there’s about 200 minorgenes and that’s where each person is a little different. And so one of them, let’s just say, says, I eat too many carbohydrates. Another person eats too much fat. Another person doesn’t get enough sleep. Another person doesn’t exercise enough. Another person, you know, and when you look at all of us, we’re all a little bit different and I think that’s where the little differences come in. There’s some interesting twin studies, so they looked at twins, the ones that are identical cells from the same egg. And when you look at them as they grow, they actually seem to have pretty much the same body type. Even when they are not raised in the same family interestingly enough.
Craig Primack: And the same siblings that could have the same parents, but with different eggs do not have the same body type. It’s a famous picture that goes around the weight loss world. So I think it is with the right genes in the right circumstances. There’s an island somewhere off the coast of Canada that’s secluded from the mainland. Throughout the years the food they eat is this fish called the hooligan fish. Hooligan fish is long and skinny and at some part of the year, I don’t remember which kind. They basically just go in the water and they take nuts and they get big nuts of these fish and they kind of boil them down to make oil from it. And the rest of the year all the food they eat, which is usually preserved fish. They dip it in the hot oil and they eat it. It’s a really a very, very low carb diet ’cause they’re out in the middle of northern Canada and there’s not a lot rowing.
Craig Primack: So in the 1950s, 60s, grocery story comes to the island and they show pictures of the grocery store. 20 kinds of cereal, soda, chips, all that and the island becomes big. Every person has gained a significant amount of weight. And some doctors from, some of them were part of our society, or some of them were researchers, started going up there and teaching and basically just eat the natural way they were. Go back to the fish, go back to oils and not a lot of carbs. And at the end of the year they had this big ceremony in the … Actually the biggest thing on the island is a Rodeo pit, so you know a thing and they put the equivalent of the weight they lost in a pile. So it was like dog food bags and flour and all that. And you see a mountain that’s like 20 feet high and all around from all the people on the island.
Craig Primack: So it’s interesting. That’s what we eat in the right circumstances. I think diabetes long ago, so diabetes you can put a little more weight on versus someone who doesn’t have diabetes. And so during times of famine you did a little better than your neighbor. And so that’s why it’s become a more and more people have that gene because it helped them live when your neighbor didn’t have that.
Audience: So what do you know about [crosstalk 00:18:12].
Craig Primack: Questions.
Audience: You do know, [inaudible 00:18:15] the long one, the last month is that on YouTube or something?
Craig Primack: So interesting. So I did tape last one and I’m taping this one. It is ready to go on YouTube. Was it actually, it’s not ready because the slides didn’t show up the way I wanted them to. So I’m trying to. And I think my kids probably know this but I don’t know how to do the video part, but I’m going to put the slide on. The video what you can do and it’s not that hard is, I don’t know ’cause I haven’t had a lot of time. It will be there. I actually I have a website that eventually it doesn’t have a lot on it but it’s doctorprimack.com and there will be a link to there. There’s probably about five articles on that website if anybody wants to go there now of things I’ve written.
Audience: Dr or doctor?
Craig Primack: Doctor. Yeah. Things like this will eventually show up.
Audience: So we’ve talked about this but what are some of the good techniques to break through a plateau?
Craig Primack: Great question. So plateau. I always go back to the beginning, diet exercise. And so we look at Diet and are we doing each of those little things? Are we sticking, you know, I’m not 100% but at least 95% to our plan. Are we exercising? Are we sleeping? And then we have if all three of those are in place and we have to start looking at the little things. Are we taking medicines that work or not work? Is there other things? Thyroid, which a lot of people we started looking at the thyroid and such. So I think that’s kind of the first five things I look at and then after that it’s not as easy. Those aren’t the obvious, but usually we find something in those couple.
Audience: Is it like if it’s not in those five things, is it okay now it’s time to kick it up a notch and exercise or kick it up a notch and diet [crosstalk 00:19:54].
Craig Primack: I can’t say there’s one answer to that-
Audience: Sleep more.
Craig Primack: So if it’s less than seven hours of sleep then sleep more would be my number one thing. I just looked at two or three nights ago. I looked a lot of the sleep data I have again, there’s an article I was interviewed for that they wanted the data. So there was one study that looked at if you sleep eight and half hours versus five and a half hours when you drop your sleep from eight and a half to five and a half, the metabolism fell by 400 calories a day. 400 calories is four miles of walking if we’re walker. So it’s a big deal.
Craig Primack: Growth hormone goes down when you’re not getting sleep. So growth hormone repairs the damage we do. So we go to the gym, we get sore, how do we repair that damage? Growth hormone, which is natural growth hormone comes on into later stages of sleep throughout the night and those two hormones and they talk about all the time and Leptin and Ghrelin. As we don’t sleep, the Leptin goes down so less full and the Ghrelin goes up more hungry. So that’s why it’s two in the morning and you go, oh my gosh, I’m hungry again. And you eat again and we justify it and say I’ve been up longer, I’m probably burning more calories. It’s actually the opposite. I’m up longer, I’m burning less calories. And when you think evolutionary, it makes sense. If we’re on the hunt and we need to stay alive to catch the buffalo is always my always my thing. You need to have the energy to do that. If you ran out of your energy early, we’d never catch up to the herd of buffalo and we’ll never had the food. Makes Sense.
Audience: And what about if you know have straight sleep? ‘Cause I assume you’re talking about-
Craig Primack: So the better our sleep is or the more in one session it is, the better, but we do think number one, you can catch up on sleep. And so if you don’t sleep well one night you can’t sleep … We used to think that you couldn’t catch up on sleep, but teenagers have showed us the opposite. You know, they may sleep til 10 or 11:00 o’clock on a weekend or later. For my daughters it’s probably 11:30. Taking naps, as long as it does not interfere with your nighttime sleep, it does help also. If you have sleep apnea or restless legs treating those on top of it. So a time when you are asleep that you’re really not asleep. All right.
Thank you for everyone for coming.