Welcome to Mayo Clinic's podcast. This month's topic is social, emotional and psychological barriers to weight loss. I'm your host, Rich Dietman.

Most of us understand one of life's basic rules, that with few exceptions, when we eat more calories than we burn, we put on weight. And most of us don't need to be convinced that being overweight or obese is bad for our health. And yet, we continue to struggle with weight loss and healthy weight management. But there's more to weight loss than just getting diet and exercise right. It's also about understanding the social, emotional and psychological factors that may prompt us to eat more than we need. Here to help identify some of the barriers to achieving weight loss and maintaining a healthy weight, and with some tips to overcome those barriers, is the Mayo Clinic's Dr. Donald Hensrud. Dr. Hensrud is a specialist in preventive and internal medicine, and he's also an associate professor of nutrition and preventive medicine at Mayo Medical School. And Dr. Hensrud is editor-in-chief of the books "Mayo Clinic Healthy Weight for EveryBody" and "The Mayo Clinic Plan: 10 Essential Steps to a Better Body and a Healthier Life," and he's a past medical editor for MayoClinic.com. Dr. Hensrud, thanks for joining us today.

Dr. Hensrud: Happy to be here, Rich.

Rich Dietman: Let's talk about obesity for just a minute and some of the causes. There are other causes, aren't there, for obesity beyond simply just eating too much?

Dr. Hensrud: Ultimately, it gets down to calories eaten, calories in vs. calories burned, but that equation is so deceptively simple. The factors that go into that equation are incredibly complex, and it starts with genetics. People whose parents were obese are at higher risk of becoming obese. We don't know exactly what the factors are that predispose people. It might be the way we inherit our genes for our appetite or different hormones, but in any case, genetics sets the stage. We make choices every day that influence calories in vs. calories out. Some are easier to make than others. And other factors that we'll talk about in a moment — psychological factors, emotional factors — also influences how many calories go in and how many calories are burned.

Rich Dietman: Plus, there are all sorts of social pressures, it seems, to eat, whether it's family activities, whether it's going out for snacks and drinks after work, all of those things are available to us almost every day of the week. Talk a little bit about some of those social pressures and how a person can manage to keep from eating too much in those situations.

Dr. Hensrud: It's challenging. Our individual drives are transmitted into social expectations and norms, as you described. Eating is fun. Eating is a social activity. We celebrate by eating at birthdays and special events, or even at casual functions like you described, going out after work. One of the things that I think people do is they either have an all or nothing phenomenon. They either have the attitude that "No, I'm not going to indulge at all," or they say, "What the heck, I'm just going to go with it." Either of those strategies usually don't work long term. If people give in all the time, obviously weight gain will result. But even if they resist all the time, or if they just say no, that probably won't work either, because there are still these drives, and sometimes restrained eating can lead to binge eating if people just fight it for so long and they say, "I can't take it anymore." So I think part of this involves planning, coming up with a realistic plan of not depriving yourself, but enjoying life, enjoying good food, but in moderation, and coming up with a livable plan. Eating healthy, managing weight and enjoying life, are not mutually exclusive terms.

Rich Dietman: So it's thinking ahead?

Dr. Hensrud: I think that's a very key point — planning ahead. Instead of finding yourself in a situation and then either just saying no or going with the flow, planning is a real key. And it doesn't have to become very rigid, you can go with the flow a little bit, but having a general idea. Such as going to a party, for example, it's very easy to stay on at the buffet table all night and just nibble. And at the end of the night, someone could consume a large number of calories. But if you eat something healthy before you go, and decide ahead of time what you're going to enjoy, how much you're going to eat, and have a general plan going in, it can be much easier to stick to your plan, and yet still have a good time.

Rich Dietman: Let's talk a little bit about what it's like in the solo situation. It's 11:00 at night and there's that quart of ice cream in the freezer and it's about bedtime, but boy, I sure am hungry, I know it's bad for me, but that bowl of ice cream is calling my name.

Dr. Hensrud: Once again, I think it's planning ahead and coming up with a realistic plan. The situations we described earlier, just say no or total indulgence, are not good strategies. So if someone wants something, wants a treat, I think that's fine. Have a realistic portion size, a realistic plan going in, fill up on other foods during the day so you don't find yourself ravenous at night. Also, realizing the consequences. Many people, it's understandable, food is a comfort, and emotional eating can lead to overeating. Some people tell me that, well, "I eat when I'm sad," other people tell me "I eat when I'm happy," and then there are those that eat when they're happy or sad and they just eat through emotions, and that can be very challenging. But not finding just the total comfort in food, but having other outlets for our emotions, and not relying on food for that emotional comfort, I think, can be a strategy that's much more effective.

Rich Dietman: Now that sounds like some serious self-analysis and understanding that goes beyond just me saying, "No, I'm not going to have that ice cream tonight." That really does sound like it takes a good piece of time and work to know oneself and how one works through these issues of sadness or happiness.

Dr. Hensrud: To some extent, yes, there's a spectrum. For example, if you look at, there are some significant psychiatric disorders — binge-eating disorder, for example, or severe depression or bulimia — where it's a very significant psychiatric disorder and food and weight can be intimately tied into that. Then if we go a little bit back up on the spectrum, everybody experiences an emotional reaction to eating. Sometimes we can get into vicious cycles if we rely on food to help us through some of those emotions and some of those psychological issues that we're dealing with.

Rich Dietman: Talk about serious mental illness for a minute, and depression, anxiety — things that go beyond just an occasional sad day or two. What I hear you saying is that those can play a significant role in eating disorders, in obesity, and that until, I'm assuming, those more serious problems are addressed, that the eating issues are not going to be changed.

Dr. Hensrud: You're exactly right. With depression, for example, some people can lose weight, other people can gain weight, and addressing the eating issues are just secondary. They need to address the underlying depression, illness or binge-eating disorder where people get in a pattern where they'll consume large amounts of food at one time. This pattern can become established and very difficult to change, but it's not just the food and the eating, it's the underlying behavioral pattern or psychiatric disorder. So the primary treatment in that situation needs to be directed toward the underlying disorder with subsequent treatment addressing some of the eating and weight issues.

Rich Dietman: Are there some tips that you have for managing stress that particularly pertain to food and eating?

Dr. Hensrud: Yeah, many people will rely on food to help them deal with stress. It's understandable. It's a comfort. But that can become a vicious cycle, it can become maladaptive, and people can gain weight then in the process. One of the things to start with is to analyze what's causing the stress in the first place. Come up with a good plan to deal with it is the next step that hopefully doesn't involve food. Many different things can be used — seeing a mental health professional, seeing a psychologist, seeing somebody else who deals with even meditation or other stress management techniques.

Rich Dietman: What about portion control? We're used to, in this country, I think it's fair to say, at least when we go out to dinner, having large servings brought to us in most restaurants and that may be when we also go to family gatherings, it may even be at home. Talk a little bit about portion control and what that concept really is.

Dr. Hensrud: I think first of all, it's understandable that we like large portions. That ties in with our inner drive to eat. The types of foods that are available, depending on what they are, may contain a lot of calories if they're high-energy-dense foods with large portions, or if they're relatively healthy, we can still eat fairly large portions of vegetables and fruits, and yet they'll contain much fewer calories. But restaurants will tell us, and they're right, is that they're giving people what they want. People like value also, and calories in some cases are very cheap. So we go out to eat, we're looking for a lot of food to have a good time, the restaurants are giving it to us, and ultimately, over and over again, that can lead to increased calories and weight gain. So what's the solution for that? I've already alluded to that a little bit. I think, as consumers, we can request certain foods, lower portion size, and in fact there's one chain right now who has went out on a limb and they're providing decreased portion sizes at decreased prices for consumers who want that. I think they're ahead of their time, and at least for a part of the population, this will catch on. The other thing we can do, instead of just saying no and not eating much food at all, is the types of food that we eat. There's the same amount of calories in 1 1/3 sticks of butter as there is in 10 or 11 heads of lettuce, or 35 cups of green beans. So the amount of food that we eat does not correlate with calories, and if we can eat more plant products, vegetables and fruits that are high in bulk yet low in calories, we can eat a lot of food and yet get in less calories and not even realize it.

Rich Dietman: Well, could you expand, Dr. Hensrud, a little bit on some of the other psychological factors that are involved in what motivates us and drives us to eat or to eat too much?

Dr. Hensrud: It's normal to eat, and yet people want to cut back on their calories and reduce their weight, so they restrain themselves. But that restrained feeling, if you think about it they can do that for so long, they lose a pound, and it's just such a struggle, but then they'll give in and all of a sudden they go on a binge. They don't lose as much weight as they want, they throw in the towel, and they're worse off than when they started. So how do we approach that? Well, first of all as having realistic goals. It's been shown in studies, and I see this in practice, that many people have an unrealistic goal of weight loss. If people lose 5 pounds, they want to lose 10. If they lost 10 pounds, they want to lose 20. They're never satisfied. So instead of having an unrealistic goal, throwing in the towel and binging, having a realistic goal and some acceptance, improving the process of eating better, and enjoying food can be a much better, a healthier attitude, and not get into one of those vicious cycles psychologically.

Rich Dietman: You see, during the course of your practice, a lot of people who lead very, very busy lives, people who are concerned about their health, so they want to do something that includes weight management. When they're a busy person and they're perhaps about ready to head out the door of your office, what are the handful of things that you try to leave them with when it comes to healthy weight management and healthy weight loss?

Dr. Hensrud: That's an excellent question. There are few people who have too much time on their hands these days, we live in a very fast-paced lifestyle. It makes it more challenging, but it's not impossible, and there are tricks that people can do. Once again, planning is key. If someone brings their lunch to work, for example, that can help control calories, control what you eat, and you can have an enjoyable lunch. It takes a little bit of planning the night before, the morning of, but that small amount of time can make a difference. Breakfast — many people say they don't have time for breakfast. Even if they don't have time, grabbing a piece of fruit or a couple pieces of fruit on their way out the door, or putting the breakfast food out the night before, can help to manage breakfast time. In the evening, planning ahead, not becoming ravenous when you get home, but having a snack in midafternoon, a healthy snack. I often tell myself that once I've eaten something, as long as I'm satisfied and enjoy it, what difference does it make what I eat? And so having some fruit in the afternoon, it may not seem quite the same as the candy bar, but after you've eaten it you still feel good, you feel satisfied, and you can feel good about what you've done. Getting home in the evening, not reaching for the snacks, and even in a busy lifestyle we don't have to cook up a gourmet meal, we tend to recycle what we eat. If I haven't had this recipe or this dish for a couple weeks, it's time to have that again. So one of the tricks there is breaking out of our mold, modifying old recipes, and trying new ones. In the modification category, instead of having fettuccine Alfredo, have pasta primavera. Throw some pasta on the stove, it doesn't take long at all, cut up some vegetables, put some tomato sauce over it, that can be a very quick meal. Or trying new recipes, different kinds of salads, for example. One of the things we have at our house is a Greek salad. Once you get used to making a recipe, as everyone knows, it goes very quickly, so trying something out, planning ahead, takes a little bit of time the first time or two, but then it becomes incorporated into your repertoire, and that can help on a busy schedule. You get home, whip up a quick Greek salad, have a whole-grain baguette and a small amount of smoked salmon, it tastes good, it's healthy, it fills you up, you can eat a lot of it, and you don't have to feel guilty about it. So there are many tricks that people can do, even on a busy schedule.

Rich Dietman: Thanks very much, Dr. Donald Hensrud. We've been talking with Dr. Donald Hensrud, specialist in preventive medicine and nutrition, and an expert in weight loss and healthy weight management at Mayo Clinic. Dr. Hensrud is also a medical editor of two books on healthy diet and nutrition, "The Mayo Clinic Plan" and "Mayo Clinic Healthy Weight for EveryBody." I'm Rich Dietman.