By Alan Koenigsberg, M.D.

One of the many attributes that was instilled in me early on in my training as a physician was the need for lifelong learning. The field of medicine constantly evolves and the need to maintain our knowledge base is lifelong.

I knew I would be sharing that knowledge with my patients, so that part made sense to me. What didn’t really sink in until much later in my practice was how much I would learn from my patients.

As physicians, we hear that comment so frequently, it almost becomes glib and we give a knowing nod. However, given that my practice as a psychiatrist involves substantial psychotherapy, I actually do listen quite a lot to my patients, as I see many of them regularly and for a long period of time.

One question that comes up a lot with my patients is how to change some habit or trait that they want to change. A common one is weight loss. I worked out with a trainer a long time ago, consulted with nutritionists and spent quite a lot of time over the last four decades of practice to learn the basics of good nutrition, exercise, weight training and the like, along with developing and maintaining the motivation to do so.

I did not have particularly good eating or exercise habits and had to learn over the years what to do. I keep a barbell and a set of weights in my office as well as at home and I use them. I have found that the best exercises are the ones we can do most readily. Having these items at hand helps.

More often than not, patients ask how to lose weight (excess fat), not necessarily wanting specific guidelines, but wanting to know how to start when they’re not motivated. They want to wait until they are motivated to lose the weight.

That does happen sometimes, such as when an obese middle-aged man has a heart attack or stroke. The motivation now exists for them to avoid a second, potentially devastating cardiac event.

Or, they may have developed diabetes, lower back pain or some other condition that limits their usual functioning.

Most of the time, however, they want motivation to knock them upside the head to start their progress. I explain to them that the motivation will kick in after they have made some progress, such as having lost five pounds.

So here are my suggestions for establishing and maintaining motivation to achieve goals:

Set clear goals. Take your time to define them and how to measure them.

Set realistic expectations. Exaggerated ones lead to frustration.

Break down goals into smaller chunks. One step at a time.

Reward yourself when you achieve a small goal. This makes the overall goal less overwhelming.

Determine why you want to achieve this goal. You need to be really honest with yourself on this step.

If you can, visualize your successes.

Establish a routine. Build in a few minutes each day to work on achieving your goal, just as you would a music lesson.

Maintain some flexibility. Life happens while we make plans. Give yourself some cushion to anticipate life’s interruptions.

Learn. Educate yourself about your goals. Read, get tutoring, consult with experts, become an expert.

Practice. Whatever skill you are learning, you need to practice attaining this new way of living. If it had come naturally, you wouldn’t need to work so hard.

Consistency. Regular practice is the key to success. Not perfection, but regularity. Achieving regular, small goals leads to confidence and competence.

Listen to others, but remember, what works for someone else may not work for you. Some people like to go to the gym in the early morning; some hate going to the gym.

Don’t compare yourself to others. This may be inevitable, but do your best to refrain from competing with others. Keep track of your progress and compare yourself this year with last year.

There’s my baker’s dozen of suggestions. Any additions and suggestions are most welcome. It takes time to achieve lifetime goals and is well worth the effort. The good news is that we are never too old to start!

Alan Koenigsberg, M.D., is a practicing psychiatrist and clinical professor of psychiatry at UTSW Medical School in Dallas. He can be reached at

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