Summer is around the corner and it’s time to try to fit into that same bathing suit…again. I see lots of frustrated patients who lose no weight or gain weight in the summer. Doesn’t make sense, does it? You’re spending more time outdoors exercising and sweating, but the fat refuses to melt away in the summer heat. Before I discuss some of the primary culprits, it’s important to understand an important fact: Your diet has a far greater impact on body composition than exercise! Repeat this line over and over until it sinks in, and especially when you decide to reward yourself with a carb-loaded post-workout meal, snack or beverage.

I routinely see patients in my practice who tell me they are “sweating it out” in the gym five days a week but the needle on the scale is hardly budging. That’s because there has been little change in their diet. If you want to lose weight, and in particular burn body fat, you must lower your body’s insulin levels. High insulin levels store body fat, and out of all your macronutrients it’s the sugar and excess carbs that are sabotaging your efforts to fit into that swimsuit.

Some reasons people struggle with weight gain during the summer and tips to avoid it:

1. Liquid fat:  We crave cold beverages in the summer heat, but these are often the most potent fat-storing summer foods. Smoothies, Frappucinnos, sodas, juices, cocktails, etc. will cause your body to store more fat than most fatty foods. The reason is because these drinks have a ton of sugar and may also have high fructose corn syrup which sends insulin levels skyrocketing. I call these “liquid fats” because even though most of these beverages may not contain dietary fat, they cause your body to store fat through their effects on insulin…so don’t be fooled by “low-fat” drink labels. Choose sparkling water and throw in some mint, lime, orange or other citrus wedges.

2. Outdoor venues: Barbecues, picnics, outdoor summer concerts, etc. are centered around eating. Pack healthy options and plenty of veggies and fruits. Avoid sugary desserts and the liquid fat drinks I mention above.

3. Frozen desserts: Ice cream is an obvious no no.  What about low-fat or non-fat fro-yo?  Again, it’s all about the carbs and sugar, so don’t get fooled by the misleading low-fat labels. If you must partake, have it served up in the smallest serving size available and eat your fro-yo nice and slow…savor every bite and don’t make it a regular habit.

4. Inactivity from the heat:  Some of us just can’t stand the sun and/or heat and spend more time indoors during the summers. Not good. Hit the gym or your local air conditioned mall for some air-conditioned walking, or take advantage of walking or exercising in the early morning and evening hours when temperatures are normally pleasant, especially here in the Bay Area.  Although I’ve focused on the diet in this article, you need to stay active and get regular exercise if you want to maintain weight loss.

5. Late night snacking:  Long summer days often mean going to bed later due to extended daylight. This also means more time to feel hungry and succumb to late night snacking.

6. Vacation moderation:  Don’t use your vacations as an excuse for unlimited eating. You’re only going to make it harder on yourself when you return home. Moderate your intake, enjoy occasional sensible and portion-controlled indulgences, and stay as physically active as possible.

7. Watch your fruit intake:  We all know fruits are good for us, but fruits also contain fructose or fruit sugar. Tropical fruits, in particular mangos, bananas, pineapples and papayas, can really pack in the sugar and lead to weight gain. Always eat more veggies (non-starchy ones) than fruits. Use tropical fruits more as toppings for salads and unsweetened yogurts.  For example, carve off a few mango or papaya wedges and add to your salad rather than eating a huge portion telling yourself “fruit is good for me so I’ll eat more!”  If you like making smoothies at home, make them more “green” with veggies and add a handful of berries to sweeten them, rather than making just plain fruit smoothies which are loaded with sugar.

My advice is to avoid these common summer fat building habits and instead, focus on eating and drinking natural, unprocessed, unsweetened foods and beverages while staying physically active.

Ronesh (Ron) Sinha, M.D., a Palo Alto Medical Foundation internal medicine doctor, contributed this blog post. Dr. Sinha is the author of The South Asian Health Solution, he works closely with the South Asian community to help reduce heart disease and diabetes risk, and provides corporate health lectures to promote wellness in the workplace. His personal blog is at southasianhealthsolution.org and you can follow him on Twitter at @roneshsinha.

Meg Price lost 108 pounds after weight loss surgery.

A year ago, she weighed 280 pounds and was facing life in a wheelchair due to debilitating back pain. “My doctor told me I would probably end up in a wheelchair, but I was simply too young for that,” says Price.

Now a lively and energetic 58-year-young partner in a wedding photography business with her husband, Michael, Price had been able to keep her weight under control for most of her life by exercising regularly. All that changed in 1999 when she started suffering from terrible back and sciatic pain due to a fractured disc. After back surgery and three serious falls, she was almost disabled. Home-bound, she ended up putting on 100 pounds.

“I was in a catch-22 situation,” says Price. “My PAMF pain management specialist Toby Ratanasiripong, M.D., kept urging me to lose weight but I couldn’t get active to lose weight because I was in so much pain. So the weight kept piling on.”

The day Dr. Ratanasiripong said she would probably end up in a wheelchair with an early death, she knew it was time to take charge of her health.

“I had been in denial about my weight and hadn’t stepped on a scale for years,” says Price. “I asked my primary care doctor, Rachel Young, M.D., if she’d recommend weight loss surgery, and she said that I was the ideal candidate as it would also help alleviate my physical problems and pain.”

Price started carefully researching weight loss surgery options.

After an informational seminar and consultation with PAMF weight loss surgeon, John Feng, M.D., Price decided on a sleeve gastrectomy. During this procedure, the surgeon isolates a small sleeve-shaped section of the stomach for processing food, drastically limiting its capacity and restricting the amount of food you can eat before feeling full.

“Weight loss surgery is just the first step in regaining control of your weight – it’s not a magic bullet,” explains Price. “You must also make some big lifestyle changes and follow a very strict diet. To maintain my weight loss I eat fewer than 40 carbohydrates a day, 60 to 80 grams of protein and drink 64 ounces of water.”

Soon after her surgery, in May 2011, she also began walking to slim down and then launched into a whole new exercise regime.

“I work out like a mad woman,” says Price, who has lost 108 pounds since her surgery. “I go to eight water aerobics and six Zumba classes a week, walk three miles with my husband and dog every day and go to the gym all the time.”

The best part of losing weight for Price is her discovery of Zumba, a Latin-dance inspired fitness program.

“Previously my only option for exercise was in the water,” says Price. “Zumba made me feel like a primordial animal that has crawled out of the water and evolved into a completely new being. It’s an amazing and fun work out. I’m smitten!”

Price is quick to emphasize that weight loss surgery was the start of her journey to reclaiming her health and joie de vivre. “Dr. Feng is my savior, he helped me get my life back,” says Price. “Having weight loss surgery is the absolute best thing I ever did.”

Dina Barr lost 130 pounds with PAMF’s HMR Weight Management Program.

Dina Barr’s big dream was always to ride on one of the swings at the Great America theme park in Santa Clara. But at 350 pounds it wasn’t just a tight squeeze – it was impossible.

As long as she could remember Barr had been battling her weight – always on or off a diet.

“I was always really good at sticking to a diet and losing weight,” says Barr. “But I just could never keep it off. Finally, I just gave up.”

Barr kept gaining weight until her health issues resulted in a visit to an immediate care facility.

“I was told I needed ongoing medical care as I probably had diabetes,” says Barr. “I had been in denial about my health.”

Barr saw PAMF internist Patricia Sitnitsky, M.D., who confirmed the diagnosis of diabetes and high blood pressure and referred Barr to PAMF’s weight management specialists.

Although Barr was a candidate for weight loss surgery, she didn’t want to go that route. Instead she decided on PAMF’s HMR Weight Management Program to lose weight once and for all and regain her health.

“When I chose the HMR Program I promised myself I would stick to it for the rest of my life,” says Barr. “This was it.”

Barr is no stranger to successfully making big changes in her life. When she turned 50, she decided to follow her dream and leave her career of 25 years in marketing and communications. She’s been a middle school teacher now for 11 years and is currently teaching math and science to 100 sixth graders at Cupertino Middle School.

“Although the HMR Program was challenging, I was successful right away,” says Barr. “What’s cool about the program is that it’s really flexible. You can make it work in many different ways. Also the weekly meetings saved me. I loved the great support from everyone in the group and hearing other peoples’ stories.”

Although Barr quickly mastered the dieting part of the program, adding exercise to her routine to continue to lose and maintain her weight loss was her biggest challenge.

“The word exercise was just not part of my vocabulary,” says Barr. “I had every excuse ready – too exhausted at the end of the day, too boring, no time…”

A fellow HMR Program participant, who had been listening to her, finally helped her jump start her exercise regime.

“He came up to me at the end of the class and simply said ‘Just do it!’” says Barr. “I was surprised but hearing it from someone who was going through the same challenges as me was the motivation I needed.”

Barr began exercising 15 minutes daily with the Wii Fit program, then started getting up at 4 a.m. to go walking and also joined a gym.

“I discovered that I really love hiking a lot,” says Barr who now regularly hikes up to the Stanford Dish and around the local Bay lands.

Thanks to the HMR Program and regular exercise Barr lost 130 pounds and was ready to fulfill her two life time ambitions – a ride on one of the swings at Great America and a trip to Hawaii.

“I have to confess that I didn’t really like the swing ride, but I adored my trip to Hawaii,” says Barr. I had traveled to 48 of the 50 U.S. states and this was one of the last two I hadn’t seen,” says Barr. “It was wonderful – I fit in the airplane seat and loved my time on the beach. I could never have done this if I hadn’t lost all that weight. Now I feel like I can do anything.”

As much as the Nike ads would like us to believe we can “Just Do It” — most of us know from personal experience that knowing what to do, even desperately wanting to do, does not translate into lasting behavior change. How many times have we told ourselves, “Today is the day” – we set out with great intentions only to be waylaid by a temptation too strong to resist (name your poison) or “life” getting in the way of exercise plans. Deflated and guilty, we start the cycle over and over again.

Environments can have an influence

I recently read about some interesting research which suggests that, over and above willpower or even skillpower, our environments can have an influence – either positively or negatively – in significant and profound ways that may well be under our radar. According to Dr. Wendy Wood, a professor of psychology and neuroscience at Duke University, almost half of our behavior takes place every day, in the same environments – home, car, school, work, etc. Dr. Wood explains that even though people think they are making choices all the time, many of our repeated behaviors are cued by our everyday environments. “Most people don’t think that the reason they eat fast food at lunch or snack from the vending machine in late afternoon is because these actions are cued by their daily routines, the sight and smell of the food or the location they’re in. They think they’re doing it because they intended to eat then or because they like the food.”

Dr. Wood’s studies demonstrated that people repeat well-practiced behaviors whether they intend to or not. She has also found that physical locations are some of the most powerful behavioral cues. For example, one of her studies demonstrated that college students who transferred to a new university were able to break their TV habit if the TV was in a new location, whereas those students who found their new dorm TV to be in the same place as their old dorm, did not significantly change their viewing habits.

Think about it this way: If you leave a bowl of apples on your counter, are you more likely to eat them than if they are out of sight in your produce drawer? If you’re like me, you’ve no doubt lost count of the number of times you’ve cleared out that drawer of rotting produce! If you removed the comfy cushions on your couch, would you be as likely to spend time watching TV? Trying to avoid a fast food habit? Dr. Wood suggests driving a different route to avoid the visual cue. Similarly, as we like to say in our weight management program, if it’s there, you’ll eat it – and the corollary, if it’s not there, you can’t eat it.

Focusing on triggers

Early on in my career, I worked with smokers to help them quit their cigarette habits. We focused a lot on “triggers” or cues to smoke; how being in certain environments or with particular people, or practicing an everyday behavior (like reading the newspaper, drinking a cup of coffee, or driving a car) could produce at times an overwhelming craving or urge to smoke. Environmental cues and triggers can also work against us – or for us – when working to develop other new health habits. I’ve been working hard (trying to follow doctor’s orders!) to incorporate more strength training into my exercise routine. What has helped is to tie doing certain exercises to my every day “get-ready-in-the-morning” routines. For example, I started doing “wall sits” while I brush my teeth. I’ve put a stability ball near the TV as a cue to do my core work.

What’s the bottom line?

Bottom-line: The more effort we put into problem-solving setting up our environments and cues to work for us – to support habits we’re trying to put in place, or to reduce the cues or ease of practicing behaviors we’d like to avoid — the less we’ll need to rely on willpower; even better, we’ll provide a boost to that skillpower we’re working to develop. Now, to practice what I preach, I need to find a way to get cued to take — and use — those hand weights which have been way too firmly ensconced underneath the TV!

This blog post is contributed by Karen Handy, MPH, a behavioral health educator and manager of nutrition and diabetes education at Palo Alto Medical Foundation. She supports patients making health behavior and lifestyle changes, co-facilitates PAMF’s bariatric support group and writes a blog on weight management and health behavior change for Sutter Health’s MyLifeStages website.  Ms. Handy enjoys spending time with her three children and is interested in reading, running, healthy cooking, hiking and travel.