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Eating seems to be the go –to activity that fills up our so-called recreational or relaxation time. It is such an essential part of our life style that it seems rude and inattentive to have friends or family over to our home and not feed them or to meet someone for conversation without including a meal, snack or at least coffee and a pastry. Recently I received a flyer announcing a lecture series given by a local academic and tucked into the corner of the paper was a notice that refreshments would be served immediately following the talk. It is hard to think of any activity devoid of the opportunity to eat, although I suppose bungee jumping and deep-sea diving would qualify.

Anyone attempting to maintain weight loss or prevent weight gain faces the problem of almost endless opportunities to eat at recreational events. It requires enormous will power stamina to crunch on ice cubes rather than Buffalo wings or potato chips and cheese dip or nurse a diet soft drink rather than a beer. And despite the many electronic devices willing to record the number of chips or wings consumed so you know at the end of a game how many calories you just consumed, it is unlikely that someone will punch in those numbers after each wing or chip is eaten.

However, a graver threat to weight maintenance is eating as recreation. Nothing to do on a cold dark Sunday afternoon? Go to the refrigerator or pantry and find something to munch. Bored with commercial breaks that are longer than the television program segments? Wander off to the kitchen to find something to eat. Dreading a three-day holiday weekend stuck in the house with young children while a spouse is off on a business trip? Go to the supermarket beforehand and stock up on cookies and ice cream as a reward and diversion from playing endless rounds of Candy Land. Working hours on a report, legal brief, research material, tax returns? Leave the computer or desk for a few minutes and relax with some nibbles.

The act of eating can be recreational; it allows us to stop whatever we are doing and relax our mind and even our emotions. Smoking does the same thing but unfortunately its side effects such as chronic sickness and/or death make it a much less desirable avenue of escape from work, boredom and loneliness.

Weight-loss programs recognize the danger of recreational eating and attempt to teach the dieter to choose non-caloric forms of entertainment and diversion: go for a walk, volunteer, learn to play an instrument that uses your fingers and your lips, get a pedicure. Given the high percent of people who regain weight after these programs, one might suspect that these suggestions, regardless of their worthiness, are not being followed. Moreover, eating, especially eating at home, trumps many other forms of recreation by being immediately accessible, cheap (the food is already paid for) and requiring little equipment other than a fork, possibly a microwave, and napkins.

Perhaps this is the time to consider a radical approach to this problem. To paraphrase the alleged words of Marie Antoinette, “let them (the dieters) eat cake.” Well, not cake exactly but a low-fat, portion-controlled carbohydrate. Rather than saying “no, you can’t eat when you are bored, or lonely or want to take a break” dieters should be informed about “take a break” foods that can be eaten without impairing their weight loss.
Popcorn, pretzels, breadsticks, low-fat ice cream, rice crackers and sweet breakfast cereal are inexpensive, ready-to-eat, good tasting, easy-to-store snacks that can fit into any diet or weight maintenance program. Their virtues extend far beyond their crunchiness and ability to produce a tasty diversion from work or tedium. These, and similar low or fat-free carbohydrate foods, will improve energy, good mood, and focus within 20 to 30 minutes after being consumed. And, unlike Buffalo wings or nuts or even fruit, they will shut off the need for further eating for at least a couple of hours. The reason is deceptively simple.

A brain chemical, serotonin, is made after an ounce of carbs like pretzels or rice crackers or Frosted Flakes are eaten. Serotonin liberates us from boredom, fatigue, irritability, restlessness and distractibility. Sweet and starchy carbohydrates are the only food to bring this about; fruits don’t and protein foods actually prevent serotonin from being made. Alcoholic beverages do not make serotonin and neither do nuts, as they contain equal amounts of carbs and protein.

Even better, recreational carbs need to be eaten in only small amounts to bring about this effect. About 120 to 130 calories containing 30 grams or so of carbohydrate is sufficient. Diets should be able to accommodate that number of calories, as we have shown in our book, The Serotonin Power Diet. But these recreational snacks do come with a warning. Overdosing; i.e. continuing to eat beyond the therapeutic portion, will add only calories, not good mood and diversion. Even serotonin won’t be able to speed up your report, make your kids stop whining, or get your team to win the game. Eating these foods will give you the relaxation you crave without the penalty of added pounds—and perhaps you still might consider learning to play the trumpet.
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What the article pointed out was how fast weight is regained after a diet. People with multiple sizes of clothes in their closets know the peril of thinking dieting will result in permanent weight loss. They know that every low weight will be followed by a return to a higher weight, if not immediately, then soon thereafter. Over a lifetime, their weight profile will resemble the stock market during one its more chaotic years. Apparently after substantial weight loss, the levels and activities of hormones and other substances that control hunger, fat stores and metabolic rate are impaired, thus causing the body to veer to its pre-dieting weight. Those people with a genetic profile associated with obesity might as well stock up on Rocky Road ice cream and potato chips because their fat trap is deep enough to prevent any rescue.

Does anyone succeed? Yes, but the number is far fewer than those who fail. But it is important to realize that an estimation of how many have succeeded is totally inaccurate because most former fatties do not announce their success to folk who know them only as thin people.

“Hi. My name is Judy and when I was in second grade, my classmates called me Fatso.” This is true—I was called that awful name—but I usually do not greet people with this self-revelation. I learned that my skinny primary care doctor was quite pudgy in high school when his wife told me. He never said a word. A close college friend tried every popular diet while we were in school without success. When she graduated, she lost 40 pounds in a year and has never gained an ounce back. Even her husband never knew her as fat. Our stories don’t make it into magazine articles or onto talk shows, and we rarely offer our bodies to researchers so that the reasons for our success can be discerned.

There are obvious reasons why weight is regained after diet:

1. Muscle is lost, calorie output is decreased, metabolism is slowed and a permanent decrease in calorie intake is necessary to maintain weight loss.

The solution: Quickly build muscle mass, increase physical activity and resign yourself to eating less.

2. Quick weight loss is pathological. The body is stressed just as if weight were lost because of a serious infection, surgery or inability to digest or absorb food. Forces in the body are mobilized to regain and restore body mass.

The solution: Avoid these kinds of diets.

3. Triggers that caused weight gain crawl out of wherever they were hiding while you were on a diet and cause you to start overeating again.

The solution: Identify these triggers before starting on a diet to remove or disarm them. Practice techniques to stop them from interfering with your eating while on the diet, and, like physical therapy after a bad back flare up, never stop protecting yourself against their reoccurrence.

4. The longing to return to a pre-dieting eating and drinking style pre-empts healthy, calorie-controlled food choices made on the diet.

The solution: Either drag out your larger size clothes or decide to give up the uncontrolled eating that caused weight gain. This may seem harsh but so is being condemned to a chronic medical problem caused by obesity.

5. Successful stretching of the stomach by gradually increasing portion size so eating large amounts of food becomes easy.

The solution: Make yourself feel full before starting a meal by increasing serotonin. Do this by eating about 130 calories of a fat-free or very low-fat carbohydrate food 30 minutes before a meal. Serotonin causes satiety so portion size can be easily controlled.

6. Food becomes the go-to recreation.

The solution: Try non-eating recreations while on a diet. By its conclusion, you will have an itinerary of non-caloric distractions. This could include activities that range from pole dancing to dating web sites to learning ancient Greek.

7. Emotions overwhelm willpower and eating to feel less stressed, less depressed, and more calm is more important than maintaining weight loss.

The solution: Eat about 30 grams of a low or fat-free carbohydrate snack twice daily on an empty stomach. This is best done as a late afternoon and mid-evening snack. Serotonin will be produced and your mood will shift from distressed to tranquil.

8. Inadequate sleep and persistent tiredness cause automatic, mindless eating in order to stay awake.

The solution: Do not go to the kitchen. Go to bed. Search out ways of getting enough sleep. Its lack not only causes weight gain; it even affects cognitive function.

9. Genetic predisposition to obesity seems a convenient rationalization for weight gain.

The solution: Regardless of genes, everyone loses weight in a famine. You don’t have to starve but watchful eating and consistent exercise trump an inherited tendency to gain weight.

10. Antidepressants and related medications cause substantial weight gain. A side effect of these medications is inhibition of satisfaction after eating.

The solution: Avoid food plans that avoid carbohydrates. Increase a sense of contentedness and satiety by increasing serotonin before a meal. A small fat-free or low-fat carbohydrate food (like a small roll) eaten 45 minutes before the meal counteracts the effect of the medication by making you feel full.

You don’t have to be stuck in the fat trap described by Ms. Parker-Pope. Follow these simple suggestions and you will be released to live a healthy, thin life.
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Magic diet pill!

Melt your fat away!

Diet and exercise not required!

Scientific breakthrough promises 10 pound weight-loss per week!

You may even be offered a free trial of 30 days or a money back guarantee. Even though this hype should be about as convincing as thinking that your Christmas gifts were delivered by a sleigh instead of UPS, we post-holiday individuals really want to believe that swallowing some “magic crystals” or pills, or drinking a unique tea, will turn our pudge into muscle and dissolve our fat. Of course this miraculous feat will be accomplished safely and without side effects.

"Not so", says Dr. Michael Levy, director of the Food and Drug Administration’s Division of New Drugs and Labeling Compliance. He is quoted on an FDA consumer web site warning dieters that weight-loss dietary supplements may contain, “…hidden prescription drugs or compounds that have not been adequately studied in humans.” Case in point: The prescription weight-loss drug Meridia (generic name sibutramine) was removed from the market in October 2010 because an increased prevalence of heart disease and stroke was associated with its use. Now the drug is being sold, on the Internet, as a hidden ingredient in “newly discovered” herbal supplements. This October, a year after sibutramine was removed from the prescription drug market, the FDA warned consumers not to buy Ja Dera 100% Natural Weight Loss Supplement. This exotically named, natural supplement contains sibutramine. But how would you know from the pretty leaves on the label that the main ingredient was manufactured in a pharmaceutical facility?

If you go to the FDA’ consumer web site http://www.fda.gov/ForConsumers/Consume ... 245742.htm, you will see lists of products containing what they term “tainted” ingredients. Tainted means that the products contain, according to the FDA, harmful ingredients not listed on the label including controlled; i.e. addictive drugs as well as those prescription drugs with known side effects including death. The list, just for December, was amazingly long with intriguing names such as Magic Slim Tea, PhentraBurn Slimming Capsules, Health Slimming Coffee, Que She Weight Loss Capsules, Fruta Planta weight loss products, Pai You Guo Slim Tea, Fruit Plant Losing Fat Capsule and Leisure 18 Slimming Coffee. Who thinks up these names? My favorite was Slender Slim. Is there any other kind of slim?
For years I would become apoplectic when looking at advertisements for serotonin-containing capsules, “...guaranteed to remove cravings and increase satiety.” My shouting at the computer and occasionally sending letters that probably disappeared into a virtual wastepaper basket did not get the manufacturers of these fraudulent pills to admit that serotonin cannot—and will never—get into the brain from the blood, so taking it by mouth is totally useless. Perhaps these products have found their way onto an FDA’s “Beware of This Product” list. Certainly it should be on the, “Don’t Waste Your Money on This” list.

Occasionally the courts have been used to bring attention to products whose hype is not supported by weight-loss results. A few years ago, a product called Sensa Weight-Loss Crystals was heavily promoted and advertised in women’s magazines. Product testimonials filled up computer screens. The idea was novel: Sprinkle Sensa crystals on your food and their odor, presumably of pleasurable foods, will supposedly stimulate a specific area in the brain that will turn off the appetite. The advertisement predictably promised 30+ pounds weight loss without dieting. Last spring, a federal class action suit was filed in the U.S. District Court in San Francisco and included an accusation by one disappointed dieter that she was tricked by Sensa’s advertising into believing there was a scientific foundation behind their claims. This woman’s frustration is easy to understand, but what is harder to understand is how anyone could believe in the sales pitch. If smells activates the satiety or appetite control center in the brain, then inhaling the smells of bread baking, or chicken frying, or chocolate cake cooling should take away our appetites. Speaking for myself, I find it just makes me hungry.

So another crop of weight-loss supplements will appear in 2012. Here are some I predict will be appearing:

1. Coconut water as the new miracle fat burner. Slimming teas and coffee will be so last year;

2. Thin gel strips that can be put on the tongue (they are used now to deliver caffeine as an energy boost) to deliver an appetite-destroying drug. Some preparations may try to sneak in ephedra, an amphetamine-like drug that has been banned by the FDA for years, as it is linked to many deaths;

3. Deep-fried protein bars for those who are following a high-fat, high-protein diet and don’t have time to cook. These will be consumed several times a day instead of meals; or

4. Specially formulated crystals to remove all flavor, color and odor from food. Because boring food offers no pleasure, this will work to decrease spontaneous food intake.

Before you start on any diet on January 1, consider this. A comfortable, slow, weight-loss diet, accompanied by exercise and increased muscle mass, always works. There are no side effects, no outrageous fees or shipping costs, and no need to drink or ingest a concoction, with an exotic name, that was probably made in Brooklyn.
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The next day, as I checked in at my gym, I saw a message written on a large board: "Are you going to gain five pounds this holiday season?"

Well, yes, I thought, if the gym members, like most everyone else, chew their way through the ubiquitous holiday snack offerings. Chocolates, nuts, candies, cheese, sour cream dips, cakes and cookies are but a few of the foods set out in bowls, on platters and trays everywhere you go.

Hannukah potato latkes (pancakes), dripping with oil, or jelly doughnuts fried in hot oil, followed by coin-shaped chocolate candy add another opportunity for holiday weight gain. Mercifully, people rarely eat the oil-laden delicacies all eight days of the holiday.

The holiday of Kwanzaa is another opportunity for overeating, although the foods typically included on the feast day, "Karamu," include healthy ingredients such as sweet potatoes, okra, rice and chicken. Sweet potato fritters and sesame seed biscuits may make an appearance, but these high-fat foods compete with collard greens and black-eyed peas.

Nevertheless, all three December holiday traditions are often successful in generating a five-pound weight gain (at least) and perhaps even more, especially when calories from alcohol are also increased. This is not cause for alarm if gaining five pounds puts the eater slightly over his or her perfect weight. But alas, for most of us gaining five pounds, like an unanticipated credit card charge, simply makes the problem even more difficult to solve.

"If I can't lose weight during the summer, I am in bad shape literally all fall and winter," a houseguest told me last August. "My weight starts to creep up by October, probably because I work, and too little light makes me too tired to exercise. So by December, I am already 15 pounds heavier than I should be. I dread the holidays because I always gain even more weight. As a result, my back and knees feel the effects all winter."

The solution to preventing or minimizing weight gain isn't all that difficult. It simply takes focus, i.e., focus on what you have just eaten, are chewing on now and planning to eat in the next few minutes. And the best way to do this is to talk to yourself (silently, of course...).

"Do I really need to eat this third handful of cashew nuts or a fourth gingerbread cookie? How many chocolate Santas did I just eat? The dip is good, but must I put so much on the potato chip that it starts to break? Yes, my first bite of that potato pancake was heavenly, but the third one tastes cold and greasy. Maybe I should stop eating it. Can I put anymore food from the buffet on my plate? It looks pretty loaded. I guess I don't have to eat it all. How many appetizers have I eaten so far? Was it three or four? More? Better make it no more. Is this my second drink? The eggnog looks good but all those calories! I should get diet soda instead. I really want Aunt Jessie's coconut cake but I feel stuffed. If she lets me take a piece home, I can save it for when I am really hungry."

Like putting charges on your credit card, you can decide that you are able to "afford" the calories at the party, feast or open house, or you can choose to stop eating because you have already consumed more than your caloric limit. But don't fool yourself that if you decide not to notice how much you are eating and drinking, your scale won't notice either.

Do you know those advertisements for furniture that promise "no interest or payment required for 18 months"? Eventually, of course, you have to pay, and if you can't you may lose your purchase. Well, eventually, you will have to "pay" for your overeating. Just as limiting your credit card charges during the holidays takes away much anxiety and worry over bill-paying in January, why not limit your unhealthy eating during the coming weeks? Those five pounds do not have to be inevitable, and what a wonderful gift you will be giving yourself to enter the New Year without the extra weight of the past.]]> http://www.serotoninpowerdiet.com//blog/index.php?entry=entry111213-092112
One of the basic recommendations for motivating people to exercise has been to tell them to get a dog and take the animal for long walks, and even runs. But now this advice seems to be subverted by not only the proliferation of dog parks but also the appearance of doggy gyms in shopping malls and, hard to believe but true, a kind of doggy treadmill that you can buy for home use. One remote but possible outcome of having the dog exercise while we stand or drive the dog to its gym is that the dog will be lean and fit while we will reap the unfortunate effects of gaining weight due to ever-decreasing physical activity.

Whether we walk our dogs or stand and let the dogs play in a dog park should not have any impact on our weight, should it? Of course not, if we follow a lifestyle that has many opportunities for physical activity besides going to the gym for a few hours each week. Alas, for many, long work hours, family and community commitments have eroded almost all opportunities to move.

A few days ago, I sat next to a woman at a dinner who complained that she had gained five pounds in one month because her new job compelled her to drive rather than walk to work. "I changed absolutely nothing else in my life. I ate the same way and kept the same workout schedule and errands on the weekends. But sitting in the car a couple of hours each day, rather than walking 45 minutes to work and then back home, decreased my energy use enough to cause this weight gain. It's dreadful. At this point I have no idea how I can squeeze some exercise time into my very limited hours at home."

When I asked why she couldn't exercise at lunch, she laughed. "Lunch? We eat at our desks or, if we are in a meeting, the food is brought in. The only way I could escape the office at lunch would be if there were a fire and we had to go outside. No one takes a lunch break. You would be regarded as lazy if you did."

National obesity experts have focused on the absence of gym time in many schools and play time when the kids come home as one cause of increased pediatric obesity. But very little attention is directed to the lack of exercise time for adults, even though we are becoming fat at an alarming rate. These same experts tell the country that physical activity is mandatory for our physical and mental health. What they don't tell us is how to fit exercise into our lives.

When can people with these schedules and obligations exercise? Consider the:

• Person working two jobs and looking for a third; or

• The college student with a long commute to school and both an afternoon and a weekend job; or

• The working parent taking children to daycare early in the morning, picking them up after work and going home and starting the second job as mom or dad; or

• The adult caring for a live-in parent who needs constant care; or

• A corporate worker whose day starts at 7 a.m., lasts until 10 p.m., and often includes weekends; or

• The regional manager who must travel constantly and spends "free time" at home catching up with work in the office, etc.

The list could go on and on, and indeed might be much longer than a list of people who do have the time to exercise regularly in addition to walking their dog. And it doesn't even include obstacles to exercise for those who do have the time, which include:

• No sidewalks or shoulders on the road on which to walk;

• Late sunrises and early sunsets;

• Snow, ice or excessive heat;

• Cost of health clubs or home exercise equipment;

• Danger (assaults on women has been a problem along a popular running path where I live and many areas may be unsafe for someone running or walking alone);

• Air pollution; and/or

• Medical problems that limit mobility.

If we are to achieve a fit country, we have to go beyond talk and public service announcements. Exercise has to be made as accessible as getting food when one is hungry. At present, having the time to exercise is a privilege granted to only a relative few in our society.

]]> http://www.serotoninpowerdiet.com//blog/index.php?entry=entry111203-141603 We tend to marginalize soup. It is usually offered as a first course and sometimes is regarded as a nuisance food, to be eaten quickly so that the main course can be consumed. In restaurants diners often reject soup in favor of another appetizer such as a salad. “I hate ordering soup when I go out to eat,” a friend told me. “I am always afraid I will slurp it noisily or it will dribble down my chin. And then it fills me up too quickly so I don’t enjoy the rest of my meal.”
But soup takes on another role when it becomes half of a lunch, paired with half a sandwich. The combination of hot soup and sandwich is somehow more satisfying than a sandwich alone, perhaps it is because it is something our mothers would give us for lunch on a cold rainy day (tomato soup and a grilled cheese sandwich was traditional in my neighborhood). When served as the main course for dinner, soup is eaten slowly, with time for conversation, or can be taken into another room to be eaten while checking check e-mail or starting on homework. Sometimes soups provoke interest into the source of the ingredients, as the spoon detects something that may have come from a previous meal. When I was in college, we were served something we called “garbage soup” toward the end of the week. There was no evidence to support the notion that the kitchen staff recycled its leftovers in this dish. Nonetheless, we used to fish around to see if we could identify the leavings of a previous meal in the mix.
Soup does not have to be the repository of whatever seems to be languishing in the refrigerator, although most soup recipes will forgive you if you do want to throw in a soft tomato, noodles from yesterday’s supper and the celery stalks hidden at the bottom of your vegetable bin. The neat thing about soup is that it is easy to make, inexpensive and the variations are almost endless.
The best soups for this time of year are those which can function as a main course, eaten with fresh crusty bread and followed by a baked apple or pear. Soup works well when everyone in the family eats at a different time: The toddler who eats at five and the spouse who doesn’t get home from work until eight can enjoy the same meal. Most soups withstand constant reheating or simmering and work well in a “fix your own supper when you get home” type of kitchen.
Soups also do not require much preparation time, although admittedly some should cook for at least 30 minutes, if not longer, so that the flavors of all the ingredients become acquainted with each other. Although most soup recipes list their ingredients with precise measurements, in actuality the measurements are relative. It makes little difference if you add a half or three-quarters of an onion or one or two garlic cloves. If the soup is too thick because you added too many black beans or potatoes, then add water to thin it out. Soup too thin? Use a hand-held immersion blender or a food processor to purée some of the ingredients and add them back. The soup will be thickened instantly. The only measurements that should be followed are those for salt, pepper and the seasonings. However, do not add a lot of additional spices or herbs, like a quarter of a cup of cumin or red pepper flakes if the recipe calls for a quarter of a teaspoon. That type of mistake is hard to undo.
The proliferation of boxed broths and vegetable soups such as cream of tomato, cream of squash and black bean are useful as a base for whatever other ingredients you want to add. Of course you can heat and eat these soups from the box, but they tend to be somewhat uninteresting and not substantial enough for a main course. Heating up boxed cream (there is no cream) of squash soup? Add chopped apples and cranberries or even that dollop of cranberry sauce still in the refrigerator. Starting with a black bean soup? Add lentils or a can of black beans, red bell peppers, garlic, lime juice, cumin, cilantro and maybe even a splash of sherry and simmer. Chicken broth can embrace a diversity of ingredients from leftover chicken (or turkey), any vegetable in the refrigerator, leftover rice, pasta or potatoes and the juice from that half a lemon you forgot you have. Don’t save chicken soup with these add-ons for the flu. It is a welcome soup when you are healthy.
Chowders are a category of soup we tend to associate with summer eating, especially near the ocean as in clam or fish chowder, but they work well in a kitchen far away from seagulls and clam shacks. Clam or fish broth is also available in cans or boxes and can be transformed into something tasting like summer vacation by the addition of celery, onions, new potatoes (so you don’t have to peel them), fish chunks or minced clams and milk, Other than chopping the ingredients or using a food processor to do this task, and tasting the soup every so often to make sure it is seasoned, there is little to do before putting it on the table. If you can find large oyster crackers to crumble in the soup, the dish will be complete. Chowders are an easy way of getting enough calcium, and if lactose intolerance prevents you from drinking milk, use lactose–free milk when making the soup. Corn chowders are even easier to make, especially if you use frozen corn kernels and there are no food police to prevent you from making fish-corn chowder.
Finally, don’t look at a recipe for soup and despair because you have only half of the ingredients listed. Make substitutions from what you have in your own kitchen. It is very hard to fail unless you burn the soup—and that is really hard to do.


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My physical therapist's thoughts were echoed in a recent article in the June 15 edition of JAMA (Journal of the American Medical Association) on the prevalence of obesity among adults with arthritis. This article found an amazing and alarming incidence of obesity among adults with arthritis. The prevalence of obesity was 54 percent higher among individuals with arthritis compared to adults without arthritis. People with arthritis suffer from joint pain and limited mobility. Obesity, as this report points out, can increase the pain because extra weight places mechanical stress on the joints and may even indirectly increase the degeneration of cartilage.

When both obesity and the pain of arthritis limit physical activity, then weight loss becomes difficult. Many people with arthritis have difficulty walking, ascending or descending inclines, and climbing steps. Many arthritis sufferers are unable to utilize much of the equipment in a gym and even walking, recommended in all weight-loss programs, is not an option.

As the article mentions, too little has been done to help the obese arthritic patient lose weight. Even a small amount of weight loss will relieve stress on the joints and bones, but patients are not getting the personal and community-based weight loss help they need to accomplish this necessary goal.

The obese with arthritis, even more than the typical obese population, needs an enormous amount of nutritional, emotional and social support. There must be a weight-loss program tailored to fit their particular needs. Chronic pain, sleepless nights due to discomfort, lack of social interactions because mobility is so limited, the absence of much pleasure and distraction except eating, are all factors that must be considered. Just telling people to eat more vegetables and fewer cookies is not sufficient.



Are there hospital or community-based programs specifically for people with arthritis? According to the JAMA article, there are not enough, since the prevalence of obesity among people with arthritis is rising rapidly. And opportunities to exercise to strengthen muscles and burn off calories are probably even more limited. Exercising in water, according to my physical therapist, is effective for people with weight and physical limitations (she told me about a patient who needed a knee replacement who lost over 250 pounds walking in water). Still, as she acknowledged, very few of her patients had access to a pool and even if one were available, their handicaps made it almost impossible to enter and exit the water.

One of the problems with reading a report such as the one published in JAMA is that it is too easy to overlook the fact it addresses individuals and not statistics. The obese woman who had to be helped into a wheelchair because she could not walk to the physical therapy room, the very overweight man whose daughter had to support his weight so he could walk across the hall, the colleague who told me that she feels she has to starve herself to lose weight because she can't exercise off the calories: These individual -- and so many more -- deserve an effective way to lose excess weight, decrease their pain and improve the quality of their lives.

Year ago when it was discovered that exercise was important in maintaining cardiac health after bypass surgery, cardiac rehabilitation units developed specific exercise programs for the recovering patient. Now we take for granted the physical activity component of the post-operative regimen, but it had to be researched, tested and taught to health care providers who then monitored their patients.

Specific programs for the obese arthritic patient also need to be developed. Physical therapy is not sufficient since its intent is not to produce weight loss but rather to increase mobility and protection of orthopedically-stressed areas. Let us hope that articles such as the one in JAMA will be a catalyst to developing weight-loss and exercise programs for this underserved population.



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Perhaps television advertisements for antidepressants should use the same pictures except run them in the opposite direction. The first picture would have a skinny woman stepping on the scale, looking happy, and the last picture -- the same woman, now obese -- looking horrified at the numbers on the scale.

As with the weight loss shown in the advertisement, weight gain associated with the use of some antidepressants, mood stabilizers and other drugs prescribed for mood disorders does not occur overnight. The process may be gradual and perceived initially as an unwelcome change in appetite. Often people who do gain weight on these drugs never had a problem with overeating, food cravings, portion control and unhealthy food choices until they started on their medication. After several weeks, though, they notice they are no longer feeling satisfied after a meal that would have contented them pre-medication. Snack foods that had no appeal before treatment are now irresistible. Late nights become a battleground between willpower and cravings, and willpower usually loses.

Adding to this unhappy mix of factors causing an inevitable weight gain is the inability to exercise at pre-treatment levels. An email I received recently from someone who gained more than 60 pounds on his medication attributed some of the weight gain to his inability to exercise. "I stopped going to the gym," he said, "I just feel too lethargic and tired to exercise."

Weight gain as a side effect of some antidepressants has been known since the 1960s and, despite the proliferation of new drugs over the past 20 years, it has not gone away.1 Not everyone experiences it, but for those who do the weight gain can range from trivial to heartbreaking.

No one has yet identified how these medications change the appetite, and perhaps even levels of physical activity and metabolism, to cause weight gain. It has been suggested that some of the antidepressants may act on other chemicals in the brain, called neurotransmitters, known to increase hunger. Animal studies have also found that one drug, used for severe mood disorders, might possibly block the ability of serotonin to shut off eating. But of course, even if and when we understand how these drugs cause overeating, the problem of what to do about it still remains.

Fortunately, the type of overeating caused by the medications gives us a hint of what might be taking place in the brain. Most people complain of a need to eat more carbohydrates and of an inability to feel satiated or satisfied after eating a meal. This combination of symptoms, such as carbohydrate craving and absence of satiety, point to a problem with serotonin. In addition to regulating mood, serotonin, acting on other cells in the brain, monitors our eating. Serotonin does not make us start to eat but rather turns off our eating by making us feel that we have eaten enough. The feeling of satiety or satisfaction is similar to what we feel when we have had enough liquid to drink. No matter how thirsty we may have been when we started to drink, once the body receives enough water, it is very hard to continue drinking. Serotonin makes us disinterested in eating even if the food is tempting.

Antidepressants, mood stabilizers and related medications sometimes seem to interfere with this effect. Instead of feeling content and disinterested in further eating, an individual thinks, "I feel full, but I still want to eat something," or, "Those leftovers aren't going to be left over very long because I have an urge to snack." In worst case situations, some medications leave an individual so unsatisfied another dinner may be eaten an hour or so after the first, or the person will wake up in the middle of the night feeling ravenous.

It is easy to see how adding on calories from larger portions, frequent snacks or two rather than one supper each night causes weight gain. It won't happen overnight, but like the advertisement for weight loss run backward, over weeks or a few months the body can be transformed into an unrecognizable, overweight shape.

Typical weight loss methods are irrelevant for this type of weight gain. Obesity experts promote nutritional education, calorie labeling for fast foods, increasing consumption of fruits and vegetables and strategies to prevent stress-related overeating. These wise and workable methods are fine for someone who gains weight the traditional way. But some people gaining weight because they are on Zoloft, Depakote or any other medication for mood disorder know how to eat healthily and would be doing so if they were not on their meds. 2 Their brains' control over eating has been damaged, and an admonition to eat more greens is not going to change that.

Restoring the ability of the brain to control appetite is the only strategy that will work, and this means restoring serotonin's appetite-controlling function.

We discovered somewhat by accident that increasing serotonin in the brain brought about this effect. The pesky, and sometimes almost frightening, need to eat brought about by antidepressant use goes away when serotonin is made. Dieters whose weight gain was caused by a mixture of medications (antidepressants, mood stabilizers and anti-anxiety drugs) were able to stop gaining and start losing weight when they increased serotonin levels prior to meals. Patients who came to TRIAD, the weight management center I ran at Harvard University, were told to eat a specific amount of carbohydrate an hour or so prior to meals, and also as a snack. The carbohydrate, eaten on an empty stomach and with little or no protein or fat, stimulated the production of serotonin. Less than one hour after eating the carbohydrate, new serotonin was made and it decreased the nagging need to eat. Our patients reported feeling content, and often for the first time in weeks the constant need to put food in their mouths was gone. They lost weight because they gained control over their eating.

Eating carbohydrates to make serotonin may seem like too simple a solution to antidepressant weight gain. Moreover, given the belief that carbohydrates are a "fattening" food, perhaps a hard solution to accept. But healthy, fat-free or very low-fat carbohydrates (e.g., pretzels, rice cakes, or even marshmallows) are a potent tool to fight the weight-gaining potential of antidepressants, and you and your scale will benefit.

Hardman JG, Limbird LE, Gilman AG. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill, 2001. ISBN 0-07-135469-7.

Hardman JG, Limbird LE, Gilman AG. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill, 2001. ISBN 0-07-135469-7.

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Among the more trivial but still agonizing stresses these days is going into a dressing room with three-way mirrors and a handful of bathing suits. Moans, gasps and little wails reverberate off the walls as customers take the first real look at their bodies since the first snowstorm. I’ve heard all the following comments:
“What happened to my waist?” “Were my hips that big last year?” “Maybe I should just buy a non- see through cover-up and stay under a big umbrella.”

Although it is tempting to vacation in the southern hemisphere where it will be winter in August, given the cost of everything these days, most of us will spend our holidays on the shores of a nearby lake or beach. And unless the weather proves as disastrous as it was this past winter, there should be a few days when putting on a bathing suit and lying on a blanket or beach chair is irresistible.

Do not despair. Beaches do not require model-perfect bodies unless there is a photo shoot going on of model-perfect bodies. But if you have been thinking of losing weight since you threw away your Christmas tree, the bathing suit might be the catalyst that gets you to do it, now.

If you do decide to make the commitment to lose weight, why not use your brain to help you?

Weight is lost when less food is eaten than needed by the body. The problem is how to we get ourselves to stop putting food in our mouths even if we know we are eating too many calories to lose weight?

The answer is carbohydrates. Potatoes, pasta, rice, wheat, corn, barley, beans, quinoa, oats and lentils are part of the answer. These are healthy carbohydrates, fat-free in their natural state. Eating them by themselves with very little protein allows the brain to make a very important brain chemical, serotonin. Most of us associate serotonin with keeping our mood stable. But serotonin also functions as nature’s own appetite suppressant. Making serotonin makes our appetite go away. And it is our appetite, not just hunger, that causes us to eat more than we need.

Alas, all those medications used to make serotonin more active, those antidepressants that prolong the mood-regulating function of serotonin, will not take away your appetite. In fact some of you may be gnashing your teeth over weight that you gained from taking these meds. It is not known why those drugs make many people eat more. But they do.

Not surprisingly, drug companies have been trying to find an appetite suppressant that will activate the satiety or appetite termination function of serotonin but so far have not done so. Why wait for the drug companies? You’ll want to get into that bathing suit in a couple of months.

An English muffin, ¾ of a cup of Cheerios, a handful of new potatoes steamed with some fresh dill, or cup of oatmeal will give you enough carbohydrate to start the process of making new serotonin. Adding butter, sour cream, bacon, or any other high- fat ingredient may make the carbohydrate taste better but remember that the brain has no taste buds. Think of the carb as a diet pill. Diet pills don’t come coated with butter or wrapped in bacon. Neither should the carb you are eating to stop you from eating too much.

As we recommend in The Serotonin Power Diet, a small fat -free carbohydrate snack an hour or so before a meal increases serotonin and takes the edge off of the appetite. This is why eating a roll or several breadsticks before your main course is served in a restaurant leaves you feeling less hungry than you were when you gave your order to the server.

But carbohydrates come with a warning. If they are processed into ice cream, chocolate, cookies, pizza, piecrust, fried batter, or coated, covered and drenched with fat, they will not make you thin.

Still, there is more good news. Carbohydrates will not deceive you into thinking you have lost weight. One of the gratifying features of a low or zero-carbohydrate diet is that as the stored carbohydrates in the body are used up, water is eliminated. The loss of 5 or 6 pounds of water makes the needle of the scale drop by 5 or 6 pounds. It is great feeling to see that weight loss but it will not be translated into a smaller size bathing suit—or smaller hips for that matter.

Carbohydrates will do one more positive thing for you. They will keep you in a good humor. It is sort of a value-added feature of this class of food. By making new serotonin, you won’t fee grumpy and irritable. Your default mood will be feeling benign and calm. So when you see that the bathing suits seems to be priced per inch, you will be more inclined to giggle rather than growl.





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There are many reasons we don’t get enough sleep or enough good sleep. Jet lag, long work commutes, infants, gastric reflux, barking dogs, snoring spouses, hot flushes, alcohol consumption and stress are just some of the reasons we wake up so frequently. When any of these things happen, we don’t go through all the critical stages of sleep or get out of bed before we have slept long enough.
According to the experts, the average person should sleep about seven to eight hours a night and during this time, go through the four stages of sleep. Stage one lasts about brief 10 minutes (it is said that if you awaken during this period you might deny you were asleep at all). Stage two is relatively long and accounts for about 50% of sleep time. Stage three is the phase when the body repairs and restores itself. Stage four is marked by REM (rapid eye movement) sleep that comes at the end of the sleep cycle. This is the stage when we tend to dream.
Spending the correct amount of time in these various sleep stages is a goal many of us rarely attain. Awakening several times during the night for whatever reasons changes the length of time spent in some of these sleep stages or may eliminate them altogether. Often we have to awaken before going through the last stage of sleep because work, family or being in another time zone necessitate getting up before the last cycle ends. Most of us are familiar with the mental and physical discomfort that comes from inadequate sleep, and we don’t have to be told about the muddle headedness, digestive problems, headaches, and exhaustion that pursue us until we can crawl back into bed again.

For more than 15 million Americans disrupted or shortened sleep is a permanent way of life. These are individuals who work a non-traditional schedule. Either their work begins mid-afternoon and lasts until late evening or it begins around midnight and lasts until 6 or 7AM.

These workers may be invisible to us but the health consequences of working evening and nighttime shifts are all too visible to them. Studies on the health of people who work non-traditional hours show a high incidence of obesity, diabetes and the risk factors associated with cardiovascular disease such as elevated cholesterol levels and high blood pressure. Inadequate and disrupted sleep is a common complaint; they are often excessively sleepy but may have trouble falling and staying asleep during daylight hours.

Why should it be so hard to adjust to a new work schedule that requires being awake when one is normally asleep and asleep when one is usually getting up? The reason involves a clock like mechanism in our brain which keeps the cells of our body in rhythm with the light and darkness of the outside world. There is a daily or circadian rhythms to all our functions . For example our bodily temperature dips and peaks at specific times during the day and night, certain hormones also rise and fall with time of day and sleep is naturally initiated at night rather than in the morning. So when we force our bodies to sleep or be awake when the brain clock wants the opposite , the rhythm of our bodies is in conflict with the outside world. Eventually the brain clock adjusts to the new schedule or time zone which is why jet lag goes away.But when a shift worker has some days off or daytime commitments that cut into sleep time, this adjustment can be slowed down.

After sleepiness, weight gain is probably the most common side effect of shift work. As several of my weight-loss clients who worked afternoon or evening shifts told me: “You eat to wake up, you eat to stay awake, and you eat to sleep.” And a transit policewoman added, “There is nothing to eat at 3 AM except doughnuts, pizza and Chinese food.”
Weight gain doesn’t have to be inevitable. After all we travel to new time zones for brief periods and even though we eat and sleep at new and uncomfortable hours, we can monitor our food choices and portion sizes so we don’t come back 5 or more pounds heavier.
If food is brought from home, then the whole problem of what to eat and where to find it is avoided. The only adjustment is when to eat those meals and snacks. It is easiest to eat one meal before leaving for work and then have the main meal during the shift , perhaps 3-4 hours after it starts. High-fat foods tend to make people feel tired regardless of when they are eaten so they should be avoided. Eating a snack around two hours before the end of the shift such as breakfast cereal, pretzels, popcorn, and some raisins or dried cranberries takes the edge off of hunger and makes it easier to eat a light meal after the shift is over. The final meal should be mainly carbohydrate, like oatmeal or a baked potato plus fruit. It is often easier to eat this at home , almost like a bed time snack .The carbohydrate in the potato or oatmeal increases serotonin so it is easy to wind down before going to sleep.

The most important thing the shift worker can do to prevent weight gain is to get enough sleep. It is very hard to control eating because sleepinesss seems to obliterate will power. And yet today, many shift workers are still unable to obtain enough sleep or sleep that goes through all the necessary stages. It is to be hoped that those people responsible for developing health initiatives to decrease obesity recognize this problem and are developing strategies to resolve it.
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