Interview with Dr. Sue Popkess-Vawter
Paul B. Schlosberg
Lesley University
November 29, 2006
Introduction
Obesity in America is at epidemic proportions. Research and various forms of intervention are used as attempts to thwart this terrible growing social problem. Experts often agree that the physiological concept of weight gain is rather simple: too much caloric intake and not enough calories expended equals body fat gain. However, beyond this it becomes more hazy and complex. Important questions to ask are, if the dynamics of weight are so simple, then why are so many people overweight? There must be psychological, sociocultural, and even spiritual reasons that people overeat, and if so, what are they? Additionally, why are so many weight programs generally able to help people lose weight for the short term, but unable to help maintain weight-loss over the long term?
As a fitness professional, and in my research work as a graduate student at Lesley University, I have reviewed many weight-management programs. I have found no shortage of weight loss philosophies available, and, it seems the public is frankly overwhelmed with weight-management information. Yet, in my view, many of the books and programs on weight do generally have much to offer that is beneficial; though some are faddish, and one must use a discriminating mental “palette” to interpret them.
I recently learned about Dr. Susan Popkess-Vawter’s holistic weight-management program at the University of Kansas, and I believe it is unique in some important ways. Her program is more in-depth and comprehensive than most I have studied. Unlike programs that address only diet, exercise, or both, Popkess-Vawter’s program additionally addresses the psychological and spiritual aspects of weight.
Undoubtedly, it is becoming more common to see commercial programs that now take a mind, body, spirit holistic approach to health, and to weight-management. However, Dr. Popkess-Vawter’s is one of the first holistic weight programs using mind, body, and spirituality I have seen at a major university: the University of Kansas Medical Center. Her program has received substantial federal funding from the National Institute of Health (NIH). In the following interview Dr. Popkess-Vawter, a former nurse, discusses these topics.
Interview with Dr. Sue Popkess-Vawter
Part 1
Paul: Can you explain a little about your program and about the body, mind, and spirit aspects of holistic weight-management?
SPV: I think the body and the powers of the body are fascinating. Now that I am beginning to understand the body better, and I am hooking up with a higher power, it is like whoa! There is no stopping what we can do with this program. I shifted from an illness critical care perspective to a wellness perspective in the middle of my career. Now I focus on keeping people well. I have struggled with weight most of my life, so I come from a personal perspective of what it is like to feel really bad about yourself because of the way your body looks. So, anyway, that is where I am coming from, I went from the physical side of the weight loss battle and of having my own personal struggle, and then, I thought, “Now, why can guys lose the weight in the drop of a hat and women are struggling?” And I figured that one out…
Paul: So I am curious, what was the answer? Is it because guys have more muscle mass?
SPV: Yes. And, because of female hormones.
Paul: Well, that is probably true, but I think that as men get older their hormones also change, it definitely gets more difficult for men to lose fat as well.
SPV: Oh absolutely. The way I came to spirituality was through my own personal experience, because when I understood the physiological reasons for weight gain, then I said, “Well why do we go to the refrigerator and eat without having hunger?” So the separation of the emotional eating and the physiological eating is what I became interested in. I have gone further to say the same thing about exercise. We think we are treating ourselves well by taking the day off, whatever the excuses are, and it is just the opposite of what we actually need.
So, I got through studying the exercise and the eating, and finally I came to spirituality, what I call the glue that really holds the rest together. The glue is spirituality, and I equate it to self -esteem.
Paul: That sounds quite interesting.
SPV: I recently went to a conference of Jennifer Crocker’s who uses the Rosenberg self-esteem measure. A lot of people criticize that it is a very global measure, and that it is a trait versus estate kind of measure. She has done work to show that there is improvement in self-esteem over a shorter term, and it is a reliable measure too. Now, her work is primarily psychological and she does not get into spirituality, but to hear her talk and read her work and look at her studies is important. Her work has very much to do with how we feel about ourselves.
Now here is a quickie on my beliefs: I allow people to interpret my spirituality any way they want, because I cannot force something on them. They have to relate to a higher power in a way that is meaningful for them. So, my personal belief is I call it God, or, the Lord. I grew up Methodist, and am not a Catholic. And, I also kind of get into Eastern Buddhism, and other similar concepts.
It doesn’t really matter to me what a person calls a higher power, it is more important that they have a belief in a higher power. I have had maybe two clients who have had a hard time with that, likely because of their past. My own father is a good example of this -- my grandmother crammed religion down his throat every night and he hated it. However, he really had a very strong spirituality. It is the same with the clients that do not relate to a kind of religious term. I say to them, “What about intuition or gut feelings? Or, perhaps, when you just know in your heart that something is right...” I just describe it in many different ways and there has not been anybody yet who has had a problem understanding what I am saying.
Now, the trouble I have come across, and this is in my earlier research with reversal theory. When people, women in particular, and some men, feel selfish it is because the Catholic religion and some of the others have done a guilt trip on them. They feel that what I am proposing they do in self-care is selfish. So I learned and got a heads up to be alert about this type of thing right away. A person dropped out of my study, and wrote me a long letter that it was selfish to do what I was saying. Then I realized that her situation was not really such a major problem, because in fact it helped me to focus on why women have such a hard time caring for themselves. So I started targeting all my interventions in this way to say, “Now wait a minute there is a difference here -- self-care is not selfishness.”
With my clients, I use the metaphor of a cup. I say, ok, if you fill that cup up, and you start giving to others from your cup, and then eventually you look down and the cup is empty, well, then you cannot give what you don’t have. So it is maintenance to continuously fill the cup, but you do not have to keep it at the top and then never give to anybody else. However, you have got to take the time to fill it in order to be able to give. So I look at the giving to others as very much a part of this. This seems to make sense and none of my clients have had trouble with that.
I do telephone interventions, I created a program consisting of five sessions. It is a lunch and learn at noon-time, the sessions are one hour long, and at the start of the five sessions we have over a hundred people together on the telephone. Eventually many drop out like any other weight management program. Anyway, the other day one woman was saying “I philosophically disagree that we don’t need other people, I disagree that this is something that you can totally do on your own.” I said, “I think you misunderstood me, it is a balance.” It is giving to others and being with others, but when we rely upon others to do our care for us, or to encourage us and support us to the point that we are not supporting ourselves, then it is not going to last.
So those are the big hurdles I have had in my research and my practice. But, I still have no problem focusing on the spiritual part to keep a long term view and a balance, and on the eating and the exercise, and on the esteem. So, the esteem is equated with a higher power -- when one believes in a higher power one feels really good about themselves.
Paul: Yes, I absolutely feel the same way. Now, I am sure you have also come across the challenge of people that do not have any faith. How do you deal with that?
SPV: You know, I have not come across that yet. My son is twenty-four. He went through developmentally rejecting religion. Both of my boys did. I took them to church, and it was worse after church than going in. And, so I thought, “Oh now this is not accomplishing what I want.” And, so in my own spiritual path I have shared that with them and not crammed it down their throat, but have just tried to share things with them. He ended up getting into philosophy, and you probably know some of the guys he was into, I never get the name right – Krishnamurti. I cannot even name all the other ones he was into. But, anyway he was searching and that was all I cared about. However, even if people are atheist, agnostic, or whatever, it still does not bother me because there is something within them that is a voice, I just call it your voice, and that it is a higher power inside each of us.
Paul: Like an internal compass guiding or pulling us to something.
SPV: Yes, Yes, in the program I go into cognitive restructuring, and I talk about positive and negative self-talk. And, it is that positive voice…
Paul: I guess you are saying that because people are attracted to your program, therefore they are already moving in the direction of health and wellness, you feel like there is something inside them that has sort of called them to it, in a way. Not only that, but they are interested in a holistic program which means a “spiritual” program; and, therefore they must be open to the idea of spirituality to begin with.
SPV: Exactly, so I try to explain the idea very clearly. This is not religiosity. If you have a religious belief that coincides with your spiritual belief, that is fine. But, your positive voice usually is whispering to you, and your critical voice is usually shouting at you. The shouting comes from many other people from your past that you have believed. I really get at the belief system. I think that cognitive restructuring has to get at the belief level, or you are not going to correct the action level.
Paul: Well, I know that when personally I finally made a decision in my own life, “Now this is it! I am really going to focus and devote myself to proper diet, exercise, and a total wellness program,” that my self-esteem began to improve tremendously. Perhaps, we can use the term sense of self, to refer to the positivity that comes into your life when you take steps to care for your health. It really is important, because when you take action and you do something that is the right thing taking care of yourself, you begin to feel like, “Hey, I am just doing something good and right in my life.” Do you agree?
SPV: “The right thing to do” -- that gets it right there. So anybody who does not have a name for a spiritual guide, I would say, the “knowing what is right,” is it. And, to me that is a higher power. And when I believe that I have a higher power within me, that it is not outside of me, and when I focus within [I have access to it]. I think that is influenced by Eastern thought.
Paul: Yes, I agree.
SPV: So one is going within, and listening to know what is right, and that doesn’t mean it is written down somewhere. It is moment to moment, the momentary presence and awareness of knowing what the right choice is. It is not necessarily a mind thing; it is a heart thing. Now, regarding self-esteem and spirituality, did you see the Da Vinci code, or did you read it?
Paul: I saw it but I did not like it that much.
SPV: It is about the feminine influence. I saw it on the history channel the other night, they talked about [the movie], theologians and different philosophers and other folks spoke about it. You know the author made fiction out of it. Going way back historically, there was an element of truth in what the author said. But, if you believe in the Yin and the Yang, the balance between the feminine and the masculine and the belief that every person has both regardless of their dominant sex. It means the balance, the abilities that go with the feminine and the masculine, are available to every body.
Paul: Yes, I do believe that.
SPV: I know that you are not a nurse, but you may be able to appreciate that nursing and teaching are female dominated professions. We come from way down the list, way down on the food chain of feeling like we are human beings.
Paul: I may be able to relate a little to that being Jewish. I was raised Jewish, and I grew up in an Irish Catholic community. And the Jewish people weren’t always accepted. Well I guess we had a good amount of Jewish people in our community too, so it was not so bad, but I could definitely feel the anti-semitism.
SPV: So that kind of second class citizenship, or even third class citizenship, spurs a kind of focus on negative beliefs about yourself. Now regarding spirituality, I think it is an individual thing. And without that you are again going outside of yourself. And that’s what women and my clients do, and they come to me and they say, just tell me what to do. How many times should I weigh myself, what kind of workouts should I do, it’s like, tell me what to do. And I am saying, I will help you, I can tell people what to do, but they have got to learn what to do on their own and what is right for them twenty-four seven.
Paul: Yes, absolutely, and I think one key to helping others is understanding that point. As helpers we cannot do the work for our clients. It is like, you know you can take the horse to water but you cannot make them drink. So that is why coaching is really motivation and education. It is motivation and education because we try to inspire clients to want to take care of their health, but we can’t force them to do that. We can attempt to educate them as much as we can, but hopefully we can educate them to want to educate themselves. What are your feelings about it?
SPV: Bingo. That’s what I tell them right off the bat. You know when I interview people or explain the program, I tell my student nurses this, you know you can’t motivate other people they have to learn to motivate themselves. And most of them have failed so many times.
Paul: But you can try to motivate them to motivate themselves.
SPV: Well, yeah, I guess so. But I try to knock the props out from under them a little bit.
Paul: Well, I guess you’re right about that. Some of that motivation stuff can be a little bit rah rah I guess.
SPV: And as a fitness and wellness coach, you seem to have a philosophy that kind of agrees with mine. But I will bet you that went through your coach training programs and you have met coaches who have this philosophy that is “come on do this my way, or come on you gotta do it this way…”
Paul: I think one of the main things that is missing in most coach training programs is the spiritual component. Because when you leave that out you miss a huge part of the picture.
SPV: Well I always tell folks, you know I can’t be with you 24/7. You know when you are in those dark doldrums and when you are stressed or tired, and you bottom out [wanting to use food for comfort]. Those are the times you have to call upon yourself and your higher power, and if you do not see yourself as part of your higher power, then you know you have to go straight to the higher power and say I am doing this again come on, help me out here…That is what I teach people.
Paul: Yes, we need to have grounding within ourselves. We need inner strength.
SPV: Sure, you can call a friend. Those are all good techniques. But, just like I told a woman last week. I said you know, people may love you and they will do anything for you, but they are just human beings and they have their own personal time, which they cannot necessarily give to you.
Paul: So how many people have you had in your program?
SPV: Well, you know the article I sent you from the Kansas Nurse, well, that article quotes numbers more than anything. It is a nutshell of my whole program.
Paul: You mean the Hybrid View of Weight-Management article?
SPV: Yes, because that gives the historical approach and the theoretical basis and everything. I would say I am up to 150 -200 clients, and that means I have seen them at least once. I have had quite a few of those that have seen me over a year. It is counseling that goes way beyond the food and the exercise. That is why they keep coming back. Now they may be seeing psychologist, or in some cases a psychiatrist. You know the psychological counseling is very much a part of what I do. I got a grant to beef up that part of my background and I took a lot of psychology classes. And so it is very much rooted in psychology, but then when you get to the spiritual part, and in fact I have worked with psychologists who don’t go into spirituality, they do not necessarily see it the way I do.
Paul: Well, Susan, we have covered a lot about your program, I guess we need stop now and resume the second part later. Thank you so much for your time, it has been a pleasure.