What Lifestyle Changes Can I Make to Address My Obesity

In General, How Can Obesity Affect My Lifestyle?

Lifestyle modification, also referred to as behavioral weight control, includes three primary components: diet, exercise, and behavioral therapy.

Everyday activities that many people take for granted are affected by excessive weight. If you struggle with obesity you are probably familiar with its many physical and emotional consequences. Extra body weight makes getting up from a chair or walking more difficult. You might find yourself struggling to catch your breath after walking to a store or while preparing dinner. You might also become tired more easily, and you are at an increased risk for a host of diseases and illnesses. Medical conditions (e.g., heart disease, stroke, high blood pressure, diabetes, joint pain, respiratory problems, gout, gallstones) are all worsened by having extra body fat. See module 6 for more information regarding the medical consequences of obesity.

Although your health is jeopardized by having excess weight, many people who need medical attention avoid seeking help or delay making medical appointments due to their fear of being stigmatized because of their excess weight. A dear family friend of mine had rescheduled her yearly physical multiple times for fear that the nurse who weighed her would comment on her weight when she was on the scale. She dreaded going to her appointment. Together, we were able to strategize about how to inform the nurse before being weighed that her weight was a sensitive issue for her. The appointment still caused her anxiety, but she felt better advocating for herself. Many people recognize that obesity can be a target of prejudice and that learning more about stigma can be challenging.

I also worked with someone who had struggled with anorexia nervosa as a teenager. As she worked toward recovery and restored her body weight, she continued to struggle with her relationship with food. Later, she became obese as an adult. She decided to write about weight stigma in college and read article after article on weight-biased medical professionals and those in the general public. As she was nearing the end of her research paper she found herself struggling more with her body image and her mental health. Obesity plays a significant role in our mental and emotional health. Anxiety, depression, and fear can be problematic and affect our self-esteem. More about weight stigma is presented in module 16. Module 2 explains more about depression and moods that are related to obesity. In sum, obesity interferes with all aspects of life.

Should I Go on a Diet?

Information about diets seems to be everywhere (e.g., in the tabloids at the checkout counters [detailing the latest diet of a movie star], talking to colleagues about their newest weight-loss trick, or talking to your uncle about the same 15 pounds he has been losing at Christmas for who knows how many years). Each year, millions of people make a New Year’s resolution to lose weight. As a registered dietitian, I’m often asked for my opinion on the best method for losing weight and about how to lose fat and weight quickly. Keep in mind that being obese is a health risk. If you decide to change your eating habits you should focus on making health improvements rather than on decreasing your weight. Weight loss is a billion-dollar industry. If there were one quick, easy, and effective method, there wouldn’t be so many different diets; we would all be in a desirable weight range. At the end of the day, weight loss is achieved when our bodies use more energy (calories) than we consume. Our society has made it easy to eat more and to move less. We can pay a mere 50 cents more at a movie theater to get unlimited free refills on our soda and we can use moving walkways in the airport instead of walking.

There is no quick and easy solution for losing weight. Weight loss takes time and commitment. Maintaining weight loss takes even more effort. Losing weight just to lose weight might not be motivation enough to make and maintain lifestyle changes. You should question your motivation to lose weight. Do you want to look good at your sister’s wedding? Do you want to decrease your cholesterol level and avoid taking another medication?

My advice for a diet—or, better yet, for a lifestyle change—is to identify small, measurable goals toward which you are willing to work. Identify SMART goals: Specific, Measurable, Attainable, Realistic, and Time-bound goals. Identify a clear goal (Specific) that you are able to refer to and ask yourself if you have achieved it (Measurable). Make a goal achievable (Attainable and Realistic) and give yourself a time frame (Time-bound). Regularly evaluate your goals. If you have achieved your goal, how can you maintain your new habits? If you did not achieve your goal, can you break the goal down into a smaller goal or decide whether you need to make a new goal toward which you are ready to work.

For example: Henry, a man who had gained 10 pounds over the past year saw his cholesterol increase to 250 mg/dL. He was prescribed several different medications, and he hated the thought of adding yet another pill to his health regimen. For years, he had wanted to lose weight and started multiple diets but had difficulty continuing with them. When he saw his cholesterol level rise, he wanted to make changes in his nutrition and exercise schedule before deciding to take a new medication. We discussed the plate method along with the benefits of exercise and increasing his fiber intake. Henry was attentive and engaged throughout the hour-long nutrition sessions. At the goal-setting point of our session, he identified three goals: losing weight, decreasing his cholesterol level, and eating healthy. Together, we broke down each goal into SMART goals. We noted that Henry typically ate breakfast, worked through lunch, and then visited the vending machine in the late afternoon when he got really hungry. Then, he ate a balanced dinner each night that he made with his partner. Instead of focusing on weight loss, we agreed on more immediate goals (i.e., he would bring lunch from home each day and take a brief break to eat, he would reduce his visits to the vending machine every afternoon). These changes would help him keep from getting too hungry during the afternoon and would assist him in making healthier choices. Although it would be difficult to see whether his cholesterol level had decreased in a few weeks, Henry thought that he was probably not consuming at least 25 grams of fiber each day. He would move his focus from decreasing his cholesterol intake to increasing his fiber intake. He could eat either two slices of whole-grain bread or one cup of cooked oatmeal in the morning. We determined that his goal of eating healthy should be broken down into a more achievable goal. He would follow the plate method at dinner by eating half a plate of vegetables, a fourth of a plate of a starch, and a fourth of a plate of a lean protein. We reviewed his goals during our follow-up session two weeks later. He found that he enjoyed eating his whole grains at breakfast, and he believed that using the plate method at dinner was helpful. Bringing his lunch to work was more difficult because he frequently forgot to bring something from home. This provided us with an opportunity to further break this goal into component parts. We strategized about lunch options. He had already identified that he would benefit from increasing his fiber intake; lunch provided an opportunity to add a fruit serving. When we discussed his favorite fruits, Henry said that his partner had agreed to purchase oranges and apples at the grocery store this week and that he would keep them at his desk at work. He needed a meal that did not require warming and we identified that he would either bring in a sandwich on whole-grain bread (e.g., a salad with chicken and beans, or a wrap) and he would pack his lunch the night before going to work. Every other week Henry would review his goals to identify which ones were working for him and which needed tweaking. At a 6-month follow-up appointment, his cholesterol level was rechecked, and it had decreased to 200 mg/dL. His physician agreed that prescribing additional medications to decrease his cholesterol was not needed.

Should I Change How I Am Eating?

Following a diet can be challenging. Many people want to eat healthily but do not always achieve their goal. One year, our wellness coordinator and I organized a Fruit and Vegetable Challenge Month at work. Employees were provided with handouts that we developed; each week, these new goals were to increase the variety of foods eaten and their general intake. I thought that this challenge would be a “no brainer.” I’m a registered dietitian, I eat healthily. 

During the first week, I did amazingly well and I enjoyed eating two fruits daily. As we reached week three, I recognized that eating an adequate amount of fruits and vegetables was easier said than done. I grew tired of eating carrots and hummus as my afternoon snack. Moreover, having a banana for my evening snack was proving to be boring. Where was my variety? My weekend intake record revealed that I rarely ate fruit even though I ate it regularly during the week. My weekends were filled with activities and I was on the go most of the time. At work, I ate at a beautiful fruit bar in the cafeteria and eating fruit there was easy to do. People often think about what they are eating and drinking, but they are often eating and drinking much differently than they had intended. Keeping a weekly log of my vegetable and fruit intake helped me to identify my habits and areas where I could make improvements. If you are uncertain whether you need to make nutritional changes, keep a food log; it can be an easy way for you to guide your eating patterns. I encouraged others to keep a log for 3 to 7 days of everything they ate and drank. It is also helpful to incorporate days off and weekends into your food log because those days have eating patterns that can look very different from those on weekdays. People often forget how many times they dip into a co-worker’s candy dish or how many sweetened beverages they consume. A food log reveals our habits; when we are honest with ourselves about what we eat and drink, it can be a real eye-opener. After you establish your typical intake, take a moment to detect patterns. Are you eating on a schedule? Do you tend to skip meals? Do you eat when you are bored, or do you like to get second helpings when there is free food? Creating a food log is a great way to help you identify changes in your diet.

Tactics for eating well involve eating on a schedule, listening to your body (e.g., feelings of hunger and fullness) and enjoying a variety of foods. Try aiming to eat every 3 to 4 hours around the same times each day. Our bodies love being on a schedule. Eating consistently helps us achieve stable blood sugar levels and helps our metabolism (e.g., eating six small meals a day, or three meals a day with several snacks). Meals typically contain larger portions than snacks. Snacks enable us to meet the food group recommendations that you are not eating at regular meals. The plate method is a visual method of organized eating. You can visit choosemyplate.gov to understand more about creating portions and following recommendations from each food group. The plate method encourages you to fill half of your plate with fruits and vegetables; a quarter of your plate having lean proteins, and a quarter of your plate filled with starchy foods. After you have incorporated dairy and sparingly added oils or fats, you will have gathered all of your food groups. Recommended portion sizes vary frequently from what most people eat in one meal.

I had a client, Caroline, who wanted to become pregnant but was having difficulties conceiving due to polycystic ovarian syndrome. Her physician recommended that she make lifestyle changes to improve her chances of becoming more fertile. Caroline and I met to achieve balanced eating to improve her blood sugars. I educated her on the plate method and she was surprised by my recommendation to eat six servings of starches daily. She explained that she was only eating three servings daily and was reluctant to increase her intake. We reviewed her typical day and she explained that she usually ate a bagel with cream cheese early in the morning as she left for work. For lunch she ate a turkey and cheese sandwich, potato chips, and a soda (that she packed at home). Around 2:30 p.m. she would meet her co-worker for a coffee break and eat a yogurt with granola with a large vanilla latte. Dinner typically consisted of chicken or fish with a large salad. Before bed, she and her husband ate ice cream together. Together, we discovered her bagel was equivalent to four starches, her lunch provided another four starches (due to the chips and the two slices of bread) and her afternoon snack contained one starch (the granola), totaling nine starches. We noticed that her dinner was light and it left her hungry after an hour or so, when she ate the equivalent of three servings of ice cream. Caroline identified that she could switch her bagel to two slices of whole-grain bread with peanut butter and a banana, pack a wrap with a small tortilla (with turkey and cheese), a pear, and a sparkling water, and she could continue to eat her yogurt and granola as her snack and switch to water from the vanilla latte. She and her husband decided to add rice, potatoes, or corn to their dinner to promote fullness and decrease their ice cream servings to two scoops and use a smaller bowl. Caroline felt these goals were simple yet powerful exchanges. Within the next 6 months her menstrual cycles became more regular and she was delighted to share that she was pregnant.

Listening to our bodies for feelings of hunger and fullness sounds easy, but it can prove to be quite difficult. Do you know when you begin to feel hungry? Can you pinpoint during a meal when you are reaching satisfaction? Many people eat so quickly that they do not take the time to assess how their body is feeling before, during, and after a meal. As discussed earlier, eating every 3 to 4 hours is key to achieving balanced eating. Check in with your body and make sure that you start to eat a meal or snack before you are ravenous. The ability to achieve balanced eating goes out the window when we are hungry. As you begin to eat notice the texture, taste, and smell of your food. Take time to enjoy the flavors. Assess your fullness throughout the eating episode. Roughly 5 to 7 minutes into a meal you should ask yourself if you are eating for hunger or because there is still food on your plate. Try to feel the sensation of fullness arriving. Put your fork down throughout the meal and take time to chew and to drink your beverage. Continue to eat until you are satisfied, and you will be satisfied for the next 3 to 4 hours. After you eat, notice how you feel. If you feel full after a meal remember what that experience feels like so that you can stop eating sooner during the next meal. If you are hungry an hour after a meal, you might not have eaten enough at the meal or snack. Respect your hunger and your fullness; with practice, you will be better at eating for your bodies’ energy needs. Use the Hunger/Fullness Scale (see Table 9-1) to help you identify where you are with your hunger before, during, and after a meal.

Just as eating on a schedule and respecting your hunger and fullness are essential for balanced eating, so too is eating a variety of foods. Each food group provides your body with key nutrients. Within each food group, the different colors and types of foods provide you with a variety of nutrient profiles. Try to eat foods that have different colors within the fruit and vegetable groups. Taste the rainbow! Each color provides you with a different anti-oxidant. If you eat the same foods each day you are eating the same nutrients, which also means that you are missing the same nutrients each day. Eating a variety of foods helps to keep meals interesting.

Are There Certain Foods That I Should Avoid to Lose Weight?

There are no good or bad foods. Most people have difficulty with eating appropriate portions. A well-balanced eating plan should not encourage you to avoid either certain foods or entire food groups without medical necessity. There are no perfect foods nor is one food superior to another. Kale is a great food but it does not contain all the nutrients that your body requires. Your body deserves to eat a variety of foods from each food group to meet its nutritional needs. Each food group provides your body with different macro and micro nutrients. Due to the diverse nature of nutrients provided by each group you need to select different portions from each group.

Several sources of information provide their own unique recommendations so that you can meet your energy requirements. MyPlate Daily Checklist, which you can find on choosemyplate.gov, provides examples of food group recommendations for various calorie allowances. A person’s food plan is personalized (based on age, gender, height, weight, and physical activity level). The website has a MyPlate Checklist Calculator to help you determine calorie estimates. The calculator provides you with a food pattern to maintain your current weight and another food pattern to help you promote weight loss. These food patterns are a great place to begin. Each pattern provides recommendations with portion sizes from each food group. You might find that more support is necessary to assist you with weight loss. Losing weight and maintaining weight loss is difficult. Registered dietitians are nutrition experts who can guide you to balanced and appropriate food decisions. Registered dietitians are trained in best practices and evidence-based choices.

I call foods that do not easily fit into a food group “fun foods” (such as cookies, cakes, pies, candy, or even fried foods). Many people elect to restrict these foods when they decide that they are going to eat better. All food is allowed in moderation. If you tell yourself you cannot have a cookie, what do you often find yourself craving? A cookie! This does not mean that you should eat cookies to your heart’s content. Remember, we need to honor our hunger and our fullness. Identify what “moderation of fun foods” looks like to you. I love fun foods, and I try to aim for one portion daily, although my husband aims to eat fun foods three times a week.

I had a client, Raymond, who wanted to change his eating habits, and he was encouraged to do so by his physician. Raymond had tried to lose weight numerous times, but he frequently became frustrated when he could not eat perfectly. He enjoyed socializing and found that when he was trying to lose weight, his friends frequently wanted to go out for ice cream or go to the movies (where he had difficulty saying “no” to popcorn). When he was trying to eat healthier, he either avoided going to the movies to eat well or he threw caution to the wind and ate whatever he wanted. He had difficulty balancing his social life with sensible eating. As we discussed, moderation and not visualizing healthy eating are not all-or-nothing. Raymond realized that he could have the best of both worlds. He could permit himself to enjoy fun foods three times a week. He could enjoy popcorn at the movies by choosing a small bag with light butter and he could drink water instead of soda. When his friends decided to go out for ice cream he “passed” on the banana split and enjoyed a medium size ice cream portion, instead. Raymond simply had to choose when he was going to enjoy his fun foods. At times, this meant deciding to have the ice cream on Thursday and to substitute broccoli for onion rings on Friday. Raymond learned to enjoy his fun foods in moderation and he no longer felt the need to “throw in the towel” on his balanced eating.

Should I Try Weight Loss Supplements?

Certainly, a person cannot rely on a single food or supplement to burn fat. They should also decrease their calorie intake and increase physical activity. However, when used as part of a healthy diet and lifestyle, natural fat burners may accelerate weight loss by either increasing metabolism or decreasing appetite for healthy adults. 

Traditional approaches to weight loss cannot be substituted by natural supplements. That said, they may help people burn slightly more calories every day, gradually increasing weight loss.

Resurge is of the most popular weight loss supplements that promise to help you shed pounds and sleep better. Because studies have shown that sleep deprivation is associated with deficiencies of growth hormone and elevated levels of cortisol, both of which contribute to obesity.

While other supplements promote nutritional factors, meal replacement forms, appetite suppression, or similar effects, Resurge boosts your body’s metabolism by increasing your core temperature. However, before making any purchases, you might want to read some Resurge reviews because the supplement industry is rife with scams.

It should be noted that pills or supplements are usually not recommended for children under the age of 18 because some of their ingredients might have unknown side effects. 

Although the formula of Resurge doesn’t have any stimulants, you should still talk with your doctor before you start taking the supplement, especially if you have health concerns.

Do I Need to Drink 8 Cups of Water Daily?

The amount of fluid you need depends on your medical conditions, body weight, and physical activity. A quick way to calculate your fluid requirement is to divide your weight in pounds by two, to equal how many ounces of fluid you require daily. For example, if you weigh 250 pounds: 250/2 = 125 ounces or 15.6 cups of water. You get fluid not only from what you drink but also from the foods you eat. Drinking an adequate amount of fluid is necessary for your overall health. Fluids assist in breaking down food, move nutrients throughout your body, regulate body temperature, and are essential for all cells to function. Our thirst mechanism can be difficult to identify and many people think that they are hungry when they are actually thirsty. If you want a quick method to determine whether you are well hydrated, inspect your urine and aim for the color of light lemonade. Be mindful to limit sweetened beverages, they add calories quickly.

What Is Emotional Eating?

Emotional eating is using food to manage your emotions (i.e., to self-soothe).

You might not even recognize when you are engaging in emotional eating. Happiness, sadness, boredom, excitement, loneliness, stress, anger, regret, and fear are all emotions that can lead to eating when you are not hungry. Many well-planned diets have been hijacked by emotional eating. I encourage my clients to “hit the pause button” when eating outside of their normal eating times. Pause, and ask yourself whether you are hungry or merely eating to relieve emotions. How do you feel? If you have identified that you are eating to modify an emotion, the next step is to face the emotion head on. I had a client, Sarah, who struggled with emotional eating. She was an accountant who noticed that she always gained weight around tax season; over the years the weight had piled on. She noticed that on the evenings when she worked late, she felt drained after returning home. She frequently reached for her favorite cookies and a glass of cold milk. This was her method of treating herself after a long day at the office. 

Although she enjoyed the milk and cookies, she recognized that she was not truly hungry and she was using the snack to self-soothe. Sarah was encouraged to identify alternative strategies for relaxing instead of eating. She discovered that she enjoyed watching a few minutes of funny YouTube videos. Sarah noticed that she felt better, laughed, and her mood lifted after seeing silly cats dancing. It is useful to have a variety of alternative self-soothing options (e.g., coloring, listening to music, taking a bath or shower, reading, knitting, working on a puzzle, calling a friend, gardening, taking a walk, meditating). You might make a list of what you enjoy and practice using the list when you are finding yourself eating in the absence of hunger. Alternative coping skills are a great way to self-soothe, but keep in mind that it is important to address your emotions. Avoiding emotions will not make them disappear. We need to allow ourselves to experience our emotions.

Is It Safe to Exercise While I Have Excess Weight?

Exercise provides you with physical and emotional benefits. Physical activity decreases the risk of premature death, heart problems, stroke, type 2 diabetes, certain cancers, falls, and depression. Exercise aids in bone health, cardiorespiratory and muscular health, concentration, and it provides you with a feeling of mastery. Prior to making radical changes it is a good idea to discuss with your medical team whether exercise is safe and appropriate for you. Your medical team will help you determine your appropriate activity level. After you are cleared to begin an exercise program, begin slowly and gradually increase the intensity level. I had a client, John, who was excited about making lifestyle changes, and he began exercising. He joined a local gym and began working out. He excelled in exercising with others and he enjoyed the comradery, competition, and opportunity to create new friendships. The trainer at the gym encouraged John to listen to his body and take a rest, if needed, during the workouts. John was enjoying the class during the first week and finding himself in competition with others in the room. However, he developed muscle pain, felt tired, and noticed that his urine had turned dark brown. He made a medical appointment to discuss his symptoms. His doctor discovered that one of his blood tests, creatine kinase, was elevated and he was diagnosed with rhabdomyolysis (a condition associated with muscle breakdown). Thankfully, John received treatment in a timely fashion and he recovered with administration of fluids; subsequently, he was able to slowly increase his physical activity again. This time he followed the trainer’s advice and rested during workouts. It is important not to push yourself too hard. You want to incorporate exercise into your lifestyle and make it something that you enjoy rather than dread.

How Often Should I Exercise?

There are many different sets of recommendations for exercise. Table 9-2 provides a summary of exercise regimens.

As you can see from Table 9-2, there are many sets of recommendations; it can be difficult to understand which is best for you. The goal is to be active. A great way to get started is to determine what you currently do. Think back to the SMART goals we discussed earlier in this Module (Specific, Measurable, Attainable, Realistic, and Time-sensitive). If you have not exercised in years and struggle with joint pain it is unwise and unrealistic for you to begin with a 30- minute jog. Start slowly and gradually increase the amount of movement your body is able to tolerate. The first week you might aim to be active 2 to 3 days with 15 minutes of walking, and then gradually increase your effort to 20 minutes, and then 25 minutes, 4 days a week, and then 30 minutes in each episode. Exercising with a partner is a great way to stay motivated. Try asking a friend to go on a pre-dinner walk with you a few nights a week. If you have access to a gym, plan to meet your friend and try out the stationary bikes to get the day started. As you establish your fitness goals you will learn how often you should exercise. You will want to create a plan that works for you over the long term.

What Kind of Exercise Should I Do?

Health-related physical fitness for people with obesity includes three components: cardiorespiratory fitness, adjustment of body composition, and muscular fitness (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096271/). Cardiovascular activity helps achieve heart health and decrease cholesterol levels and high blood pressure. Muscular fitness increases muscle strength while decreasing fat to improve body composition. You want to include cardiovascular and muscle-building exercise into your exercise routine. 

Cardiorespiratory fitness or cardiovascular endurance refers to how well your body is able to deliver oxygen to your body tissues. Basically, you want to be able to move oxygen to your muscles and not become short of breath. There are many types of cardiovascular activities (e.g., walking, water activities, biking, seated aerobics). Be mindful of any joint pain, and aim for non-weight bearing activities (e.g., recumbent cycling, using portable pedalers, seated aerobics, or water activities) if you are having problems. Remember to start slowly, possibly with 10 minutes of exercise and then slowly increase the duration of your exercise. Exercise at a pace that allows you to hold a conversation without too much difficulty. Get involved in an activity that you enjoy. If you enjoy dancing, try a Zumba® or dance class. If you enjoy sports, consider joining a basketball team or find a basketball court for shooting and playing.

Improving body compositions refers to increasing lean muscle mass and decreasing body fat percentages. As you increase your muscle mass, your body will burn more energy and it will improve your health. Muscular fitness allows a muscle or muscle group to perform continuously without fatigue. Activities for muscle fitness include calisthenics, weight training, and certain cardio activities.

Should I Attempt to Stop Drinking Alcohol or Smoking Cigarettes?

Alcohol is not calorie-free and use of it might interfere with some of your medications. Consult your physician if alcohol is contraindicated with use of any of your medications or with your health conditions; stop drinking alcohol if it is. Take a moment and reflect on how much alcohol you are drinking. Drinking in moderation is considered one drink per day for women and two drinks daily for men. A drink is considered as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor. On average, regular beer provides 146 calories per bottle, whereas light beer provides 99 calories. Liquor provides an average of 97 calories per drink, not including a mixer, such as soda or juice, which would increase the total calories in the drink. Wine provides 105 to 125 calories per serving, depending on the type consumed. If you are drinking more than moderate amounts, you might want to consider decreasing your intake. Many people find that when they are intoxicated they consume more snacks and increase their overall calorie intake. Keep in mind that alcoholic beverages add to your daily calorie intake and might be a ready target for decreasing your intake of calories.

One study found that with obesity, smokers have a life expectancy 13 years less than normal-weight non-smokers. Smoking increases the risk of cardiovascular disease and metabolic syndrome (which involves weight gain, abnormal glucose levels, and elevated cholesterol levels). Many people are fearful that if they quit smoking they will gain weight. Studies show that the benefits of smoking cessation outweigh the risk of additional weight gain. Deciding to quit smoking is a huge step in taking care of your body. There are many programs that offer support when attempting to stop smoking. The Centers for Disease Control and Prevention (CDC) has a program to assist you in creating a Quit Plan; providing suggestions on how to help you manage your cravings; various support options, such as SmokefreeTxt; or an opportunity to chat with a counselor. Be mindful to incorporate balanced eating and physical activity to combat weight gain. Drink adequate fluids and eat on a schedule. People who have smoked for years might find that they miss the hand-to-mouth habit. Be proactive and identify strategies to prevent your replacing food with cigarettes. Experiment with brushing your teeth after meals or chewing sugar- free gum or mints. Keep your hands busy by taking up knitting or crocheting, beadwork, origami, or keep a pen or pencil in your hand, or try a fidget toy or a stress ball. A support system can be helpful. Reach out for help when you are craving a cigarette.

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