Category Archives: Advice on how to Lose Weight

Working Toward Weight Gain

A few days ago, I was in the office of my ophthalmologist for my annual eye exam. The practice is huge, and the volume of patients is processed–so to speak–by a row of administrative personnel, each sitting in a cubicle. I checked in at one such space and later checked out with the same clerk. As I watched her scan the computer to then print out the appropriate paperwork, it occurred to me that her job was almost totally sedentary. She did not have to move more than a few inches to access her computer, and the printer was under her desk so she did not have to walk over to another area to retrieve a printout. She was not chained to her chair, yet I doubt she was able to leave it until lunch and then again when the office closed. Unless she had far to go for lunch, or exercised during that noon break, she was completely sedentary for hours.

Until robots take over many of the routine jobs now performed by humans, more and more employees will be working in occupations characterized by an absence of physical activity. About seven years ago, a report was published on changes in physical activity related to occupation over the past fifty years in the United States. The authors used data from the United States Bureau of Labor Statistics that analyzed the amount of energy expended for jobs in private industry from l960 on. When the data were first collected in the early l960s, almost half of non-government jobs required moderate to strenuous physical activity. 50 years later, this number dropped to 20 percent. The authors translated these figures into changes in the number of calories that are expended in work and stated, “We estimated a reduction of more than 100 calories per day in occupation-related energy expenditure over the last 50 years.”

50 years ago, the woman processing my eye doctor’s records would have been using a typewriter and thus expending more energy than tapping on a computer keyboard. She probably would have to get up from her chair and walk to the office copy machine to make a copy of my record rather than pushing a button on her computer and reaching under her desk to retrieve the paper from the printer. Multiply this by every patient, every five minutes or so, and her calorie output would have been considerably more than it is today.

The authors of this report discussed the implications of the decrease in work-related physical activity as a risk factor for obesity. They suggested that as we increase the use of labor-saving, we are promoting the increase in weight of the population in general.

They recommend physical activity to compensate for the sedentary nature of many occupations. According to them, if the woman processing my paperwork engages in 150 minutes of moderate activity a week, she will compensate for her lack of activity during her work hours. But, as they point out, only one in four Americans meets this goal. Given the long commuting time many workers face, as well as the unending tasks to be done at home, it is unlikely that the three out of four Americans who are not exercising will suddenly find the time to do so during their limited after work hours. And even if some physical activity occurs on weekends, unless it is prolonged it probably will not compensate for the inert workweek.

Chairs perched on bicycle pedals and mini treadmills, are now being used by many who otherwise might be stuck unmoving an office chair. Those who fear the consequences of prolonged inactivity welcome the opportunity to move the bottom half of the body while the head and hands are occupied in writing reports or code. The use of these devices could be expanded to a much larger population such as medical office workers or anyone else forced to spend most of the workday seated. However, this is unlikely to occur; in addition to the obvious cost of such devices, it might seem strange to check into a medical office for an appointment and find the medical secretary bouncing up and down on her under-desk pedals.

Another option is to schedule walking breaks for workers who otherwise have little opportunity to stand up, let alone walk. This requires time and attention to the employee’s schedule; five-minute walking breaks when patients are waiting in line to be checked in or out means having someone available to cover while the break occurs. This may be too much trouble logistically and too costly financially. Ironically, employees who still smoke and must leave the workplace to do so have a built-in opportunity to move. If they can take a break to smoke, why shouldn’t others be allowed to take a break to move?

Another solution is to rotate the sitting employee into positions that require walking so that for some of the work day he or she is released from the chair. In the office I have referenced, another employee takes the patient to the area where the doctor’s office is located. (The practice is so large one almost needs a GPS system to find the appropriate office by oneself.) If the person checking people in and out were to be a patient escort for part of the day, or some other job that required walking, then the sedentary routine would be broken.

But these are rather weak solutions to a major problem confronting most occupations: How do all of us whose work is associated with being relatively inert get enough physical activity without sacrificing sleep, family, social obligations, and financial goals? Perhaps the answer is for workplaces to offer brief opportunities to stretch and to move, even if it is only for 15 to 20 minutes a day.

It may not be enough to compensate for all those hours of sitting, but it is a start.

The Unfortunate Association Between Pain and Obesity

Anyone who suffers from chronic joint and/or muscular pain and is also struggling with obesity realizes how much each impacts the other.  The pain makes it hard to move to exercise without discomfort. The pain of fibromyalgia also makes it hard to deny oneself food that is pleasurable (and possibly fattening) because such eating is a source of pleasure. Pain makes it hard to be in a good mood, and not surprisingly, may potentiate depression. That, in turn, affects eating, sometimes causing weight gain, as do most antidepressants.

Thus more pain is experienced.

Another concern is that insomnia can result from pain; few people can sleep through the night because of the unrelenting disturbance. The fatigue from lack of sleep often leads to overeating, weight gain, and more pain.  And, just to make things worse, two of the drugs prescribed to help pain, especially that of fibromyalgia, can cause weight gain (Neurontin and Lyrica). And so more pain occurs.

Pain comes in many varieties: headaches, abdominal pain, joint and muscle pain, and fibromyalgia.  A review by Okifuji and Hare in the Journal of Pain Research details the ways pain and obesity interact; their review makes the reader feel grateful for every minute that is pain free. (“The association between chronic pain and obesity,” Okifuji, A., and Hare, B., J Pain Res. 2015; 8:399) When obese individuals claim that it “hurts to walk, to climb steps, to get up from a chair, to lift anything,” they are describing the way their weight affects their inability to move without pain.

According to Okifuji and Hare’s review, as BMI (a measurement of weight relative to height) increases, so too does chronic pain.  In one study, fewer than 3% of people with normal BMI reported low back pain, but almost 12% of morbidly obese individuals did so. Anyone who has watched the television series “My 600-lb Life” has seen the pain on the faces of these extremely obese people when they have had to stand or walk. It seems unbearable, yet even at a considerably lower weight, the body may respond to carrying around extra pounds with chronic pain.  The Arthritis Foundation has some compelling information about the relationship of excess weight and pressure on the knees: every extra pound carried puts 4 pounds of extra pressure on our knees. So if one is only ten pounds overweight, forty pounds of extra pressure is placed on those joints. This means that weight gain associated with a painful disease like fibromyalgia, typically more than twenty pounds, may put enough pressure on the knees to cause another source of pain.

If obesity is exacerbating chronic pain, such as that associated with arthritis or fibromyalagia, the solution is simple but not easy to achieve: lose weight.  Many studies that have shown relief of pain with weight loss.  In a typical study, when adults suffering from joint pain are put on a diet with or without the kind of exercise that their bodies can tolerate, they lose weight and their pain is diminished.  (“Diet and Exercise for Obese Adults with Knee Osteoarthritis,” Messier, S., Clin Geriatr Med, 2010;26:461; Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial,” Messier, S., Mihalko, S., Legault, C., Miller, G., JAMA, 2013 Sep 25; 310(12): 1263-73)

But anyone who has experienced even transient pain from, for example, an overly ambitious workout, the first long bike ride of the season, too much weeding and hauling a wheelbarrow, or some unexplained back pain that thankfully disappears a week or so after it mysteriously arrived… knows how hard it is to move without pain. Unfortunately, our appetite rarely disappears when the pain arrives.  A friend who is extremely active was transported through an airport in a wheelchair after a virus-like infection caused severe back pain. His agony prevented him from walking more than a few steps at a time. After he recovered, he told me how reluctant he was to move when he was in such pain.

“Unfortunately, I didn’t lose my appetite so I was eating as much as before,” he said.

Increasing mobility as a way of preventing weight gain and supporting weight loss is advised for almost all situations in which there is chronic pain, as long as there is no possibility of damage to joints or muscles. The best way to go about this is with guidance from a physical therapist who can advise on movements that either will not hurt, or cause too much discomfort. Swimming and/or aerobic exercises in warm water is less likely to cause pain than activities involving some impact on joints. Gentle yoga is also recommended with instructors who know how to protect the participants from movements that will hurt. Recumbent bikes tend to be more protective of joints and muscles than other pieces of equipment in a gym, but even this piece of equipment should only be used with the advice of a physical therapist. Walking, if not too painful, should be done where there are places to sit and rest, should the pain becomes too intense to continue.

Dieting is equally difficult. When pain restricts most physical activity, it is hard not to gain weight since the individual requires many fewer calories than when normal activity is taking place. Muscle weight may be lost due to the inactivity, but excess calories will continue to be turned into fat. A dietician can figure out how many calories should be consumed in relation to the degree of inactivity caused by the pain. And just as important, the dietician can develop a food plan to make sure that all essential nutrients are being consumed within the calorie limits. Pain and attempts to lose weight should not lead to a nutritionally inadequate diet.

Even small amounts of weight loss are beneficial. If every pound gained may make the pain worse, every pound lost should bring some relief.

Accidental Weight Loss: A Gift for the Dieter

Three of my friends are suddenly thinner, and they are delighted because none of them was dieting.  One lost weight because work required her to travel across several time zones, and she found that she was sleepy, but not hungry, at mealtimes in the new time zone. Another had unexplained abdominal pain, was put in the hospital for tests, and did not eat for several days because of the tests and the pain.  When she returned home, she found that she had lost several pounds. The pain went away unexplained, but the weight loss remained. A third moved and was so busy unpacking, she ate when she remembered to eat, and that consumed were protein bars unearthed in one of the boxes. Because she couldn’t remember where anything she had unpacked was, she walked miles in her home trying to locate the stuff she needed, such as her cell phone.

None of these women was obese, but each wanted to lose between 15 and twenty pounds, but had not gotten around to doing so (one for several years). However now, after noticing their unexpected weight loss, they put themselves on a diet because as one of them told me, “My weight loss was a gift and I didn’t want to throw it away.”

Who knows what motivates someone to go on a diet at a particular moment? Sometimes it is done during a traditional dieting time, such as the first week in January. Diets are started because a special occasion is occurring several weeks or months hence and right now the article of clothing to be worn is tight. Or the occasion itself calls for appearing slimmer; weddings and reunions are noteworthy for being diet motivators. Medical reasons are often motivators for weight loss, too, but sadly are usually accompanied by the development of a medical problem like diabetes or painful orthopedic issues. Occasionally a picture of oneself from an unflattering angle strips away the ability to deny the excess pounds, or the inability to fit into the new season’s clothes that fit a year ago demand that either weight be lost, or a new wardrobe be purchased. But these reasons for starting a diet involve a conscious ‘before’ when the individual was not on a diet, and a conscious ‘now’, when the diet has been started. Accidental weight loss is just that; no conscious decision is involved, it just happens.

Perhaps the most positive aspect of accidental weight loss (in addition to the lost weight itself) is realizing that it is possible to drop pounds without even trying. Many who struggle to lose weight believe that they won’t be able to. The pounds appear to be stuck with permanent glue to various parts of the body. Diets are started and weight may be lost, but to do so requires a great deal of effort: meal planning, and preparation, and time for exercise. Of course this healthy way of life should be followed regardless of weight change, but we are human and unless weight loss is substantial, we may feel that losing weight is not worth the effort we are putting into doing so.

Accidental weight loss seems to produce a looser skirt or pants, a zipper that goes up easily, a shirt whose buttons close without any obvious effort.  “My unplanned weight loss proved to me that when I eat less and move more, the pounds came off, “said my friend, “and I didn’t have to follow any peculiar diet, or any specific kind of exercise.“

Accidental weight loss challenges the claims that the dieter must eat, or avoid eating, foods from specific food groups, must overcook the food, or eat it raw, must allow it to ferment to produce specific bacteria, must subject the body to fasting, cleanses, supplements made from herbs and twigs, injections of fat burning hormones, hypnosis, packaged foods made in an industrial plant, or the latest tabloid ‘miracle’ diet, in order to lose weight. When weight is lost accidentally, it seems that the body wasn’t paying attention to all these diet remedies. It just responded to less food coming in, and in some cases more energy was being used up by your body, and that simply equates to that your physiology used up some of its fat stores, for energy.

The realization that the body is capable of losing weight without formal dieting should be transformed into a strategy for continuing to lose weight. The first step should be reviewing in a non-judgmental way, the eating and physical activity habits that caused the weight gain, and next figuring out what acceptable changes can be made to sustain the weight that has already been lost. With a suddenly slightly lighter body, eating smaller portions, or going for walk rather than sitting on the sofa, may become easier. Throwing away high fat, high sugar, and high sodium snacks that have been an obstacle to weight loss, might seem sensible rather than a culinary sacrifice and exploring alternate methods of decreasing stress other than eating.

After accidental weight loss, you are unlikely to continue to lose weight without consciously making an attempt to do so, but you will be able to. Your body has shown you that it is able to remove a few of those pounds you once felt would never be lost. Now your body is just waiting for you to continue to lose more.

Why Weight Loss Is Rarely Permanent

Many years ago at a meeting that addressed the usefulness of prescribing appetite suppressants for weight loss, one of the speakers (whose name will not be mentioned in case my memory is incorrect) said,

Obesity is a chronic disease.  Don’t think that allowing a patient to use weight-loss drugs will produce a permanent weight loss, or that other weight-loss intervention will also stop future weight gain. Obesity, like depression, alcoholism or autoimmune diseases, is chronic, and chronic diseases may go into remission because of medication and/or effective behavioral changes….So while sometimes one treatment is sufficient, the depression or skin rash never reappears after the initial intervention. The alcoholic stays abstinent.  Rarely is it that the diet plan or diet drug or surgery produces a permanent, positive change and weight stays normal. More commonly? The disorder reappears, more than once, and requires repeated behavioral, and/or medical interventions. Indeed, chronic treatment may be the only way to prevent flare-ups, a return of drinking, or depression.”

He went on to say that there is a bias toward people who gain weight again and again. We all know this…From the cruel remarks we make when someone is on a diet (Another one? Not again!) or gaining back the weight lost from the previous one (See, I knew she would never keep the weight off! ) to the hopeless attitude of physicians who give up helping a patient deal with constant diet failures (There’s no point wasting time talking about losing weight; he/she never listens.)

Weight-loss advice ranges from suggesting the most ridiculous or severe diets, to the simplistic mantra of portion control and exercise. Or else we keep quiet and shake our heads. “See,” we say to each other, “she has gained back all the weight she lost last year.“ And then we judge the currently popular diet with the comment, “Too bad this didn’t work, either.”

Yet so many of us have friends, colleagues, relatives, and acquaintances who have been abstinent and suddenly are found drinking again, perhaps after years of not doing so. When they are able to resume their AA meetings or come out of rehab, we don’t berate them with, “You failed. What is the point of helping when you will fail again? “ Rather, we support their effects to succeed.

If we treat obesity as a disease with a high probability of reoccurrence, as is the case with depression or alcoholism, then our entire approach to treatment can differ. All interventions will be presented honestly as a means of bringing the patient into remission, which may last weeks, months, or years. Still, the interventions will not be presented as a permanent cure. Taking out a diseased appendix is a permanent cure for a diseased appendix. Staying abstinent, if not a cure for alcoholism, is remission one day at a time.  Losing weight is not a permanent cure for obesity. Rather, it is remission from overeating and underexercising, one day at a time.

Treating obesity as a chronic disease allows a variety of interventions to be tried without blaming the patient if he or she fails to succeed at one or the other. Depressed patients are often switched from drug to drug, and the patient is not blamed when the depression doesn’t respond to a particular medication. Just as talk therapy is considered as important as drug treatment for depression and related mental illness, so too talk therapy should be part of the obesity treatment. Recognising what might erode control over eating is essential for success on a current diet, but also in delaying the onset of another weight gain flare-up. Semi-annual check-ups of weight status must be mandatory so the patient and care provider can identify emotional, situational, or even hormonal changes that might start the weight gain process. Such check-ups should remove the inevitability of weight gain in the minds of the patients.

For example, people who suffer from winter depression resign themselves to gaining weight over the dark months of late fall and winter, since weight gain is one of the symptoms of this particular type of depression. People also assume and anticipate gaining weight over the holidays. But why should this be? Would we assume that a friend, a recovering alcoholic, would start drinking over the winter, or that someone who is depressed every winter not be treated because the depression will come back the next year? If a patient had an intolerable flare-up of psoriasis, which can be maddeningly itchy, then every winter wouldn’t a dermatologist take steps to prevent it from occurring?

Because we don’t view obesity as a chronic disease, we simply do not treat it when we should. We don’t say to someone gaining weight, “You are experiencing a weight gain flare-up. It is important for you to be treated now before the situation becomes intolerable or hard to reverse.” A patient who has reoccurring depression should obviously be treated long before the symptoms become life-threatening. When the weight gain flare-ups occur, treatments also should be initiated. They include appetite suppressants, therapy, consultation with a physical therapist about exercise, use of calorie-controlled meals until control over eating is resumed, and participation in weight-loss support groups.

Of course, none of this will work if the weight-gaining patient refuses to acknowledge what is happening and/or resists treatment. Not all alcoholics who have failed to remain abstinent acknowledge what is happening or seek treatment; when they do, many are able to go back into remission. We must tell the obese individual to stop hoping for permanent weight loss. Keep the weight off today, and we will be there to help you if tomorrow is a problem.

If I Don’t Pay Attention to What I am Eating, Will the Food Contain Calories?

“What do you usually eat on a typical day when you are not dieting?”

I often ask this question when meeting a weight-loss client for the first time. Although I write down the information, I know that it is rarely complete. It is very hard for any of us to recall everything we have eaten yesterday or a few days ago, especially food that is not consumed as part of a meal. Did we munch on the potato chips that came with the lunchtime sandwich? Did we pop a few nuts in our mouths when we saw the bowl on the coffee table? Did we taste the food we are making for dinner and perhaps do more than just taste? Did we or didn’t we have a glass of wine with dinner, or was it two?

As hard as it is to remember what we ate it is even harder to remember how much. Few of us visually measure the size of the entrée put in front of us in a restaurant, or notice the quantity of food we eat at home. Was the chicken 4 ounces or 6? Was the rice a half a cup or two cups? How big was that piece of blueberry pie? And sometimes our best intentions to eat only a small part of what is put in front of us get lost when our attention is directed elsewhere while we are eating. I remember seeing a couple aghast at the size of their meals when it was put down in front of them in a restaurant known for their supersized portions. But they consumed everything on their plates because their attention was diverted to an intense discussion they began as they started to eat. The faster they talked, the faster they ate, and I suspect they never noticed how much they were eating until their plates were empty.

Reading emails on one’s smartphone, watching a video on a laptop device, or texting with the non-fork containing hand also interferes knowing how much is being eaten. When attention is elsewhere, the act of eating becomes automatic. The fork moves from plate to mouth to plate again, and the eater may not notice how much is being eaten until the plate is empty. If an hour later the eater was asked what and how much was eaten, he or she might be able to give only vague details. Indeed, sometimes the eater denies that much was eaten at all. “I just tasted the food and left most of it,” he will claim when the reality is that there was nothing left on the plate when he finished the meal.
Unless we must keep track of our food intake for health and weight-loss reasons (for example, a diabetic keeping track of grams of carbohydrate), we usually give only perfunctory attention to what we are eating. But even if we forgot what we put in our mouths, our metabolism does not. A calorie we do not notice eating still counts as a calorie we have eaten.

This absent-minded eating can make it very hard to lose weight. The heavily advertised weight-loss programs that restrict all food intakes to packaged drinks, snacks, and meals delivered to your door make paying attention unnecessary because the meal choices are programmed to enable weight loss. But if you are on a weight-loss program that gives you choice of what, and to some extent, how much you are eating, then often the only way to keep track of what you are eating is “to keep track.” There are apps for this, along with the traditional paper and pen food diary. Some people are able to keep track of everything they eat (they also balance their checkbooks), sometimes for months, and they are usually successful in losing weight and keeping it off. But for the rest of humanity for whom even keeping track of today’s date is difficult, recording everything that is eaten becomes very tedious very fast.

People who have maintained an appropriate weight for many years often follow an unchanging menu for breakfast and lunch. They don’t have to pay attention to what they are eating because their meal choices never vary. They often have rules about what they will eat for dinner as well: limited alcohol intake, salads with dressing on the side, eating only half the restaurant portion or sharing an entrée, avoiding fried foods and dishes with thick sauces or melted cheese, or avoiding all carbohydrates or all fats.

Weight-loss programs that do not make it necessary to pay attention to what and how much is eaten because all the foods are pre-measured rarely offer effective advice on how to pay attention to what is being eaten after the diet is over. The concept doesn’t sell very well in television advertisements for people who just want to lose the weight, but it is critically important to do so.

Making rules that limit food choices may be the most effective method, but may turn eating into more of a chore than delight. One thing that helps is spending 20 seconds to look at what is on the plate before eating. In those 20 seconds you can decide what you will eat in its entirety, what you will avoid and what you will eat sparingly. Taking a picture with a cell phone so the calories can be figured out later is also useful. It also may give you an idea of whether you have eaten anything healthy that day. Mindless snacking is a caloric hazard. Dipping one’s hand into a bowl or bag of snacks like nuts, cookies, or chocolate almost always causes excess calories to be eaten without any memory of doing so.

Not paying attention to what you are eating has a price: you may not know but, alas, your clothes and scale will eventually know only too well.

Will the Bacteria in Sauerkraut Make You Thin?

Most of us pay less attention to the many colonies of bacteria living in our intestinal tract than we do to the possibility that there may be colonies living on Mars. Recent research suggests it is time to do so. Our gut contains densely packed colonies of bacteria that affect not only digestion and diseases of the intestinal tract, but also our immune system and, according to some research, perhaps hunger, weight, mood, and athletic performance as well.

According to an article by Drs. Zhang and Yang, our intestinal tract contains more than 1000 or more bacterial species. These varieties of bacteria, of which we are usually unaware unless we have “tummy troubles,” function to assist in digestion,  particularly of high fiber fruits and vegetables. They break down the chemical composition of fiber, thus transforming the indigestible carbohydrate to substances, as well as short chain fatty acids, which are used for energy. Our bacteria are also gatekeepers, helping the intestinal immune system deal with foreign antigens or proteins when they enter our body. Intestinal bacteria contain enzymes that make vitamin K, a critical component in the formation of blood clots. Intestinal bacteria also synthesize other vitamins: biotin, vitamin B12, folic acid, and thiamine.

That the bacterial flora can change is well known to anyone who has taken antibiotics for several days, and then confronted with less than optimal intestinal functioning. The antibiotic wipes out so-called healthy bacteria, and sometimes it takes several days or longer to restore normal functioning.

Zhang and Yang’s report asserts that diet also causes significant changes in gut bacteria. Consumption of a high-fat, high-sugar diet causes unhealthy bacteria to flourish. Conversely, diets low in those nutrients, but high in fiber, bring back a better class of bacteria. For somewhat obvious reasons, most of these studies are done on laboratory animals, since they require samples of intestinal bacteria found in the feces, and it is hard to find human volunteers for these studies.

Is it possible that our bacteria can affect our mood? Some scientists suggest that we can reduce anxiety and depression if we have the good kind of bacteria. This is based on evidence that intestinal bacteria make neurotransmitters, the chemicals that transmit messages in the brain. But it seems unlikely that our gut will control our mood since neurotransmitters made in the gut never get into the brain. (But interestingly, we do talk about our gut having feelings, i.e., our language is full of expressions that suggest our gut has moods: a feeling in my gut, gut response, gut reaction, etc…)

Intestinal microbes may affect the amount of ghrelin, a hormone that tells the brain whether we are hungry. But if so, no one has figured out what species of intestinal bacteria may do this—or whether they will make us feel so full we will eat less. Now athletes are allowing their intestinal bacteria to be analyzed to see if they differ from those of sedentary folk. According to an article in a recent issue of Outside magazine, some super-fit athletes do have varieties of bacteria not found in non-athletes. However, since they tend to follow extremely healthy, low-fat diets, is it their diets or their incredible athletic feats that change the bacteria? (Or, do the bacteria contribute to their athletic success?)

Much more research has to be carried out to show that intestinal bacteria are having a direct effect on hunger, athletic performance, or obesity before we can start manipulating our bacterial colonies to bring about certain desirable health effects.  To be sure, there are some studies now gaining interest, that have tested the effects of fecal transplants in which bacteria from healthy volunteers may be transplanted to the intestines of those suffering from an intestinal disease like irritable bowel syndrome. These studies are showing promise in helping people whose intestinal disorders do not respond to conventional therapies.

In the meantime, while we are waiting for more science to support some of the claims that our gut bacteria can alter our heath for better or for worse, we are told to load our intestinal tract with good bacteria. Supposedly, these good bacteria can be eaten if we consume fermented foods such as sauerkraut (fermented cabbage), miso and tempeh (fermented soybeans), kimchi (a Korean dish of fermented cabbage with hot spices), kombucha tea (a fermented drink made with tea, sugar, bacteria, and yeast). and kefir (a fermented yogurt drink). These foods contain probioticsor living bacteria, that when ingested populate our intestinal tract with good microbes. Pasteurization will kill the microbes, both good and bad, which is why many yogurts and canned sauerkraut are not on the list.

But there is a problem. Although scientists can identify many of the species of good intestinal bacteria, they are not listed on a package of tempeh or a bottle of kombucha. Moreover, how many bacteria are we actually eating? Probiotics may differ in their content of something called CFUs, or colony-forming units. CFUs describe the density of viable bacteria in a product. According to Dr. Shekhar K. Challa, a gastroenterologist who wrote Probiotics For Dummies, quantitating the CFUs of probiotics in most food products is almost impossible. CFUs are not listed under calories or any other place on the food label.

So will eating unpasteurized sauerkraut make enough good bacteria to make you thin (that is, if good bacteria will make you thin)? Probably not. But sauerkraut contains almost no calories, and chopping a cabbage, mixing it with salt and watching it turn into sauerkraut is something to do on a snowy afternoon. And after you eat it, its bacteria will have a happy home in you.

References

(“Effects of a high fat diet on intestinal microbiota and gastrointestinal diseases,” World Journal of Gastroenterology 2016, Oct 28; 22(40): 8905–8909) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5083795/

Don’t Avoid Exercise Because It Makes You Hungry

Among the many kinds of advice given to those who are trying to lose weight, exercise usually ranks just below diet. But just as weight-loss advice can be contradictory and confusing, so too are the recommendations for exercise. No one disputes the benefits of physical activity on everything from improved digestion to better cognition. The adverse effects of ignoring the prescription to move ones body are just as compelling: no exercise equates to bad sleep, bad bones, and bad mood, among other unpleasant symptoms.

But many dieters and weight maintainers are reluctant to exercise because they fear the effect on their hunger. Exercise seems like an ineffective, and indeed unworkable, way of losing weight when post-exercise appetite may lead to eating many more calories than those worked off. Anecdotal reports by dieters of feeling ravenous after a stint on the treadmill or weekly Zumba class supports the erroneous belief that exercise while dieting should be avoided to prevent overeating.

Curiously, highly-trained athletes (who, of course, don’t have to worry about their weight) are the least likely to want to eat after their highly intense exercise routines are completed. In a study published a few years ago on appetite among female athletes, the scientists found that intense exercise actually decreased subjective hunger. Moreover, ghrelin, the hormone in the gut and blood that regulates hunger, was decreased and another hormone that shuts off appetite, increased. (“No Effect of Exercise Intensity on Appetite in Highly-Trained Endurance Women,” Howe, S., Hand, T., Larson-Meyer, D., Austin, K. et al Nutrients, 2016; 8 ) The same effect had been found earlier in studies carried out with male endurance athletes.

Since most of us are not likely to devote a good portion of our lives to training for competitive athletic events, we cannot rely on this for suppressing appetite after exercise. However, it seems that even unfit obese men may also experience a decrease in hunger after intense exercise, at least for 30 minutes after the exercise session completed. Whether they overate several hours later was not reported. (“The Effects of Concurrent Resistance and Endurance Exercise on Hunger Feelings and PYY in Obese Men,” Asrami, A., Faraji, H., Jalali, S., International Journal of Sport Studies, 2014 4; 729-)

But one may ask: what is wrong with being hungry after physical activity? Isn’t hunger a natural and inevitable response of the body after calories are used up? A Food Network show featuring life on a ranch in some unnamed cattle-raising part of the country often features recipes for the “hungry” family and ranch hands after a day of especially hard work. It would be absurd for the workers to avoid physical labor just because they are very hungry when they return home to eat a substantial meal.

But most of us have traveled far from the natural progression of physical activity to hunger to eating to a return of energy, and thus being able to work again. The “I am so hungry that I could eat a horse” (or whatever animal comes to mind) statement after hours of manual labor or recreational physical activity seems to many like a prescription for weight gain, rather than the way nature intended us to feel.

But it is not. Hunger is natural. The hormones causing us to want to eat are there to make sure we do so in order to live. If hunger disappears, as is the case for some with late stage Alzheimer’s disease, the individual will not survive unless others make sure to feed the patient.
In short, we should stop being afraid of being hungry. Hunger means our bodies need food the way being thirsty means our bodies need water. How we satisfy our hunger is what we have to improve if we want to stop gaining weight and begin to lose it. Just as we could, but should not, satisfy our thirst by drinking gallons of champagne or sugary sodas; we should satisfy our hunger not by consuming junk food, but by eating foods that not only supply calories (to replace those used up in exercise) but also needed nutrients into our bodies.

Dieters are told to try to eat fewer calories than needed so the calories in their stored fat will be mobilized to make up the difference. But unless the dieter goes on a drastically low-calorie diet, or a diet that eliminates certain categories of foods, it is possible to eat less, satisfy hunger, and still lose weight. We often eat beyond feeling full, that is, beyond the cessation of hunger; this is why we eat dessert. If eating stops when hunger disappears—even if all the food has not—weight can be lost.
Should you eat before or after exercise? It depends on your body. Some cannot exercise after eating and will eat breakfast after, rather than before, working out in the morning. Others find that they don’t have the energy to play tennis or go hiking unless they have eaten. Therefore, they will eat enough to give their muscles fuel for their workout, but not so much that they feel too stuffed to move.

Sometimes during long bouts of exercise, such as a long bike ride or hike, the first sign that the body needs food is not hunger but fatigue. I remember once when I was cross-country skiing all day, I become too exhausted to move my skis up a hill to get back to the lodge. As I stepped outside the track to let a woman behind me pass, she handed me an energy bar. “You need food,” she said. “Eat this.“ She was right. Within a few minutes I felt my fatigue lift, and I was able to continue moving.

We are told to be in touch with our bodies. Exercising, being hungry, and eating healthfully are excellent ways of communicating with ourselves.

 

 

 

Is the US Becoming More Obese Because of Medication?

Despite a blizzard of weight-loss programs, touting novel fat-reducing foods, and innovative exercise devices, the country is getting fatter and fatter. The Centers for Disease Control and Prevention reports that nearly 4 in 10 U.S adults, according to their body mass index, can be classified as obese. Obesity is not evenly distributed among the states. The losers; i.e. the thinnest states, are Colorado, Hawaii, Massachusetts, and D.C. The gainer is West Virginia where almost 40% of adults are obese.

We have been becoming heavier for so many decades that we forget how thin we were as a country 80 or more years ago. It is only when viewing newsreels of the first half of the 20th century in which most adults look extremely thin that you realize what we now consider thin was considered normal weight back then.

The same old reasons are brought out yearly to explain why we, and indeed the rest of the world, is getting fatter: junk food, sugary drinks, dependence on motorized transport rather than our two feet, humongous restaurant portions, intestinal flora that make our bodies store fat, too much time on electronic devices, and too little time in the gym.

Might our growing obesity be related to the weight gain after smoking withdrawal? Weight gain is common among ex-smokers, and studies as reported by the National Bureau of Economic Research (Sharon Begley, “Gut Check”) suggest that it may be 11-12 pounds on average. But a close examination of who gains the most weight indicates that smokers with the lowest BMI are most likely to gain the most, and 11 or 12 pounds is not enough weight gain to make them obese.

Could medications used to treat mental disorders be another, mostly overlooked cause of national weight gain? That psychotropic drugs—the medications used to treat depression, anxiety, bipolar disorderschizophrenia and other mental diseases—cause weight gain is established. Sometimes the weight gain is only a few pounds, stops after a month or two, and is lost as soon as the treatment ends. But many drugs cause substantial weight gain because the patient experiences a relentless urge to eat. Moreover, to the chagrin, indeed horror of some patients, stopping the medications does not always cause weight loss even with dieting and exercise.

Data on the use of psychotropic drugs comes from a 2013 Medical Expenditure Panel Survey discussed in a Scientific American article by Sara Miller.  One in six Americans is taking a psychotropic drug, although not all are being prescribed for mental illness. There have also been many studies showing that depression itself is linked to future obesity. A common depression, Seasonal Affective Disorder, is diagnosed in part by the overeating and weight gain of patients during the increased darkness of winter. Often the depression of PMS and pre-menopause is accompanied by overeating and weight gain as well.

Yet in the list of causes for our increasing girth, reasons such as genes, inflammation, bad gut bacteria and bread are more likely to be found than the weight-gaining potential of depression and the drugs that treat it.

Where are the weight-loss programs specifically designed to help those whose overeating is caused by lack of sunlight, or hormones affecting appetite control centers in the brain, or drugs that hijack control over satiety? Where are the support services for those who are embarrassed to go to the gym because their medications have turned their formerly fit and slim body into a much heavier one?  Recently someone who has been struggling to lose the weight gained on her medication for obsessive-compulsive disorder told me that her dietician put her on a low- carbohydrate diet. “I was craving carbohydrates all the time,” she told me, “so the dietician figured the easiest way to take care of that problem was to remove them from my diet. She did not realize that my medication had caused the cravings even though I told her. And since I couldn’t stop my drugs, I just craved bread and pasta so much on her diet that I began to binge.”

 

This story is typical in that this patient was not seen as needing specialized weight-loss help because her weight gain was the result of a drug, and not related to emotional issuesor an inability to make healthy food choices. Moreover, the dietician’s advice to remove carbohydrates showed lack of knowledge on the effect of eating carbohydrates on serotonin synthesis. Serotonin levels drop when carbohydrates are not consumed and often lead to a worsening of the obsessive-compulsive disorder, depression, or other mental disorders.

How long is it going to be before weight-loss professionals acknowledge that many of the obese in the United States are that way because of their medications? How long will it be before thought, labor, and money are put into programs to address their special needs?

Will 2018 bring about needed innovations in weight-loss therapy for these individuals, or will we just become fatter?

Losing Weight in a Weight-Loss Resort: Will It Stay Off?

The New York Times recently reported on the change of ownership of one of the better-known weight loss/fitness resorts, Canyon Ranch. The article described the resort’s comprehensive program for those who want to lose weight and improve their fitness. Like many other facilities frequented by those who can afford both the very high price and the time off from work, Canyon Ranch offers more than well-prepared low-calorie food and exercise opportunities that include hikes, exercise classes, a fitness center, and individual training. Massages, lectures on stress-reduction/mindfulness, consultations with nutritionists and physicians, and even wrinkle-reducing treatments prepare the guests for entry into the real world in a much-improved physical and mental state. Sometimes people will stay at facilities like Canyon Ranch or others such as Hilton Head for weeks if they have a considerable amount of weight to lose. Some places stress hours of strenuous exercise and all restrict portion size and variety of food. No alcohol, of course, is allowed.

It is hard to obtain information on whether, after returning home, participants are able to maintain their lower weight, increased fitness, and decreased stress. The article mentioned that at least half of the people who go to Canyon Ranch have gone there before; one woman had visited the facility more than 100 times. No information was provided as to whether she needed to return frequently to maintain her weight and fitness status, or because she simply loved the facility or both.

The transition from staying in a facility detached from the realities of daily life (some forbid the use of electronic devices, television, and newspapers) to the real world may jolt the individual out of his or her newly found healthy lifestyle and make the return to old eating and exercise habits unavoidable. The weight-loss resorts don’t have satellite ‘drop-in centers‘ to reinforce what was learned and practiced while participating in the residential program. Few can maintain the four or five hours of daily exercise in which they engaged while at the resort; at least, not without giving up their day job. Reproducing the low-calorie meals with their emphasis on vegetables, grains, and lentils takes more effort than ordering takeout. And eating away from home at work, meetings, social occasions, and while traveling limit further the ability to obtain the foods offered at the weight-loss facility.

In short, taking on and keeping new habits requires time and effort. Plunging immediately back into the life led before going to these weight-loss resorts may shatter the new lifestyle acquired there.

People whose weight-loss efforts begin at home with dieting, and perhaps some exercise, are familiar from the very beginning of their diet with the struggles they must overcome to lose weight. They are dealing with all the stress triggers- temptations to overeat, work, family matters, exhaustion and lack of time, that may have contributed to their gaining weight.

Those who opt for stomach reduction surgery face an additional struggle because they cannot overeat without making themselves sick, and yet may also face all the factors that caused their weight gain. In contrast, people whose path to better weight and fitness starts in the otherworldly atmosphere of a residential weight loss and fitness facility are helped enormously by the elimination of triggers to overeating.

That is, until they leave.

However, there could be an enduring positive effect to losing weight and becoming more fit as a result of participating in a residential weight-loss facility. Success at seeing oneself thinner, even if it is only by a couple of pounds, and gaining stamina and strength, could motivate and reinforce further weight loss and fitness efforts. Many people don’t start diets or refuse to do any physical activity because they assume they will fail, at one or the other, or both. Stories of people self-identified as unfit, who go to one of the more physically demanding weight-loss programs and find themselves able to hike four or five hours a day, and then participate in hours more of physical training, are often shocked at their ability to do so. People who at home have not been able to give up their high-calorie foods and instead resist eating “healthful” foods, learn to enjoy varieties of grains and vegetables at these facilities and may try to continue eating these foods when they return home.

Could they have initiated these activities and changes in food choices without going to a weight-loss resort? Of course. But at home, they have a choice not to. At the resort, they either do or do not eat what they are served and participate in often grueling physical activity programs, or drop out of the program.

Most adults will never have the opportunity to go to a resort where food, physical activity, stress, sleep, and pampering are designed to make them feel optimally healthy. But might it be possible to take some of the effective programs at these facilities, such as healthful menu selections, opportunities for recreational exercise, e.g., hiking, stress reduction techniques, and introduce them into the workplace for everyone?

These methods of weight loss and fitness seem to be reserved for the few who can afford them. But like many things in our society, from indoor plumbing to cell phones, eventually they become available for most. Perhaps someday, strategies to eat healthful foods, maintain a normal weight, and achieve fitness will be available without staying in a weight-loss resort.

Will Watering Your Stomach Increase or Decrease Food Intake?

His water glass at dinner needed constant refilling, and I was worried that he had some sort of metabolic condition. But that was not the case. My relative by marriage said he always gulped water with every bite because it decreased his need to chew his food. “I swallow faster so I can eat faster,” he told me. Growing up in a family where there was competition for seconds, he learned that if he was the first to clean his plate, he got the remainder of the food on the table. The habit never left him.

Using water to lubricate swallowing is also behind the success of competitive eaters. Such people’s ability to consume enormous amounts of food in short periods of time made overeating into a sport. They train their stomachs to accept 30 hot dogs or chicken wings in the amount of time it takes to unfold a napkin. An interview with Yasir Salem, a competitive overeater ranked #10 in world competition by Erin McCarthy on the Internet site, “Mental Floss,” revealed his use of water in his training. He stretches his stomach by drinking daily a gallon of water after eating several pounds of a bulky vegetable, e.g., broccoli. And during a competition, he dunks hot dog rolls into warm water to soften them, so they can be swallowed quickly and with little chewing.

Competitive overeaters, as well as members of a family competing for the last chicken leg, are not the only ones who use water to eat quickly. Binge eaters will also drink water or other liquids to make it easy to consume large amounts of food in a small period of time. Indeed, many of us probably drink water or soda with our food when we find ourselves needing to finish eating in a hurry.

Drinking water with food to increase the amount of food eaten contradicts general wisdom about the use of water during a meal to decrease food intake. The use of water to fill up the stomach before the meal begins has been recommended for decades. ”Drink one or two large glasses of water before you sit down to eat,” say most weight-loss advisers, “and you will find that you can’t put much food in your stomach.” This is contradicted by Mr. Salem, who told his interviewer that he drinks a gallon of water before starting the eating competition, to effectively flush out his digestive system and make it ready for large quantities of food.

Similarly, drinking water with every bite of food, or at least after two or three bites, is strongly recommended as a way of slowing food intake. If, as the theory goes, you have to put down your fork or spoon, pick up your water glass, take a sip or two, put down the water glass, pick up the eating utensil and start eating again, the rate of food intake will slow considerably. Unlike my relative or Mr. Salem, the food is presumably chewed and swallowed before the water is imbibed. The water is not a lubricant to make swallowing faster and easier, but instead as a “time-out” from putting more food in the mouth.

Drinking more water also completes the end of the meal. If the plate is cleaned, but the eater does not feel full, diet coaches recommend drinking one or two large glasses of water at the end of the meal to convey the sensation of fullness. Carbonated water may work even better because if enough bubbles are swallowed, the stomach feels bloated and incapable of receiving more food. Carbonated drinks such as beer or sugar-filled sodas are not recommended because they deliver excess calories.

Obviously water can increase or decrease food intake depending on how it is incorporated into the eating process. And since most people attempting to lose weight are not going to be competing for seconds or entering an eating competition, drinking water before, during, or after the meal will, hopefully, decrease food intake. The water intake between bites is supposed to slow eating sufficiently so the brain will signal to the eater to stop before the stomach is totally filled up with more food than necessary.

But curiously, this seemingly innocuous recommendation has met with some resistance by those who claim that drinking water with a meal decreases the ability of the stomach to digest food. Water will dilute the enzymes in the saliva that start the process of digestion, and then further dilute the stomach enzymes that work to break the food down more before sending it to the small intestine; so claim the anti-water folk. Although debunked thoroughly by scientists, the recommendation to avoid water during a meal continues to circulate.

One of the problems with relying on water to confer satisfaction and fullness after consuming less food than desired is that water doesn’t stay in the stomach very long. It passes through much more quickly than food and, once gone, may leave a sense that now there is room for more food. If the eater wants to eat less without using will power to do so, then the most natural, drug-free way is to increase the serotonin levels in the brain. This is accomplished by eating a pre-meal snack of about 20 grams of a starchy carbohydrate such as a small roll. Twenty minutes later, the brain will make new serotonin and this neurotransmitter will convey a sense of fullness or satiety to the roll eater.

Starting the meal with the feeling of not being very hungry is helpful to slow your eating. If you are feeling somewhat full, you are more likely to eat slowly and eat less—and leave the seconds to someone else