Cleveland.com's weekly health and fitness column 'Stretching Out' recently explored the challenges people-of-size face when embarking on a journey to lose weight. The publication sought the expertise of Dr. Anita Maximin, clinical psychologist in the Center for Bariatric Surgery at St. Vincent Charity Medical Center. 

In her role at the Center for Bariatric Surgery, Dr. Maximin counsels hundreds of patients a year on how to mentally prepare for their weight-loss journey, and often on how to change their mindset around diet and exercise. Dr. Maximin provides motivation and encouragement for people hesitant to begin an exercise routine. The full text of the column is included below and can be read on Cleveland.com, here.

Exercise of any form is key to overcoming obesity: Stretching Out

Getting started in fitness is hard enough. Doing so when you're obese is substantially harder.

But it need not be impossible. With the right frame of mind, expert advice, and the support of friends and family, even the heaviest can seize control and begin to win what may feel like a losing battle.

"Any form of movement is a way to get started," said Anita Maximin, a clinical psychologist in the center for bariatric surgery at St. Vincent Charity Medical Center. Even short efforts, she said, "add up fast" and can "make it a lot easier to keep moving."

Exercise, in this battle, is key, as Maximin suggests. Dieting alone won't cut it or lead to victory over such life-threatening ills as diabetes, high cholesterol, hypertension, chronic pain, difficulty breathing, and depression, all of which are commonly associated with obesity.

Most of the hundreds of patients seeking bariatric surgery each year at St. Vincent have tried and failed to lose weight strictly by eating like a caveman, cutting back on carbohydrates, or following some other faddish meal plan. Meanwhile, recent research by the Cleveland Clinic shows bariatric surgery to be an effective path to long-term weight loss and healthy blood glucose levels.

"The amount of benefit you get from this surgery...is pretty remarkable, and it's durable," said Philip Schauer, a researcher and bariatric surgeon at the Cleveland Clinic.

Eating habits have to change, of course. Instead of a rigid, restrictive diet, however, Maximin recommends a mental reset, a wholesale change of food philosophy, with customized help from a nutritionist or dietician.

"It becomes more about what you can have and what your plate should look like," Maximin explained. "Our culture is built around food, and everybody comes in with their own personal history of eating and how they enjoy food."

The exercise part of the equation isn't any easier or more straightforward. Again, it's a process demanding personalized attention and support. 

Just as they've struggled with dieting, most who come to St. Vincent seeking bariatric surgery - a process that itself usually requires weight loss and counseling - have also tried and given up on exercise, after experiencing pain, fear, or embarrassment, or some combination of all three.

"I can't just say go to a gym and expect that they're going to go," Maximin said.

No, Maximin has to meet people where they are, to push for exercise that's realistic, as well as effective.

For those who feel embarrassed, Maximin has recommended (and seen success from) walking at night. Clients begin by pacing a driveway or parking lot and slowly add distance, until they're going around the block or hitting some other, longer benchmark.

In general, persistence is paramount. Given the choice between shorter but more frequent workouts or longer sessions with more breaks, Maximin said she prefers the latter. Personal trainers also can be helpful, she said, provided they're experienced, sensitive, and in agreement with a client's physicians and nutritionists.  

Those who find movement painful, meanwhile, Maximin urges to swim or walk in a pool. In fact, she said, for most people, "If you can get in the water, it's the single best thing you can do."

And don't worry about looking good in a bathing suit. As Maximin said, most people in fitness center or therapy pools won't even notice. They'll be too self-conscious or absorbed in their own workouts to care about someone else's appearance. Certain facilities even take pride in being "judgment free" zones.

Family and friends play a critical role, too. Even if you're not the one seeking or needing to lose weight, you're still vital to the process.

A supportive environment at home, work, or other common setting often makes all the difference between weight-loss success and failure. In some cases, Maximin said, those who would make a change don't, after meeting with resistance or apathy from others.

You may even be the person who starts the process and sees it through, the one who steps up and offers to accompany another on the journey. If so, you may be the most important figure of all.

"You're not telling anyone what to do," Maximin said. "You're saying, 'Let's make some healthy changes together.'"