07/27/2011 05:08 pm ET | Updated Sep 26, 2011

I Left My Diet in San Francisco!

San Francisco is rated third healthiest city in the United States by This distinction is based on health status, nutrition, exercise, mental health, and life balance.

Activity options abound both indoors and out -- from our many museums and shopping options to Golden Gate Park, Muir Woods and Mt. Tam just north of the Golden Gate Bridge. Let's face it, what's not to love about San Francisco? It's beautiful; we have an abundance of restaurants -- any ethnic choice you can imagine -- that accommodate every possible food preference or need. We're an open-minded, non judgmental and welcoming people. We have all different constellations of families.

Our many different neighborhoods offer different cultural experiences, from Chinatown to the Russian hub in the Inner Richmond. Tourists love the curves of Lombard Street, the chocolates at Ghirardelli, the Boudin sourdough bowls full of clam chowder at Fisherman's Wharf, and the aquatic acrobatics and distinctive grunts of the sea lions at pier 39. We even get full spectrum of weather options from the sun in Noe, Castro, and the Mission to the cool fog out in the avenues. Dog lovers get a great workout off-leash at Fort Funston where you get a two-fer of pleasure by watching the hang gliders.

We're known as a foodie city, everything from Michelin starred Boulevard restaurant to the wide variety of food trucks and carts on the streets of San Francisco.

The flip side of all the wonderful variety San Francisco offers is that it poses challenges for those of us who are working at maintaining a healthy lifestyle. We all have to make the choices every single day to be healthy.

Just look at the dilemma posed on Irving Street (down from my office at 919 Irving) between 7th and 8th Avenues. Should I go to Burn and do a combination of Pilates, weights and cardio, or relax and have a chocolate croissant and coffee with the locals at Tart to Tart? Although it seems like a no-brainer to choose exercise if your goal is permanent weight loss, it's also important not to deprive yourself of minor indulgences. All dieters know what happens with too much deprivation. That's right; minor become major indulgences.

Using the concepts of cognitive behavioral therapy, or CBT (how our thoughts influence our emotions and behaviors) and mindfulness (paying attention in the present moment, without judgment) you can develop a plan for permanent weight loss. You'll need to be able to tell the difference between a treat and a mistreat. Talking back to sabotaging thoughts is a necessary skill to develop. Thoughts such as, "I'm tired, I don't feel like going to the gym," need to be replaced with more helpful responses like, "I may not feel like it now, but once I get going, my mood is likely to improve (endorphins and serotonin kick in) and I'll burn 400 calories".

Yo-yo dieters often beat themselves up for failing at yet one more diet. CBT can help you discover why you end up putting the weight back on after weeks or months of healthy eating. Is it a lack of planning ahead or tracking, or perhaps subtle sabotage by a family member? Is it untreated anxiety or depression, or a relationship problem that you're attempting to soothe with food? Are you lonely or bored? Do you graze while preparing dinner and then eat a full meal when you finally sit down with your family? Does a work stressor have you hitting the vending machines in the afternoon? Maybe you catastrophize about being hungry when it's an emergency only for those with diabetes. Of course it's a good idea to eat small meals throughout the day so you're not ravenous. Using these ideas and tools, you can join the statistics of the healthy, fit San Franciscans.

So the next time you have the thought, "I had a bad day, I deserve a treat," pause for a moment and decide whether the hot fudge sundae is really the treat you need. It just might be a better choice to climb one of our lovely hills or paddle around Stow Lake. So if you're leaving your heart in San Francisco, learn the tools to keep it healthy.