Call of the Cookie
A Science-based Program to End Emotional Eating
By James S. Fell, MBA, CSCS
and
Margaret Yúfera-Leitch, PhD
Introduction
I know how it goes: your boss is channeling Linda Blair to the point where you’re waiting for the green vomit to fly, your kids are whining they have so much homework it qualifies as a hate crime, the dog won’t stop peeing on the rug, your mother-in-law is on the phone and she wants to talk to you and the toilet seat got left up and you fell in.
Life keeps serving up lemons someone fished out of a dumpster behind a T.G.I Friday’s until you just want to start main-lining Häagen Dazs and plowing through a bag of Doritos like the apocalypse is imminent.
But it doesn’t have to be this way. There are alternatives to gluing your butt to the couch and scarfing pizza dipped in chocolate sauce because today sucked. Real, science-based alternatives instead of fluff and nonsense spouted by some Oprah-endorsed “eating guru” whose qualifications amount to been there, done that.
No amount of group hugging or “empowerment” is going to help you battle your eating impulses. There is no quick and easy way to learn how to control what you eat. Following a calorie-conscious and nutritious diet is not comfortable at first. It is a skill that needs to be learned because we’re not evolutionarily programmed to instinctively know what’s best for us to eat. Being toilet trained isn’t a natural instinct either, but I’d argue that it’s worth the effort.
This is also worth the effort. You are worth the effort.
The cost-benefit analysis
It’s going to take some effort.
If you believe in quick-fix miracle cures for getting in shape, then you’re not alone. In 2007 the Federal Trade Commission launched a massive survey of consumer fraud in the U.S. and found that people were more likely to be taken in by a weight loss scam than any other type of fraud.1 It’s not all “bank inspectors” and pyramid schemes; in 2006 fraudsters scammed five million Americans wanting to lose weight by selling pills, powders, machines, wraps, creams and even earrings. Yes, some people thought wearing special earrings would help them lose weight.
Are people who believe such things stupid? Not necessarily.
In his 1997 book Why People Believe Weird Things, Skeptics Society founder Michael Shermer asserted that “smart people” could be more susceptible to believing outrageous claims than others. He further explained: “More than any other, the reason people believe weird things is because they want to. … It feels good. It is comforting. It is consoling.”2
Besides, sensationalism sells. Just look at Oprah, Dr. Phil or Dr. Oz and the guests they have on their shows. Extolling that sustained weight loss only comes via a slow and steady approach with a significant amount of intense exercise and dietary restriction just isn’t sexy, but “six-second abs” is. We’ve got people saying it takes just “Eight minutes in the morning,” you can get a “Four hour Body,” or go on a “17-Day Diet” and all of these books and products become bestsellers. There is no shortage of profiteers taking advantage of the obesity crisis by pushing gimmicks and scams on a desperate populace.
We like to believe in the myth of the quick fix, because as Shermer says, it’s comforting; at least until the crushing reality of how hard weight loss really is smacks us in the face like a week-old halibut.
If you want to get rid of fat and be healthy; if you want to get and stay in shape, then this is going to take serious effort from now until the day you dirt nap. There is NO quick fix. There are no miracle cures for being overweight – not even liposuction, because the fat comes back.3 This is going to take a fair amount of exercise and a lot of dietary control and you won’t transform into a bikini model in a month. You know this is true, because when has anything worthwhile in your life ever been accomplished with ease?
Okay, I think that’s just about enough doom and gloom for now. Let’s move on to explaining why all of the above can actually be good news if you take the right approach.
First off, this program is a phased approach that takes you through behavior change at a gradual pace you can tolerate. There aren’t any time schedules here. We’re going to make you slightly uncomfortable one step at a time. When each new step – each new behavior – becomes comfortable and routine, then it’s time to get a little uncomfortable again. These baby steps add up faster than you think and the end result is that you learn to love the journey so it doesn’t seem like you’ve sold yourself into weight loss slavery. Eventually you’re not thinking about being on a diet or engaging in an exercise program; healthy eating and physical fitness is just part of who you are.
Adding to your life résumé
If you’re overweight and you hate being so, then that’s a problem; one that is difficult to solve, but if you do it – if you work hard and persevere – then it gives you tremendous experience as a problem solver, and this is a useful skill that can be applied to myriad other aspects of your life.
To elaborate, internationally-renowned behavioral psychologist and Stanford University researcher Dr. Albert Bandura examined this phenomenon with the development of his ground-breaking self-efficacy theory. Getting in shape is called a “performance accomplishment” and Bandura stated, “After strong efficacy expectations are developed through repeated success, the negative impact of occasional failures is likely to be reduced. Indeed, occasional failures that are later overcome by determined effort can strengthen self-motivated persistence if one finds through experience that even the most difficult obstacles can be mastered by sustained effort.”4
Am I the only one who said, “Hell, yeah!” after reading that?
Are you experienced?
Now if you’re a bit frightened at this point about pursuing exercise, know that you’ve already built up a list of performance accomplishments in your life that can be applied to getting in shape. Have you finished a challenging school program? Earned a big promotion? Raised a child or three? Built a house? Convinced your mother-in-law you’re a good cook? Fixed a car’s transmission? Any time in your past where you’ve faced a difficult challenge and persevered through planning, persistence and patience you’ve built a valuable life skill that can be applied to adopting exercise and changing your diet.
And those performance accomplishments build on one another. The argument is that if your life sucks (or is just kind of blah), getting in shape does WAY more than simply give you a healthier and hotter body to live inside. It gives you the mental discipline and willpower to kick even more ass at the rest of life. It sure did the job for me. I used to be an overweight nobody. After getting in shape I married a hot doctor, got an MBA, had a successful business career, and then became one of those few people who could make a living as a freelance writer, which includes getting a popular fitness column with one of the most respected newspapers in the world: The Los Angeles Times. None of that would have happened had I stayed the way I was, because getting in shape is what gave me my zest for accomplishment. Now that’s what I call return on investment.
But wait, it gets even better.
The exercise connection
Exercise is actually fun. Really.
Don’t bail out just yet. I’m going to get into way more details on this later, but for right now know that exercise is absolutely critical as a tool to fight food cravings. When it comes to weight loss, burning calories is fine, but it’s secondary to the psychological, hormonal and chemical changes it initiates that allow you to gain control of what you eat.
Are you an inactive couch potato? Do you hate the idea of sweating? I understand, because I used to be the same way. I was the high school spaz who made the geeks look good and I always got picked last when teams were being selected. I sucked at every sport imaginable growing up, yet now I love exercising long and hard almost every day of the week.
Love it!
John Lennon was right. If you want to get in shape, all you need is love. Forget that stuff about “Only 20 minutes, three times a week.” That word “only” implies that exercise is a form of punishment to be endured to achieve a specific end. They’re saying, “We know you hate this, so we’ve come up with a miracle method that minimizes the amount of time you have to spend doing something you detest.”
And it’s a crock. Exercise is not punishment. It’s an awesome and righteous lifestyle to be embraced with passion and vigor until the end of your days.
I feel like I’m freaking you out right now. If the old me read the above two paragraphs he’d be rolling his eyes.
Know that it’s all about pacing. Feeling the love for exercise doesn’t happen quickly. For now, just take it on faith that I can teach you how to find your exercise passion, in time. Your exercise soul mate doesn’t have to be the best calorie-burner or muscle builder, but it will come to define you as a person. Also don’t feel the need to be monogamous to any one physical activity. In the fitness context, polyamory equals cross training.
Exercise will teach you a lot about yourself and put a smile on your face. Those people who you see running mile after mile, cycling long distances, getting up early for fitness classes and pumping hardcore iron in the gym all have one thing in common: they don’t hate it.
And you will learn to love it too. If I’m good at one thing, it’s teaching people to embrace the exercising lifestyle. I’ve had over a hundred articles on the subject of exercise motivation alone published in major news media and it is the primary focus of my consulting practice.
Enough about exercise for now; just know that I’m going to kick your butt later.
Learn, plan, prepare, THEN do
Nike is wrong, so please don’t “Just do it.” Making the effort doesn’t mean you just jump into a 180-degree change in lifestyle. Most people can’t do that without believing God threatened to shove a lightening bolt up their ass if they don’t lose weight. To repeat, behavior change needs to be paced, and the best way to do that is via building what is called self-efficacy (that Albert Bandura stuff I mentioned above). Simply put, self-efficacy means you have built up self-confidence and feel comfortable about your abilities when approaching a new behavior, which increases the likelihood of you continuing on in a specific task.4
So, in the spirit of “learn, plan, prepare, then do” we will start off learning what motivates people to eat and how our brains react to certain types of food. To do this we’re going to have to clear some things up first. Let’s start by telling you that “emotional eating” isn’t a very scientific term.
Yes, emotions can play a role in food choices and caloric intake. It’s not uncommon for people to seek solace and pleasure from food if they have suffered emotional trauma. Such eating is the result of loss of impulse control, where we seek a band-aid solution to close a gaping wound.
We put “emotional eating” in the title for marketing purposes because it’s commonly known, but in reality eating is either hedonically or homeostatically motivated, meaning it’s done either for pleasure (hedonic) or for fulfilling bodily energy requirements (homeostatic). Unfortunately, modern society has switched to a condition where the majority of us eat to derive pleasure; we do this because the food supply has programmed our brains to behave this way. Unfortunately, pleasure-focused eating results in over-consuming unhealthy food that results in weight gain. Our goal is to switch you towards viewing food as a source of healthy fuel rather than just satisfying your taste buds. I’ll be honest up front and tell you that it’s not going to taste as good, but your brain and your body will adapt.
Now let’s talk about what motivates us to eat.
Your brain on food and why we like what we like
You have no idea how much impact what you eat has on your brain.
On second thought, perhaps you do.
Think of turnips. No butter, just a plain cooked turnip. Imagine taking a big bite. Even if you like turnips you can’t eat that much because when the taste hits your tongue it’s not like your mouth just had an orgasm, is it?
Crème brulee though? Or cookie dough ice cream? Or “Mmmm… I love Turtles”? Total mouthgasm.
Unlike a real orgasm however, there isn’t much afterglow from junk food. Plowing through half a pizza or a box of chocolates doesn’t make you feel good for the rest of the day. And while a sexual romp can keep you sated for a long time, junk food begets more junk food: you keep eating well beyond the point of your bodily energy requirements. The addiction grows, and you need even more sugar, salt and fat to quench the desire for the next mouthgasm.
I’m just going to stop writing that word now, okay?
The point is that evolution has programmed us to like certain flavors. If you put something sweet on a baby’s tongue, they smile. (Doctors will actually use sugar solution to relieve pain in infants undergoing minor procedures such as drawing blood.) Put something bitter on an infant tongue, however and it elicits a wail akin to poop-up-the-back. (Yes, I’m a dad. Been there, done that.)
One of the reasons why we like sweetness is that it represents nutrition. A piece of fruit is at its peak of nutritional value while also at its sweetest. For millennia of human evolution seeking out sweetness was good for us, until technology started messing with things and making nutritionally vacant yet calorically dense hyper-sweet “foods” like hot fudge sundaes. Not only that, but such foods are soft rather than crunchy, allowing for a fast ingestion that generates an immediate sense of pleasure. I’m not sure if this is a correct analogy, but it seems similar to the difference between injecting heroin and smoking it.
Salt, conversely, isn’t an inherited taste preference, but it doesn’t take much exposure for us to start liking it, which in turn can lead to over-consumption of salt-laden foods.
Sugar, fat and salt all create a chemical cascade in your brain that is an intricate interaction of hormones, neurotransmitters, endorphins, satiety signals and reward sensations. And it’s tougher for some people than others. Some people are more “reward sensitive,” where they crave the fix that drugs, alcohol or highly palatable (extra-yummy) food gives them more intensely. Others are what we call “super tasters,” who experience greater taste intensities, both positive and negative. They’re more likely to love sweet foods and hate the bitterness of things like vegetables.
This is basic operant conditioning psychology based around the stimulus-response model of behavior change. If a stimulus, such as putting a Caramilk bar into your mouth, elicits a positive response, such as thinking, Whoa mama, that tastes good, then this behavior gets reinforced and you seek out that rewarding feeling again and again. It works the other way as well, where a bad taste is seen as punishment and you end up avoiding foods you don’t like.
We’ll go into greater detail of the interaction between body and brain in the coming chapters, along with providing you with real-world advice on how understanding how your brain reacts to different taste sensations helps you navigate the modern food supply to lose weight, be healthy and fuel a high-performance body. Even for the reward-sensitive, the impulsive eaters and the super tasters, we have advice on how to control your cravings.
Your life on food
Money talks.
I live in Canada and I spoke with family physician and renowned obesity expert Dr. Yoni Freedhoff about Health Canada, which is the “federal department responsible for helping Canadians maintain and improve their health,” and how it appears as though it will sometimes put the health of corporations before citizens.
Freedhoff was involved in consultations with Health Canada on the development of the new food guide and asserted that the department is not interested in anything that makes Canadians more aware of caloric intake. “I think it’s insane that the food guide provides zero guidance on calories,” he told me. “Mary Bush was in charge of the 2007 food guide and she laughed at me when I recommended calories be included. It didn’t strike me as particularly funny.”
Dr. Freedhoff also said, “I think Health Canada has gone out of its way to exclude calories from national nutrition guidelines and in so doing has hamstrung Canadians’ ability to become calorically literate. We’ve had a number of bills presented to government to put calories on menus and they always get struck down. I know that the food industry has opposed calorie labeling. They ultimately oppose anything that affects sales. Industry has tremendous input into the Canada Food Guide and they don’t want calories taught.”
If we actually knew how many calories were in some things this would be bad for the bottom lines of food manufacturers, restaurant associations and farmers. The economy needs us to consume and heaven forbid a government branch would put our health before the health of the economy.
There are similar situations in the U.S., where the American Dietetic Association is overly cozy with companies such as Coca-Cola, PepsiCo and Kellogg’s.6 It’s a fact that food corporations are powerful lobbyists; a recent example of which is restaurant lobbyists persuading state lawmakers in Florida and Arizona to prevent their governments from outlawing toy giveaways with high-calorie kid’s meals.7
So, many countries’ governments don’t always do a great job of looking out for the health of its people when it comes to food, but corporations can be even more blatant in their nefarious deeds. I mentioned that I have an MBA and I know that the #1 goal of any corporation is maximizing shareholder value. They don’t care about you, unless somehow caring about you translates into making them more money.
In most cases, not caring about you is what makes them money because they’re giving people what they want. We’ve voted with our wallets, partially because most don’t understand how badly our food supply is manipulated to promote over-consumption. This is why they spend millions lobbying governments to keep regulations lax, so they can offer their addictive substances to our yearning mouths, creating a society where only the well informed and strongest-willed can resist the call of the cookie. Or the Crispy Crunch. Or the Baconator. Or the… you get the idea.
This isn’t a conspiracy theory. I don’t believe the moon-landings were faked or that aliens abduct rednecks out of trailer parks and probe them or that the Kardashian clan is the result of an unholy union between the Loch Ness Monster and a rabid Sasquatch. Actually, I’m on the fence about that last one.
Although I’m a skeptic, I accept that this is the reality of our profit-driven economy and when it comes to losing weight, it’s your enemy. In our modern society you need to learn how to navigate the influence of food corporations and restaurants if you want to control your appetite.
I should note that things could be changing. A little. Slowly. I mentioned that companies don’t care about you unless there is money to be made from doing so. Well, some corporations are waking up to the possibility of profit from helping consumers eat fewer calories. This is not a reality yet, so you must remain vigilant, because the food industry has an advertising budget second only to the automotive industry and many companies will use every trick in the Advertiser’s Handbook of Manipulation and Misinformation to get you to consume and over-consume. Once we teach you these tricks and how to avoid the near brainwashing, you’ll be better armed against falling for the high-calorie ploys and how to properly navigate the grocery store.
And if they don’t already, grocery stores will play a big role in your life, because eating out is fraught with so much peril that you’re better off avoiding doing so as much as possible.
See, restaurants are in the business of making money and they do that via repeat business. One way they get this repeat business by making food taste extra good. They make food taste good by jamming it full of fat, sugar and salt (the first two of which are calorically dense) which all promote you to eat way more than you need. In most cases, eating out makes you fat. Such is the peril of pleasure-focused eating.
I’m not saying you can never eat out again, but once you understand the dilemma that it poses, you’ll want to less frequently. We’re going to take the fun out it, which is going to reduce the reward sensations you feel, which is going to make this all a bit easier. Also, there are tips you can learn to ensure that when you do eat out, you don’t inhale more than a day’s worth of calories in one meal.
Why a pill won’t make you thin
There are pills out there, but none of them work well.
Orlisat (sold as alli) can help you lose some weight at the expense of fudging your pants and Sibutramine (sold as Meridia) has some appetite suppressing effects yet comes with serious health dangers. My wife is a family physician and asserts that no patient of hers stays on alli for long (because of the poo) and she rarely prescribes Meridia because of the increased risk of heart attack, stroke and other serious health consequences.
Experiments have been done with anti-cannabinoids as well, which work great to suppress appetite, but they also suppress your will to live. Think of smoking pot (a cannabinoid). If you’ve never done it, you know the stereotype: it creates a feeling of euphoria and causes munchie attacks. Anti-cannabinoids do the opposite. They give you the anti-munchies, but also the anti-euphoria. It’s a bad trip, man.
Weight loss supplements are no better, as they either don’t work, have dangerous side effects or both.
A pill could one day arrive that will be an excellent appetite suppressant that lacks dangerous side effects, but that day is not yet here. Until then, it comes down to you.
Your brain on exercise
Yeah, this stuff again.
You know how I mentioned some people are reward sensitive? Such people are more likely to be addicted to food, alcohol, drugs and even gambling. I interviewed actor Daniel Baldwin (for an LA Times article), who has been on both Celebrity Rehab for his drug and alcohol addiction and on Celebrity Fit Club for being obese. He got control of his addiction demons and credits intense kettlebell workouts with enabling him to stay clean and sober, get control of his diet and lose a huge amount of weight.
In other words, Daniel is getting his fix now from working out and you can too. If you’re addicted to food and/or other things that are not good to be addicted to, exercise can be your replacement addiction. The good news is it’s damn difficult to get to the point where you need to rein this addiction in. Our bodies can take a tremendous amount of physical punishment before they start to experience sustained negative effects and most people simply can’t find enough time in the day (or have the energy reserves) to reach this level. What I’m saying is, don’t worry that developing an “exercise addiction” is going to be anything but good for you. Truthfully, having what psychologists would call an actual addiction to exercise is extraordinarily rare.
You may hate exercise and that’s cool. Remember, I used to hate it too. The trick is to be open to the possibility of learning to love it.
As I mentioned earlier, it sure doesn’t happen overnight. I tried and failed to become a runner three times before it finally stuck. We’ve got some great advice in this book about the process you can go through to transform from detesting the thought of being sweaty, to finding an exercise that doesn’t completely suck, to taking that tiny ember of “doesn’t suck” and nurturing it into a flame and an eventual raging bonfire of exercise awesomeness. It can be done; it just takes baby steps.
If you’re not currently active, you may fear the thought of exercise and I can’t really blame you because it hurts at first. I’m not going to call you lazy. You just don’t like it because you haven’t found your passion yet. My current ones are weightlifting, running, cycling, downhill skiing and sea kayaking. I still HATE swimming.
Not only does all of this exercise give me a rush of the same feel-good chemicals in my brain that junk food does, it also serves to strengthen my will for dealing with food so that I am far likelier to make healthier choices. It will do the same for you.
How much you exercise is up to you, but know that the more frequently and intensely you exercise the better the outcomes both in terms of physical fitness and your ability to make wise food choices and resist highly palatable, high-calorie junk (it will also burn more calories, which helps). To drive home the point of the power of baby steps, imagine you start with 15 minutes of exercise a week and add only five minutes each week. Within a year you’d be exercising four-and-a-half hours a week. That’s enough to get some really impressive results.
Four-and-half hours a week may seem like a lot, but it’s manageable when you ease your way into it. Also, note that the average American spends more time than that watching TV in a single day. You can choose more than this, or you can choose less. This is about finding your own personal level of “good enough” that is both enjoyable and sustainable.
If you don’t exercise I’m not going to blame you for not being active and you shouldn’t blame yourself. This is NOT about blame, but about ownership. You are the 100% undisputed owner of your body and if you feel like it’s a gelatinous pile of protoplasm then no one suffers from this more than you do. Your body is where you live; it’s home, sweet home until the day you become worm food.
The good news is that if you take the proper steps to gradually transform your body into a lean and powerful machine then you get to live in a much nicer metaphorical house. Actually, forget the house analogy, because they don’t move.
I wanted to talk cars and compare the wonder that is transforming from some piece of junk rusted-out old Pinto towing a U-Haul full of lard into a brand new, high-end and finely-tuned BMW. However, Margaret convinced me that female readers might be more interested in a shoe analogy, so here we go.
Imagine what it’s like to go from dawdling along in crocs with charms to a brand-new pair of black patent peep-toed Louboutins. Can’t quite imagine what it’s like? According to Margaret, it’s friggin’ awesome. If you’re not into shoes, I’ll attest that going from Pinto to BMW is equally awesome.
This is why I like the idea of focusing less on the numbers on the scale and more on physical performance improvements. This is what can really drive you to achieve, because you’re not so intent on losing something, but on gaining. You’re gaining energy, strength, functionality, health, speed, flexibility and overall physical and mental ass-kickery.
You also lose fat, but that’s just a side benefit.
You may be old, morbidly obese, injured, sick and got screwed in the genetic lottery, but you can still ditch the clunky old footwear (Pinto). You may never get the brand new Louboutins (BMW), but most people can achieve some Frye boots (low-mileage Honda?). Maybe even a pair of Jimmy Choos (I got nothin’).
Getting control of your cravings
It’s more than just exercise. That would be pretty lame if all we did was tell you to go work on getting a good case of athlete’s foot (they make a cream for that, by the way).
This is a situation where forewarned is forearmed and the more you know about the food you eat and how to avoid high-calorie junk, the better able you will be able to make wise nutritional choices instead of the ones the food industry wants you to make.
Knowledge is power, in this regard, and the most important knowledge you can have is to understand that this won’t be easy and that you will fail. Then you will try again and probably fail again.
This is why you must get past the all-or-nothing mentality. Plan to fail and then plan to try again. It’s okay to quit ten times, as long as you try eleven. Two steps forward with one step back is still one step forward… And that’s just about enough clichés for one book.
And you know what? It’s also okay to cheat. Sometimes. I’m a fitness author and as a result I feel a masochistic need to hold myself to a high visual standard. What I’m saying is that even though I’m in my 40s, I’m pretty ripped. It isn’t always easy. Still, I cheat on my diet sometimes. A little while ago I had a grocery cart full of healthy food and then in the impulse section known as the check-out I grabbed a three-pack of Turtles and scarfed them all in the car before driving home.
It’s the intense exercise and practice with eating healthy that give me the will to make this an uncommon occurrence I can do without guilt. Margaret asserts that for her the story is similar. If I stopped exercising I’d blimp back out in no time because it would cause a downward spiral of burning fewer calories and ingesting more. Margaret attests that the same would happen for her if she ceased exercising, except I would never use the phrase “blimp out” in reference to my co-author.
What happens is that, over time and with practice, highly palatable food loses its hold over you. Right now, it has its claws in deep. Junk food has rewired your brain to crave it and we’re going to give you the plan to break with that mental conditioning. But it will get easier. Over time you will crave it less and eventually, you’ll crave the healthy stuff instead. You can get to the point where highly palatable food makes you feel sick – overwhelmed even – just like those three Turtles did for me.
Know that you can do this without it seeming like life will be an endless stream of dietary deprivation. You get used to not having your favorite treats all the time – highly palatable food loses its hold on you – and you really do learn to love exercise. You just need to wrap your brain around these concepts and think hard. Mental aerobics are the most important part of this endeavor. When you get the processing power of your mind involved and start to logically consider all the information and advice we have in this book, you’re many steps ahead of everyone else.
Thinking, planning and preparing are what give you the power to change.
Conclusion
The most important thing to remember with adopting an exercise regimen is to avoid the trap of the reward mentality. Some people will burn 300 calories on a treadmill and then feel they’ve earned a reward, so they go eat 500 calories worth of cheesecake. That’s just bad math.
Understand that exercise is not about allowing you to reward yourself with junk food, but about giving you the power to RESIST junk food. Over time, you will learn to crave healthier foods to fuel a high-performance body, you just need to embrace the lifestyle rather than see it as a means to an end.
This was just a basic introduction to what’s to come. Now we’re about to get all in-depth and science-y on your ass – your soon-to-be smaller and more muscular ass.
Notes to the Introduction
- Keith Anderson, Consumer Fraud in the United States: The Second FTC Survey, October, 2007, p. S-1.
- Michael Shermer, Why People Believe Weird Things (W.H. Freeman and Co., 1998).
- Terri Hernandez et al., “Fat Redistribution Following Suction Lipectomy: Defense of Body Fat and Patterns of Restoration,” Obesity, April, 2011 – Advance online publication.
- Albert Bandura, “Self Efficacy: Toward a Unifying Theory of Behavioral Change,” Psychological Review, 84, March 1977, p. 195.
- Ibid., pp. 192-200.
- American Dietetic Association 2010 Annual Report, p. 6.
- Los Angeles Times, “Fast-food industry is quietly defeating Happy Meal bans,” May 18, 2011. Accessed online from health section.