Weight gain ideas

In a world where most people are obsessed with weight loss it seems strange that some people should be concerned with how they might gain some weight. But there are isolated situations where this is the case. For example people with some forms of eating disorder, some sports people and people with a chronic and/or life threatening illness. Here I am commenting in the latter situation.

As an athlete I spent many years trying to ensure that my “racing weight” was at an optimum level. This meant keeping my weight at a lower level than average for my age and height, but not at a level that would result in depleted energy levels. When I developed cancer, and weight loss became a health issue, I found I could reverse some of the ideas, I had used to keep my ideal racing weight, to gain a healthy weight despite significant loss of appetite, nausea and a general low level of energy.

Initially I found myself engaging in eating behaviours that I suspect many people in my situation follow. That is the non systematic eating of a small range of food, that I seemed to be able to tolerate, with no idea as to how it might impact on my weight. My weight began to dip; it certainly didn’t increase. I then implemented the following plan.

  • I worked out the weight I thought I should be. I worked this out by finding the weight I thought I should be to produce an ideal BMI score. There are many internet sites that will help you calculate your BMI and interpret the score. My weight appeared to be below an ideal BMI, for a non athlete, so I did need to work on gaining weight.
  • I then worked out how many calories I needed to consume each day to maintain a good weight. There are a number of web sites that can help with this calculation. The calculation will take into account the number of calories used when resting plus the number of calories used for daily activities.
  • Once you have this figure you can decide on daily calorie intake depending on whether you want to lose or gain weight. If the weight loss is the aim then reducing your expected calorific intake by one or two percent would be the way to proceed. My aim was to increase my weight so I increased my expected calorific intake by about one percent.
  • I then worked through the food that I thought I could consume in a day and worked out the calorie count. Initially, I was eating a very limited range of food, and not very much of it, so the calorie count came to only about half of what I needed per day.
  • I worked out a balance of calories needed from a food supplement drink. There are a number of these available but I think it should be a supplement that provides good nutritional balance as well as being tolerable. The one I have used is called Ensure, produced by Abbot Laboratories. Each day I mixed up enough supplement to top up the number of calories needed for the day. I would drink this in small amounts over the period of the day.
  • Once I had my diet worked out I  kept to it as consistentlyas possible. Not easy when energy levels are down and nausea comes and goes. There have been times when I felt I was getting most of my calories from anti-nausea medication!
  • I reviewed the plan weekly particularly with regard to the change in the calorie count that would occur if I felt like eating some different foods and/or more of some food type. I then adjusted my food intake, and the amount of supplement I needed.
  • Gradually I increased my calorie intake though the food I was eating, and reduced the amount of supplement needed.

I recently came across a quote, in “Steve Jobs” a biography by Walter Isaacson, made by James Eason one of Steve Jobs’s medical specialists. In frustration with Jobs’s problematic eating behaviour Eason forthrightly stated – “You know, this isn’t a matter of taste …. Stop thinking of this as food. Start thinking of it as medicine.” I think this is a good guideline.

Over a four month period my weight has moved to a satisfactory level and stayed there. Now I do not need to follow the plan as systematically, but I have a good feel for the amount and range of food I need each day. When I have more treatment and have more problems with my food intake I will go back and re-implement the plan.

Please note: I am not a dietician, nutritionist or medical professional. Anyone with serious eating concerns should consult a specialist when they are setting up a diet plan and keep their doctor fully informed of any issues associated with their eating behaviour. I have detailed my plan here to provide ideas for people, in a similar situation, to consider. Eating problems associated with medical conditions can be complex and aspects of the plan may, or may not, work for other people.

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What if the goal posts move?

I recently wrote a blog about goal setting and how that is an important part of managing how anyone lives with a life threatening illness. One aspect I didn’t touch on was how to deal with the “moving goal post” situation; something that is probably far more common for people with a chronic and/or life threatening illness than for people in many other situations.

Certainly people set goals, and sometimes some damn thing happens that prevents that goal being achieved (say a runner sprains an ankle and can’t complete a race where they had been aiming to do a PB), but this can be accepted as a “life event” and on balance, if good goal setting practice is followed, a high percentage of goals will be achieved.

But what if, in the above example, each time the runner came to try and do a PB something less obvious happened to prevent them from achieving this goal. For example, someone insisted that s/he wear heavier running shoes, the distance is increased slightly, stopwatches start to run more slowly – in fact no matter how realistic the runner thinks their goal is something emerges to prevent it ever being achieved. Even more so, imagine the runner has been used to achieving their goals and now with every goal not achieved, for reasons that seem to be out of their control, they get more and more frustrated which seems to compound the problem.

For people with chronic and/or life threatening illnesses this moving goal post phenomena is very real. I am not sure if there are any “ideal” solutions but here are some ideas I have tried that have helped a little:

I have learned to accept that the percentage of goals I will achieve will probably be fewer than I have been used to in the past. Once, if I didn’t achieve 90% of my goals (at least) I could get grumpy; now if I can achieve 20% of my goals that is pretty good!

I set the bar low, but not ridiculously low. I have learned that setting realistic goals is possibly the most important part of the goals setting process.

I expect that achieving some goals will take much longer than would be the case for many other people. Not easy, and also can be compounded by the impact of deteriorating health in other areas. Again, thoughtful goal setting is important.

I try to be aware of things that are going well and use these as a basis for goal setting.

When I am working on achieving a goal I try to take short, steady, steps. I expect relapse – a backward step does not necessarily mean I won’t  achieve my overall goal. Also, when a goal post looms I am careful not to rush and take bigger steps while it is in front of me. That last lunge towards the post could be all it takes to actually not achieve the goal!

I am careful not to be pushed by others into setting unrealistic goals, or trying to move too fast in achieving the goals I have set myself.

Often I go back and read what other people in situations similar to mine have said about goal setting and managing the achievement of these goals.

And finally, it is absolutely OK to revise and renew goals. The one thing I can do, that most people can’t, is move my own goal posts!




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Stage 4 and setting goals

A significant psychological impact of being diagnosed with a life threatening
illness is a feeling of loss of control over parts of your life that you felt
you previously had control over.

One way to manage this situation, and feel that you are back in control over
(at least) parts of your life that you can control, is to set goals and develop
a plan to achieve these goals. Here I will briefly discuss how you might set
goals, in subsequent blogs I’ll look at planning to achieve the goals that you

The SMART acronym is often used as a guideline for setting goals. I have
modified this “model” slightly for this particular purpose with a SMART goal

Specific, essential for any goal – it must always be well
defined. You have to know what if will look like when it has been achieved.

Measurable, you need to be able to identify progress in
achieving, or not achieving your goal, in a way that you can articulate to

Actionable, you (or someone else) have to be able to do
something that will lead towards achieving the goal.

Realistic, the goal has to be one that is potentially

Timely, having some idea of the time frame for achieving the
goal is important.

It can be useful to look at people who have been in similar situations and,
if they set up goals for themselves, get an idea of how these worked for them.
For example, in a blog Toni Bernhard provides some tips from her experience of living with a chronic illness that could be used to help identify a set of goals.

It also an idea to set a global goal, and then break this down into some sub-
goals, that if achieved, will result in the main goal being achieved.

In my situation I have set up 3 main goals, with a definite order of

  1. Manage my condition to ensure that my health and well being is as
    optimum as possible in the circumstances
  2. Engage in a project aimed at developing a pervasive and enduring digital
    presence on the web
  3. Carry out tasks regarding my estate and supporting people to manage
    aspects of their lives that I had previously had a big part in helping them

In this case order was important as I figured: health number one, without
being in as good a shape as possible achieving goals two and three would be
difficult. Number two goal was next because it involves things only I can do;
when I am gone this goal will have been achieved to the extent it can be
(although others could add to the material I leave behind). Number three goal is
important, but most of what I try to achieve within this area will happen
(and/or be sorted) without me. People die unexpectedly and their stuff does get

Having set these bigger picture goals I have been able to set sub goals, and
plan for achieving these goals. I can also move my emphasis from one goal set to
another. For example, if my health is good then I can work on goals in goal set
two (and maybe a little on three). If there is a relapse in my health condition
I can park the number two goals and re-set some number one goals.

It is important to keep reviewing the goals that have been set (sometimes
daily) and revising them as necessary.

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Stephen J Gould

I recently came across an intriguing story about Stephen J Gould and his
approach to dealing with his cancer. It seemed to me that he was looking at the
psychological impact of his condition in a similar manner to me, but of course many years before I began to think of these ideas.

Gould has a presence on the web which I can access and
begin to build a picture of his thinking about his cancer. Here are two sources of

A video

Stephen J Gould

and an essay he wrote about, amongst other things, interpreting the survival
rates for people with cancer when the median is used as a key statistic to
describe a data set.

the median is not
the message

Within these two presentations you can sense a person grappling with the
psychological as well as the physical impact of the condition he is confronted

One of the key messages I get here is that I  am on the right track with
regards to my ideas around building, and in this case using, a digital presence.
Otherwise how would a person who produced his material, pre 2002, be able to
influence me today – unless I had accidentally stumbled upon his material in a
book (or similar type of document) somewhere.  In this case it would have been highly unlikely that this would have happened.

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Living in the fish bowl

A lot of people live in what is essentially a fish bowl; but usually that has been their
choice. By fish bowl I mean a situation where you are being selectively
observed by other people. So called Movie Stars are often in this position, but
typically, they invite the public and media to watch out for them when they are
out and about. With Stage 4 you don’t have lot of choice about being in the
fish bowl. Medical people, friends, family, colleagues etc., are always looking
at you to check out your current medical and/or psychological status.

In fact, it is possibly more like living in a panopticon (see: http://www.scientificamerican.com/blog/post.cfm?id=too-hard-for-science-a-digital-pano-2011-04-25),
where you know you are being selectively observed, but you don’t always know by
who and/or when it is happening.

Psychologically, accepting this situation can be difficult – particularly if this is a new
experience. Eventually, I suspect, most people with stage 4 get used to it and
get on with their lives, but the panopticon effect means that you can never
quite put it aside.

I have managed this phenomenon by accepting that it happens, that I can’t change it
(even if I asked people to stop “fish bowling” me the panopticon effect means I
could never know whether they have or haven’t changed their behaviour) and that
it really just goes with the territory. That doesn’t necessarily make it OK,
but it reminds me that I do after all live in a social world with a lot of
people who care about me.

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Time moves on: the psychological impact of living with stage 4 cancer


From a psychological perspective one of the most important
things that changes when living at stage 4 is the concept of time. To put this
in perspective it is useful to think about the different concepts of time people
in the world I live in have. These are:

  • Time in the universe: something we do not really
    understand apart from the belief the universe we live in had a start and will
    probably have an end.
  • Time as a physical entity: the passage of time
    as perceived by people and, usually, divided into agreed increments such as
    years, days, hours minutes, seconds, micro-seconds etc. Physical time is
    important in the way we organise our world and how we synchronise our
    activities with others in that world.
  • Time as a biological entity: that is biological
    rhythms and cycles.
  • Psychological time: our own perception of the
    passing of time, which is intertwined with the other forms of time we
    conceptualise. For example, many people would know that when they have a
    “deadline”, in the world of physical time, psychological time seems to move
    “quickly”, but when they are waiting for a bus it never seems to arrive!

These types of time interact and for the most part people
understand how they fit together. Sometimes there is a disruption the way time
is perceived and some readjustment is needed. Living with stage 4 is one of
those times. These adjustments will be different for each person – the
important thing is to realise the need for such an adjustment and to work out
ways to manage the changes that may be necessary to accommodate these changes.
Some examples of changes in my perception of time include:

  • At stage 4 time becomes important. When I
    mention this to people they usually interpret it as meaning I think one has to
    appreciate every moment and/or only engage in activities that one wants to
    engage in. But for me time is important because I want to fit a lot of things
    into what appears to be a more limited, physical, time frame. Many of these
    things are not particularly profound or stimulating in themselves, they are
    things I would have done over the next 20 -30 years, but now I have to do them
    within 20 – 30 months (or maybe even less). These are things like organising a
    family history, completing some work tasks that I think will be helpful for the
    future – and so on. It’s not about having more experiences; it’s about
    recording the experiences I have already had.
  • Biological cycles seem to change, sometimes this
    may be due to treatment, sometimes due to the stage 4 condition and sometimes
    due to the my bodies reaction to my perception of how time is moving.
  • The world does not change its pace. In the
    contemporary world, for many people, the psychological awareness of the passage
    of time is one of “speeding up”. Things happen more quickly, the expectation
    for speed of service increases, the time to information across the world
    increases and so on. I enjoy this increase in how things happen, but sometimes
    I would like to do things at a slower pace – and end up like the tortoise moving
    alongside the hare. Only, in this case the hare will keep going – and he
    tortoise is not trying to win a race, just move at its own pace.
  • Sometimes the reverse happens. I want to be the
    hare and some other aspect of my life is a tortoise. One example of this would
    be the pace the health system works at, or at least appears to work at.

How have I managed these changes in my perception of time?

  • My first step has been to try and become aware
    of these changes to my concept of time. Rather than getting concerned about why
    time appears to be different, I try think about the difference and the impact
    it is having on my day to day life. I then work out strategies to manage the
    differences. For example, instead of getting gloomy by the endless waiting time
    in hospital wait rooms –I make sure I always have something to do that I feel I
    do not usually have enough time to do; eg., read that special book, listen to a
    podcast. It is amazing how much downtime there is to squeeze “would I really
    like to do right now” activities into.
  • I have set up activities that I do regardless of
    what the world around me is doing. For example, my work colleagues race around
    keeping appointments – I go to the Gym for an hour. My work still gets done!
  • Because I am often a little more tired in the
    morning than when I was pre stage 4, I have changed my morning routine so that
    I do some of my early morning activities (that I would have done out of bed) in
    bed. For example, check the world news on my laptop rather than desktop. I
    still get to work on time!
  • I say no to activities that I really do not want
    to do. Often these are the “time filler” activities that friends are engaged in
    and I know if I was participating I would feel I would rather be doing
    something else.  On the other hand,
    spending time with friends and family is really important to me – so I work at
    trying to match time spent with important people in my life with activities
    that I like to do.

As I complete more blogs on living at stage 4 I will often
note that there is no right or wrong way to live at this stage. Everyone will
have different ways of how they manage their life in this situation. To me, the
important thing is that you feel in control of as much of your life as
possible, and managing time is a crucial part of this.

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The psychological impact of living with stage 4 Cancer

I will just call it living with stage 4!
I have had cancer at this level for about a year. I had
thought about blogging my experience for a while – but there are heaps of blogs
by people with medical conditions, including cancer – so I did not think my
condition was particularly special. But then I read an inspirational article in
the New York Times, about stage 4 breast cancer (not the type of cancer I have).
This article is saying something that already made sense to me: living with a stage 4 is not the same as living with cancer that will probably be cured. Yet, much comment related to living with cancer focuses on the hope of, or expectation of, a cure. But if you are a stage 4 you cannot live in the hope of a cure – you can only live in hope of good treatment.
So I think it is worth blogging about living with stage 4, and because I am a psychologist I will try and comment on what I see as the psychological impact of this situation. I may comment on other things as well.
If this helps other people who are living at stage 4 think about the psychological impact of this situation on their life, then that is great. But, read the article in the NYT – that will help to put this blog into context.
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