Can You Be Too Fat to Lose Weight?

Several years ago, Mary, a young professional woman, came to see me for help in losing weight. She was about 40 pounds overweight, gained in large part because of the sedentary nature of her job; she endured a long commute that gave her little time to go to a gym or even jogging before or after work. A decreased calorie intake more compatible with her decreased level of physical activity and a health club opening in the office complex where she worked made weight loss relatively effortless.

A few weeks ago, she came to see me. I did not recognize her; she now weighed considerably more than 300 pounds. A perfect storm of family tragedies, job loss because of her firm’s bankruptcy, and two years of treatment for anxiety and depression with a medication known to cause weight gain had left her morbidly obese. Each time she went on a program such as Weight Watchers or dieting with calorie-controlled shakes, she lost 50 or so pounds, but gained them back as soon as she stopped the diet. She told me, “I am heavier than I have ever been, and I am still gaining weight.”

Bariatric surgery had been recommended but the stumbling block was the requirement to lose 30 pounds before she would be considered eligible. This is pretty standard procedure: The group caring for her prior to and following the surgery wanted to make sure that she would be able to stick to the rigorous diet plan she would have to follow for months after the surgery. She wanted me to help her lose the weight as I had many years earlier.

But now it was going to be so much harder. Mary was no longer a healthy young woman. Her obesity had spawned a cluster of health problems: type 2 diabetes, high cholesterol, high blood pressure, sleep apnea, chronic back and knee pain, and difficulty walking. And, she told me, she was horrified at the way she looked. “The doctors said not to worry about my weight gain. It was more important to get rid of my depression. But how can anyone not be depressed if they look in the mirror and see a fat body staring back at them? And now I can’t get a job! Sometimes I find part-time employment, but my weight makes it too hard for me to take any job that requires standing. And when I apply for a job that I know I can do, I don’t get hired, probably because employers don’t want to hire someone who is so fat.”

Isolation from not working, along with an extremely limited social life, contributed to her difficulty in losing weight. “I am alone all the time. Since I rarely work, I stay at home during the day, and I never go out at night or on weekends. No guy is going to date someone looking like me, and most of my girlfriends are married. I don’t know what to do. There aren’t any support groups to help people like me, who become obese on antidepressants and, as a result, have our lives fall apart.”

She was right.

Helping her lose weight now was not merely a matter of having her eat more salads, fewer pizza slices, and getting to the gym more often. Now losing weight meant dislodging her from the lifestyle self-imposed by her morbid obesity.

She already had a diet given to her by a clinical dietician and if she followed it, she would lose weight and her diabetes would be in control. But as she told me, she cheated after less than a week on the diet, and did not think she was capable of staying on it long enough to be eligible for bariatric surgery.

We discussed ways to make small changes in her life that might positively affect her weight loss. Her physical inertness from chronic back pain and fatigue from her medication had to be overcome. I urged her to move, even if it meant going from one chair to another, at least once an hour and to walk for five or ten minutes, twice a day.  She knew from exercising years ago that physical activity would make her feel more, not less, energetic and perhaps even less depressed. And as she lost weight, walking, climbing stairs, and even getting up from a chair would become easier.

Volunteering seemed a good way of getting her out of the house and might generate a paid position, or at least recommendations that she could use in applying for a permanent job. Her acute loneliness on weekends might be diminished by volunteer activities that took place on Saturday and Sunday afternoons and early evenings.  Educational workshops scheduled for weekends could also decrease her isolation, and she lived close to an adult education center that offered such courses.

We both knew that her progress in losing weight would not be without setbacks. Unraveling the complicated reasons for her weight gain cannot be undone by a few workshops or 10-minute walks. Progress would depend on resolving them with a therapist whom she was already seeing, a post-bariatric surgery body that was no longer a visual and physical liability, a job and, hopefully, a better social situation.

Mary may not be too fat to lose weight, but her situation demonstrates how hard it is for the morbidly obese to become thinner. It is a heroic undertaking.

 

 

 

 

The Inedible Food Diet

Having recently returned from a weeklong conference, I noted, happily, that I had lost a couple of pounds. This was surprising, since so much of the day was spent sitting in seminar rooms or large lecture halls, with a large buffet lunch and dinner served each day. Moreover, the meeting took place in Jerusalem, where hotels traditionally served breakfasts whose variety and abundance of food rival that of any cruise ship.

But when I considered why I had lost weight, I realized that the cause was frustration with the foods served at lunch and dinner. At breakfast I ate the foods I usually eat at home, probably because in my jet-lagged state, making decisions about what to eat so early in the morning was beyond my cognitive ability. But by lunch, I was hungry and dinnertime corresponded to lunchtime back in my home time zone, so I was even more hungry. However, I found I could not eat the food served beyond what it took to minimally satisfy my hunger.

The food was abundant and looked attractive, but it was more or less inedible. The salads were limp and watery, the bread stale, the pasta overcooked and underseasoned, and the fish, chicken and beef tasted as if they had been cooked several days earlier and reheated. Fortunately, fresh fruit was always served for dessert, but the small cubes of cake served along with it tasted like leftovers from a long ago party. No one complained about the food; we were not at the conference to eat and conversation at meals offered enough “food for the mind” so that we didn’t pay much attention to the food for the body. But I did notice that no one went back to the buffet table for second helpings. The one meal we had away from the conference, in the home of a friend, made me anticipate eating a well-cooked meal. Alas, I had forgotten that she hates to cook and her food actually competed with that of the conference for its inedibility index. Thankfully, the company made up for the absence of culinary pleasure.

My unanticipated weight loss made me wonder if an inedible diet plan might work in a weight loss program. Some diet plans answer this question by eliminating the consumption of normal foods altogether, offering instead complete nutrition shakes or food bars. But many others advertise themselves as offering reduced-calorie foods that have been engineered to make them as tasty as foods with traditional ingredients. Other weight loss plans teach their clients how to substitute ingredients in baked foods to make them taste like food with more fat, sugar or salt so they won’t miss their favorite dishes while they are losing weight.

Could it be that this is the wrong approach? Could it be that manipulating ingredients so that a lasagna or sausage and egg patty with engineered ingredients to make it less caloric than its original version is the wrong way to get people to lose weight? Could it be that putting people into a residential facility like Canyon Ranch and presenting guests with flavorful and attractively prepared foods is sending the wrong message?

The diet industry is telling people that they can continue to enjoy eating and lose weight at the same time. Maybe this is one reason why diets are so unsuccessful. The dieter and indeed the non-dieter are rarely taught that the reason we eat is to provide nutrients and calories to keep us alive and healthy. We accept this premise when feeding our pets and quarrel with ourselves when we give in to the demands of our pets to feed them tasty but not particularly nutritious foods. “Don’t feed your dog table food!” we are admonished. The dog must eat only foods that are designed for its own nutritional and caloric needs. If you don’t give him cheese, chicken, hamburgers, etc., then he will learn to eat only dog food.

But we don’t apply this advice to ourselves. Like some pets, we want to eat only foods that taste good and when we get those foods, we often overeat them. Perhaps just as we try to get our pudgy Labrador or Dachshund to lose weight by restricting tasty foods, we can help ourselves lose weight by eating only foods with a low taste quotient.

It is well known that dieters and non-dieters use food as a substitute for whatever is missing in their lives. For many, eating is rarely done to nourish or take away hunger. Indeed, we eat when we are not hungry or continue to eat after hunger is satisfied for the pleasure of putting food in our mouths. Food is consumed as a source of gratification, a substitute for loneliness, a recreational and social activity, a stress reliever, as a symbol of celebration and ritual and because it tastes good. There is nothing wrong with using food for these objectives, unless and until, consuming them for these reasons causes weight gain or prevents weight loss.

It might be interesting to do a study in which dieters are given palatable but not particularly tasty foods and their meals are accompanied by pleasurable social interactions. Might they find it easier to eat less? If we can be weaned from thinking that life’s pleasures are found in an ice cream bar coated with chocolate, or a sandwich dripping with melted cheese and bacon, might we begin to look for non-edible pleasures and find them? This is not to say that eating delicious food is not one of life’s pleasures. But clearly it should not be the only one we seek.

Should You Be Eating High Fat Before a Endurance Events?

As with every aspect of the high/low carbohydrate diet argument, there is now some controversy about whether eating fat, as opposed to carbohydrate, is better for endurance sports.  Although lard has not become the preferred pre-Marathon Dinner menu item, there are some whom are promulgating for credit, even, that avoiding carbohydrates and eating fat will make you run or bike longer and faster. 1 Obviously if the only running you may do is after your spouse who is making off with the last pint of ice cream in the freezer, your response may be, “Who cares?” And if you are following a high protein, low carbohydrate diet, you may feel that exercising is irrelevant since you are losing weight without it. (The benefits of exercise on longevity, reduction of muscle loss, and delay in cognitive decline are something you will think about when you are much older).

But maybe you have a personal trainer who tells you to avoid carbohydrates; she read that you will lose more weight exercising if you eat only fat and protein.  Or you play golf with a friend who eats six strips of bacon before a game, convinced it improves his drive.  You begin to question something you learned decades ago: that muscles use carbohydrate for fuel. Do marathoners now chow down on lard rather than pasta before a race? You begin to wonder whether eating fat before exercising will allow you to losemore weight, because it will be burned for energy. Or maybe you can exercise even better if you just eat protein. After all aren’t muscle made of protein?

The answer is that despite what books and blogs are telling you, your body still depends on carbohydrates as its basic source of energy.

A tiny bit of biochemistry to show you why:

Adenosine triphosphate or ATP is the energy compound inside the cells.  It is metabolized to release the energy to allow you to pick up the remote if it fall off the sofa or to run a 100 mile ultra marathon. 2 Carbohydrates, fat and even protein can be converted to ATP with varying degrees of rapidity and efficiency. Protein is rarely used to fuel muscle movement because it has to be converted to glucose first; but it is needed to repair used muscle fibers after exercise and build new muscle. 3

What happens when we begin to exercise? Let’s say you are walking the dog, slowly until suddenly he  jerks the leash out of your hand and races off to catch a squirrel (a futile endeavor). For the first 2 or 3 seconds, your muscles move rapidly, using  tiny amounts of stored ATP. Then, at second 4 and beyond there is no more ATP. Your muscles begin to convert  stored glucose, called glycogen, to ATP and you and your dog can happily  run for several more minutes without the need for additional oxygen. At this point, unless you supply more oxygen to your muscles, you will hurt. Lactic acid builds up causing a burning sensation and your muscles  feel tired. You need to breathe.

In this scenario, if the squirrel runs to the next town, you have enough stored carbohydrate to run after the dog and the squirrel for about two more hours. But then you run out of stored carbohydrates and,  “hit the wall, “ or “bonk,” in athletic parlance, i.e. you run out of steam.

So now assuming you and your dog have several miles to run to get back home, your body must switch to fat as its backup energy source.  It might be a good idea to sit down on a park bench and talk to your dog about the futility of chasing squirrels, because it takes a little time for your body to mobilize fat from your fat stores.  Unlike carbohydrate, which is readily converted to ATP, fat has to be dragged out of your fat cells (the bacon you ate for breakfast is not going to be used up on the jog home) and broken down so that  one component, the  free fatty acids, are transported to muscle cells .There they are   converted to ATP with the help of lots of oxygen. You and your dog are going to be doing a lot of  panting on the way home. 4

Athletes who do endurance sports such as 100 mile ultra-marathons , day long mountain hikes, or long distance bike rides  can transition from carbs to fats as an energy source very quickly.  According to the sports nutritionist, Sunny Blende who writes for UltraRunning magazine, during a six hour or longer run, about 90% of energy will come from fat. 5 (My pudgy dachshund should read this Blende article).

So does this mean that if we plan on going on for a six hour run with our dog and squirrel, we should eat lots of melted butter the night before, or at least a pint of ice cream? Well according to Ms. Blende, and I quote, “…Even the leanest ultrarunner has about 800 miles worth of fat stored within their skinny-little self.”6  Presumably the rest of us have more than  enough fat for any energy requiring endeavor,  and do not have to eat more in order to move.

So if we can use fat for exercise, why do we need carbohydrates?  According to Matt Fitzgerald, author of Diet Cults, research done long before Dr Atkins promoted chicken fat for dieters, showed that carbohydrate is needed both for high intensity performance and endurance. He cites the diet of the Kenyan marathoners whose diet is about 78 percent carbohydrate. (They are clearly not obese). He says, “If you want to go fast, your body needs carbs for fuel.” This is true if you are running after your dog, or after a tennis ball.

Avoiding carbohydrates in the pursuit of leanness makes sense only if you want to avoid exercising. And if that is the case, you may need a dog that can pull you in a wagon.

 

 

Are Supermarkets the New Take Out Restaurants?

A new supermarket opened a month or so ago in a building that once housed the one and only original Filene’s Basement. In the place of racks of designer clothing reduced to the cost of a cup of Starbuck’s coffee, there were gleaming cases of prepared foods from spareribs to salads, freshly baked breads, rolls and muffins, assorted cookies and pastries, plus an enormous area devoted to cheese. Samples of freshly made mozzarella were being given out by a woman pounding the cheese into submission and having taken one, I wandered around to see if someone was also handing out samples of crackers.

There were, of course, long aisles of packaged goods from dry pasta to an exorbitant display of mustards. And like any conventional supermarket, the produce, dairy, meat and fish sections offered up food items that had to be processed, i.e. cooked, in order to be edible. But what was so entrancing about this supermarket, right in the center of a busy shopping area and near the Financial District, was the accessibility of foods ready to eat. The choices ranged from the banal (fried chicken and mashed potatoes) to the gourmet (freshly cooked seafood, salads with fashionable ingredients such as farro and arugula, and freshly squeezed juices and smoothies). It is hard to think of a restaurant that could offer such a wide variety of foods with prices that would match those in the supermarket.

Markets are already feeding zones for those who prefer getting their meals from a cardboard container rather than going to their refrigerator and preparing their meals themselves.  This one happens to be a newer generation of markets, located in an area where a food court and food pushcarts had been the most accessible options. Unlike older, more conventional supermarkets, the most prominent feature is the prepared food area. When the shopper walks in, he or she is assaulted and beguiled by counter after counter of ready-to-eat foods. It takes some walking and a bit of scouting around to find the produce section, way in the back of the store, the fresh fish case scrunched up against a back corner and dairy products somewhere behind a maze of aisles.  The message sent to the shopper is, “Don’t even think of buying something that needs preparation. We have already made it for you.”

Given that many Americans eat at least one or more meals away from home every day (this includes school children as well as adults), buying meals at a supermarket may be a more practical and less expensive option than going to a restaurant, fast-food chain or coffee shop. And the prepared foods at a supermarket may offer a healthier option than those at a chain hamburger or burrito shop. This is because supermarkets offer a variety of cooked vegetables, a variety rarely duplicated in upscale restaurants, and missing entirely in less expensive restaurants.  How many fast-food chains offer curried carrots, roasted Brussels sprouts or cherry tomato, red pepper and spinach salad? .

And consider this: The shopper who may be vegetable adverse can buy a tiny portion of a vegetable dish for a taste. Unfortunately, the supermarkets don’t allow the shopper to try a vegetable dish for free the way ice cream stores allow the shopper to taste an unknown flavor.  But spending 75 cents on two tablespoons of curried carrot salad or broiled cauliflower might convince the reluctant and vegetable phobic eater that vegetables can taste good. 

Supermarkets offering a large selection of take-out foods are next best thing to having your mother cook your dinner (if she is a good cook), but they could go a little further in helping shoppers put together their meals, for instance suggesting that they choose foods that are moderate in calories and high in nutrients. Suggestions for side dishes to go with a main course of grilled chicken or sliced brisket or salmon stuffed with crabmeat would be useful so the shopper would be eating a nutritionally balanced meal.  For example, a display could suggest adding a high-calcium dairy product to the meal by featuring a dessert of fresh raspberries topped with low-fat yogurt. The shopper would be encouraged to buy the yogurt and the berries and combine them at home.  Nutrient information near vegetables that may be unfamiliar, like beets or lentils, might induce the shopper to consider trying them.  

The down side of this is that the foods are much more expensive than if prepared at home. There is a substantial cost differential between buying roasted Brussels sprouts in the take-out section or buying them fresh, sprinkling them with a little olive oil and salt and roasting them at home. The same is true for throwing a potato in the microwave or buying it already cooked. And the shopper should be aware of the high oil content in many prepared foods; this ingredient keeps the foods moist and looking attractive.  However, lack of time, lack of even rudimentary knowledge of how to prepare foods, and lack of motivation to come home and prepare foods from scratch makes the enormous array of the supermarket prepared foods so enticing.

 This trend to using the supermarket as a restaurant is growing, and in the near future it is possible that the prepared food section will overtake most of the space formerly occupied by the traditional food displays. Should this begin to happen, let’s hope the decision of what prepared foods to sell is based on health considerations, as much as profits.

Being A Newbie Dieter Is Hard

Is there anyone out there over the age of 25 who has never been on a diet? In my weight-loss practice, I rarely see anyone who had not followed the “Every Diet of the Month” plan, and can probably recite calorie charts more easily than the alphabet.

But a few days ago a young woman came to see me for weight-loss advice whom had never been on a diet, and probably would never have needed to be on one if she had not gained weight from a medication she had been taking.   Following the diet was not difficult; she had always eaten healthily and, unlike a typical dieter, she loved exercising.  What puzzled her, however, was how to behave as a dieter when she had to eat in public, namely at family gatherings, social events, business meetings and while traveling.

“How do I tell my mother-in-law that I can’t eat pizza for lunch? What do I eat at my college reunion dinner next week?  I am flying to the west coast for a meeting. Should I take my own food to eat on the plane ride? What happens if I can’t get the foods I should eat? ” I was asked. She was concerned that if she substituted spinach for kale, or salmon for chicken, her weight loss would halt.
These and similar questions made me realize that dieting, like any other new endeavor, has its own learning curve. The experienced dieter can eye ball the difference between a 6 or 10 ounce piece of chicken, and is aware of how many calories are in a tablespoon of blue cheese salad dressing or glass of orange juice. She also knows what to eat on a plane, what to bring for lunch and how to “drink” at a party without really drinking. She may attend weight loss support groups and/or have friends also on diets so that problems such as: the intrusive or insensitive family members; nasty comments from co-workers about how much or little weight the dieter may have lost; and the insistence by others that the dieter eat fattening foods, can be discussed and solutions offered.

But this young woman did not attend organized weight-loss meetings, nor did she have any friends who were on diets. She joined Weight Watchers but said she felt people were not terribly sympathetic toward her need to lose weight. This was understandable since at her heaviest weight she was a size 4, and members thought she was a group leader. Moreover, everyone she spoke to had been going to WW meetings for years and/or was a veteran of many previous diets. Her concerns and questions as a newbie dieter were answered, but she felt like an amateur.

Learning a new skill, whether it is playing the violin, watercolor painting, hitting a golf ball or writing a memoir, requires instruction if the endeavor is to succeed. Obviously a Mozart or Rembrandt needed less instruction than the average mortal musician or painter, and so-called natural athletes probably can figure out how to swing a golf club or hit a ball without more than a few suggestions.  Dieting is also a new skill and, like other enterprises, if the instruction is misguided, inadequate or wrong, failure to lose weight and keep it off may result. A new dieter scammed into buying into some quick weight-loss program, or put on a weight-loss drug without any dietary or exercise advice, has little chance of keeping off the weight if (and this is dubious) the weight-loss goal is even reached.  A new dieter talked into losing weight by eliminating entire categories of food or semi-starvation, has no idea how to reintroduce food back into his or her life without losing control and bingeing. Exercise programs designed for the already fit participant may leave a novice in pain and injured.

If you buy a new computer, smart phone, watch or electronically-programmed car, experts are available by phone, email, texts, and in person to help you figure out how to work the device. And I know from my own experience that these experts are patient and gentle even when being asked really dumb questions. Many of us have received help from a co-worker or young child who takes over our computer or smart phone and, in two milliseconds, shows us some technique to make using the device easier. That kind of instant help is rarely available for the beginning dieter facing her first buffet or dinner at her new in-law’s home.

Where are the experts to help, graciously and patiently, the new dieter unfamiliar with reading labels, calorie-cutting food preparation, portion sizes at restaurants, dealing with stress-induced overeating and alcohol intake at parties? To be sure, some of these questions can be answered on the many Internet sites concerned with weight loss, and also in meetings of national weight-loss organizations. But the answers are, in general, impersonal rather than targeted toward the individual’s personal needs and lifestyle.

And yet when such advice is available, and when the dieter is successful in losing weight, the results can be life changing.  She is able not only to lose weight, but also to gain an understanding of how to maintain the weight loss permanently. Like the golfer who does not develop bad habits while learning the game, the informed and aided dieter will avoid making mistakes that may lead to a lifetime of losing and gaining weight.

Sometimes it is hard to know how and when to offer advice. Dieting for many is a private matter, and one can no more go up to a dieter and say, “You are doing it all wrong!” than a golfer can say to another, “What a dreadful swing!” But if we know someone starting on a diet for the first time, we can look for opportunities to offer our help and advice assuming we are experienced ourselves in the art of weight loss.  And whenever possible, we can help to create an eating environment and exercise opportunities to make weight loss for the newbie dieter less of a struggle. It is a favor worth giving.

Accelerating the Diet Without Dieting

A friend of mine is about to dump her diet. She promised herself a total makeover once she lost the 25 pounds keeping her from her desired weight. Eighteen of those despised pounds came off fairly steadily, and she assumed the rest would follow at the same rate. But it never happened.  Her diet stalled. Why? Maybe her portion sizes became a little more flexible, her snacking a bit mindless, and her alcohol intake a bit more forgiving.

“Just let me make it to a twenty-pound weight loss, “she wailed to me over the Internet. Well, not exactly wailed, but the unheard sounds of despair were there.

“Why don’t you try the walking cure?” I suggested. “It will accelerate your weight los, and you may lose one or two pounds in a day.”  Then I told her about my unexpected weight loss after a young relative, graduating college, walked her family not only around the university, but the immense park across the street, her favorite neighborhood restaurants, off-campus housing, and even the shopping center where she bought her groceries. My MOVES app indicated that I had walked for almost 5 hours. Two days later, my scale read almost two pounds lighter.

Most dieters, like my friend, experience this “Diet Stall”.  Weight continues to be lost, but so slowly that changes on the scale resemble traffic during rush hour. The cars and your weight loss either creep along or don’t move at all.  In part, the weight loss slow down is physiologic. The body’s metabolism adapts to the reduced calorie intake of the diet by conserving, rather than burning energy. Some muscle mass may be lost simply because less is needed to support a lighter body, thus diminishing energy use even more. And unless dieters are following a packaged drink or food plan, they begin to be a little more generous with the food they allow themselves to eat than when they were at the beginning of a diet.

Substantially increasing physical activity for a day or two may jolt the body into revving up its metabolism and burning off extra calories. A couple of stuck-on pounds should drop off and motivate dieters, like my friend, to stay on track with their weight loss goals.

But how can we do this?  Spending hours walking or engaged in any physical activity as little as once or twice a month is, unfortunately, difficult for most of us. To be sure, going on vacation and strolling around Paris or San Francisco for several hours will produce weight loss as many tourists have, to their delight, discovered. But how does one do this on our already overcrowded schedules? Walking for the sake of walking is a luxury of time that most of us don’t have.  Indeed, squeezing physical activity into an overcrowded work week or weekend takes planning and commitment.

But losing weight must also be a commitment; otherwise diets will be abandoned long before a weight-loss goal is reached. The critical period for abandoning the weight-loss efforts comes around 10 or 12 weeks after the diet is started. This is when starting or ramping up physical activity may help get you to your diet goal rather than adding the current diet to previous failures.

Starting on an exercise routine immediately produces weight loss, because your body is now expending additional calories.   But, if weight loss stalls while you are exercising regularly, dramatically increasing exercise for a brief period may be sufficient to start it up again. The problem, of course, is fitting a longer period of exercise into a crowded schedule. Going on vacation to do so is rarely an option.

Do this: Look at your calendar, find a day when your commitments are light and you have the time to spend two or three hours walking. Obviously this is easier to accomplish with good weather so you can walk outside in a park, in a conservation area, a neighborhood with sidewalks, a botanical garden, a zoo, or along a waterfront or ocean boardwalk. A friend and I often plan a two or three hour walk once a month, with a very unwilling dachshund, along a newly finished waterfront walk that skirts the harbor, or through a wooded conservation area owned by a local university. Our conversation is as active as our feet, so the time passes quickly. When the weather is unfavorable we go to a nearby museum (without the dog) and spend two or three hours walking around the galleries. We don’t want simply to walk; we enjoy each other’s company and also the fun of exploring the city or new exhibitions in the museum. But the outcome is the same. Our bodies are using up more calories than they normally do, and so the result is a small but welcome drop in weight without having to drop our calorie intake.

And remember: If you do the ‘walking cure’ be sure to keep yourself hydrated. Carry water with you. Don’t justify eating more after the walk because you did so much exercise. This will defeat the purpose of the walk, be certain to move the next day to prevent stiffness….and don’t weigh yourself for two days. It may take that long for the weight loss to show up.

Once you see that you are able to push that scale down a little further just by increasing physical activity, use this technique whenever weight loss becomes sluggish. And link the walking to something enjoyable: good conversation, interesting sightseeing, enjoyment of seasonal changes in the landscape, a favorite piece of art in the museum, or even a walk to raise money for a favorite charity.

 What you will lose in pounds, you will gain in pleasure.

Who’s Helping You Lose Weight From Your Antidepressant?

Good news: By now even mental health care givers know what their patients have known for years. Most drugs taken to relieve the symptoms of mental illness cause weight gain.

Bad news: There are probably more places to buy larger size clothing than weight-loss programs specifically designed to remove the pounds the medications added to your body.

A few days ago, I was answering a questionnaire on-line about weight gain. The questionnaire was part of a comprehensive weight-loss program supported by a government agency. I did not weigh enough to qualify for their weight-loss program, but I wanted to see how helpful the advice would be if I were indeed obese and/or became obese because of antidepressant medication.

Only one question out of many asked if I was taking medication that caused weight gain. I answered yes to see, if by doing so, I would be taken to a site that would advise me on how to get rid of extra pounds added by the antidepressants. But no. The questions continued on to ask the predictable: How often do I exercise? Do I eat more than I should? Do I eat when I am bored and/or when stressed?

The screening survey did ask me if I was hungry all the time. I answered yes to see whether a follow-up question would ask whether this was associated with my medications. It is well known that many antidepressants and mood stabilizers leave people so unsatisfied after eating that they may eat a second large meal only an hour or so after the first. Many find themselves snacking incessantly due to medication-associated appetite. Unfortunately the questionnaire was unconcerned about this.

The diet program posted on the website was no more helpful. The potential dieter was shown how to fill a small plate with foods obviously from the four food groups, and the amounts suggested closely followed USDA recommendations for healthy eating.  Curious as to whether buried somewhere in the diet or exercise advice there would be specific suggestions for people whose excess weight was due exclusively to their medications, I scanned all the other options on the website but found nothing.

Ironically, many who gained weight from taking antidepressants, mood stabilizers, and related drugs for mental disorders, fibromyalgia or even hot flushes from menopause, probably made the healthy food choices recommended on the website before they went on their medication. They never had any problem maintaining a healthy weight, a healthy degree of fitness, or healthy-food eating habits before starting on their medications. They never had to be convinced to eat their vegetables and go to a gym; this was their lifestyle…before the meds.

Sadly, conventional weight-loss advice such as on this website fails to consider that if a dieter is taking a medication that promotes overeating, the drug may overwhelm his or her willpower.  Exercise is also difficult. Fatigue from their depression and/or their medication makes it hard to move even from a chair or bed. Moreover, someone who’s formerly fit toned body is now flabby and fat, may feel too embarrassed to go back to a health club. What can he or she say? I am obese because I am taking a mood stabilizer?

A former weight-loss client of mine told me, “I go for a walk only after dark, when the neighbors can’t see me, because I know they are talking about how much weight I have gained.” Isn’t that a terrible coping mechanism for a shame undeserved?

A personalized approach to weight-loss is considered the best way of dealing with the issues that may prevent success, and weight-loss organizations offer individualized support programs to maintain adherence to a diet or exercise program, and change dysfunctional eating behavior. But where are the personalized weight-loss programs designed to:

Stop the insatiable need to eat caused by the medications?
Help someone with fibromyalgia who now faces the painful burden of moving a body made obese from medications taken to relieve pain?
Aid a formerly fit, athletic guy face his buddies in the gym when he now weighs fifty pounds more than he did a year ago, because of his medication?
Help a 100-pound overweight woman attend an event with relatives who knew her, pre-medication, as a size two?

It is not enough to ask on a questionnaire whether you gained weight from your medication.

If you ask the question, then provide the solution.

Fat Treats from Your Neighborhood Newspaper Food Writer

Last week the front page of my newspaper’s food section was covered almost entirely with a picture of six life-size doughnuts: glazed, powdered with sugar, and coated with either shredded coconut or chopped nuts. The reader could go beyond salivating over the pictures by turning to an inside page to learn where they could be bought, hot and fresh. These were no ordinary doughnuts, but specialty items like the cream-filled doughnut dipped in hard shell chocolate and topped with Frosted Flakes, caramel, strawberries and blueberries.  Or the chocolate doughnut filled with cream, rolled in graham crackers and topped with peanuts and a drizzle of white chocolate.  And should the reader decide to make them at home, the newspaper happily provided recipes, including an artery-clogging one for brioche doughnuts that called for nine large egg yolks and one stick of butter. But wait! If you wanted to make dinner before eating your doughnuts, the newspaper printed a recipe for fettuccine carbonara that called for 12 egg yolks, sausage and cheese.

I eagerly awaited the arrival of this week’s food section. Would it feature low-calorie recipes so the readers who may have gained a few pounds chasing down those incredibly fattening doughnuts could finally have guidance and incentive on how to begin losing them? Might there be a pasta recipe with fresh tomatoes and sparse amounts of olive oil and cheese? Would they publish a recipe for a fruit-based dessert, rather than another cream and egg yolk confection?  Alas, no. There was no admission that the doughnut spread might have caused the readers to spread (out of their clothes). No compensatory low-calorie recipes were printed.

My newspaper is not alone in tempting readers with foods they have no business eating unless they just scaled Mt. Rainier or trekked the length of the Amazon River.  Many women’s magazines typically feature both a diet plan and recipes for foods that, if consumed, will undo the effects of the diet. The Food Network has several programs that never should be watched by those attempting to lose weight or maintain their weight loss. There is one program featuring a guy with a strange haircut who eats incredibly fattening foods made in diners and family-owned restaurants around the country. I stopped watching the program because it always left me hungry.

Do those who decide what foods to picture in a newspaper or magazine realize how illustrations of triple-layered chocolate cake, melted cheese bubbling over a pan of lasagna, bacon-wrapped pork roast or sizzling sausage casseroles undermine will power? And more to point, do they realize how (there is no other way of saying this) hypocritical it is to talk about diets, or the latest research on sugar or carbohydrates or fat on health, and then tell the reader where to buy or how to make foods that contain copious quantities of these unhealthful ingredients? In all fairness, my newspaper did post the calories per serving for the fettuccine recipe (588 calories) but neglected to mention what the serving size was.  Moreover, no calories were given for the doughnut recipes. I wonder why?

All of this would not matter were we all thin and most of us were not engaged in a lifetime struggle to halt weight gain and/or maintain a previous weight loss. But we are not all thin; most of us do not work in jobs that burn up hundreds of calories, and too few of us exercise on a regular basis. It’s also important to consider that too many of us do not daily eat the recommended number of servings of the good stuff: nutrient-dense vegetables and fruits, high-fiber carbohydrates, and low or fat-free dairy products.  And let’s be honest. If your breakfast choices were a hot, fluffy, chocolate doughnut straight from the fryer or a bowl of cottage cheese topped with bran flakes for breakfast, what would you choose? And even if you choose the cottage cheese, wouldn’t you like a small bite of the doughnut also?

Staying at a healthy weight and eating a healthy diet would be so much simpler if unhealthy foods were not being advertised, featured in the print media, and showcased on television food shows. People who go off to spas to lose weight know this. They remove themselves from temptation and lose weight easily. People who decide to stop eating entire categories of foods like carbohydrates know this as well. They don’t have to fight against the urge to eat a doughnut or fettuccine, because they are not eating any carbohydrates.

But what about the rest of us? We need help in eating healthily without going off to a residential diet program or following unnatural diets. What if, for one month, only healthy foods were featured in the media? Good tasting healthy foods, not boiled kale or poached tofu, would be showcased; bakeries that sold whole grain, chewy, crusty breads instead of pastries would be noted. Restaurants whose menus encouraged consumption of vegetable and fruits would be reviewed, and only cooking shows demonstrating recipes using fat-free dairy products rather than heavy cream, butter, and egg yolk would be produced. Plus magazine dessert recipes would be limited to those containing ingredients from the healthy food groups. 

Maybe, just maybe, some exposed to this information might find it useful for the other 11 months of the year.

Standing Up For Better Health

“How do you like your new job?” I asked an acquaintance, an accountant who used to work at an organization with which I was involved. “I like the work,” he said, “but what I don’t like is sitting all day in a small cubicle, staring at a computer screen. ” He told me that his former job at this nonprofit required going to meetings in several offices scattered all over the building. “Some days I would walk what seemed to be miles, when I had several people to see. Not anymore. If I don’t leave my cubicle for lunch, I don’t move for eight or nine hours. I think all this sitting is doing something to my body.”

He was right to be concerned. A study published in the Annals of Internal Medicine confirmed what he and many others chained to their chairs and computers for hours at a time have suspected: sitting too long is not good for our health. [1] Scientists in Toronto reviewed several studies that looked at the association between sedentary behavior, health and longevity. While it is true that sitting still does prevent certain dangers to our health like falling (unless one falls off a chair), or being attacked by a grizzly bear, there is now good evidence that not moving may shorten our lifespan. According to the journal article, sedentary behavior is associated with a higher risk of cardiovascular disease, diabetes, and perhaps even cancer. Exercising for 30 to 60 minutes a day helps, but it doesn’t help enough, to offset the health risks of being stuck in a chair or car or truck for 8 or 9 hours a day.

Commuting adds its own sitting time to that of the workplace. My acquaintance no longer can walk or bike to work as he did in his previous job, but now sits in a car from 45 minutes to an hour and a half morning and evening, and given the traffic he encounters, he is obviously not alone.

What are we going to do about this problem? Other than lunch or bathroom breaks, few people have an excuse or opportunity to leave their chairs or stools whether they are security guards or day traders. Ironically, the only people who seem to have an excuse to move off their seats are smokers who are permitted to go outside for a cigarette. This is not a recommendation to smoke, but it doesn’t seem fair that non-smokers can’t also go outside for a mini-recess.

A few years back I volunteered to visit people in an assisted living facility. What I noticed was that everyone were either lying on a bed or sitting. Even those who could still walk weren’t. Somehow this seemed all right because the average age was over 90 (although we know now how important exercise is at any age), and I assumed that after one became old enough, it was all right to sit out the rest of one’s life. However, I suspect if I were to visit a typical office or assembly-line person working at a conveyor belt, most people would be sitting as much as the old folk. It is a sobering thought.

The sitting problem has not received as much attention as it should, given the financial and physical costs from the increased incidence of high blood pressure, diabetes, heart attacks, strokes and cancer among the sedentary. We don’t even know how inert we are. Perhaps a way to start to change this situation is to find out. The many devices that can measure physical activity could be used to see how much we move at work, while commuting, and at home.

How much and how often should we be moving? An author of the study, Robert Alter, recommends standing or moving one to three minutes every half hour and standing or exercising during commercials while watching television. He claims that exercising 30 minutes a day does not compensate for, “23 and a half hours of doing nothing…” In a sense he is endorsing fidgeting, e.g., the inability to sit, as a way to stay healthier. Some offices give their workers desks that can be raised so it is possible to work standing up as well as sitting. And desk-like platforms that can be attached to a small treadmill have some popularity, as does a pedaling device under their desk but again these are not commonplace. Bringing a dog to work that needs constant walking is another option, but even fewer workplaces endorse this.

The most important aspect of moving while working is simply remembering to do it. Computer or cell phone beeps as reminders are really necessary, because it is too easy to become so involved in work that moving is forgotten. More difficult is convincing employers of the importance of allowing their employees to stop working long enough to take a moving break. It is hard to believe that a supervisor will stop the conveyor belt, or halt the line of people going through security check, to allow a worker to stretch and walk around for two minutes every half hour. Can one enforce more frequent rest stops for long-distance truck drivers or bus drivers? There are long term health implications to budget in, but isn’t investing in improved health worth it?

Alas it seems that improving our health by moving more frequently seems like such an easy intervention, but realistically, it’s an almost impossible one to bring about.

Reference:

1.) http://annals.org/article.aspx?articleid=2091327

Are Diet Sodas Really a Diet Food?

“I’ll have a diet soda with my French fries and double bacon cheeseburger. Oh! And one of those apple things,” he added, pointing to a pastry. The guy giving the order then looked at me as I waited my turn to order coffee at the highway restaurant rest stop. “Might as well save some calories, ” he laughed as he patted his prominent abdomen. I nodded to him as I asked for my coffee to be sweetened with a packet of the blue non-calorie sweetener.

We all seem to do it: eat a high-calorie meal but drink a no-calorie beverage sweetened with something artificial, munch on a bag of potato chips along with a diet soda, dig into an obscenely rich dessert but add a non-calorie sweetener rather than sugar to our coffee or tea, and drink alcoholic beverages without concern for their calories but “freak out” if we discover we are drinking real soda, rather than the diet stuff.

But do we really think of our coffee sweetened with an artificial sweetener as diet coffee? If we add diet quinine water to a gin and tonic, is the drink now a diet drink? Is artificially-sweetened bottled cranberry juice or flavored iced tea a diet beverage? Do hard candies sweetened with a sugar substitute qualify as diet candies?

A petition just filed with the U.S. Food and Drug Administration by a California-based group, U.S. Right to Know, wants companies to stop using the word “diet” on products that use artificial sweeteners. The petition states that: “Consumers are using products — Diet Coke and Diet Pepsi — that are advertised to make us think they assist in weight loss, when in fact ample scientific evidence suggests that this is not true and (instead quite) the opposite may well be true.” [1]

Interesting. Do people really believe that they will lose weight by drinking these products? I doubt that the man standing in front of me contemplating his snack of a double cheeseburger, fries and dessert thought that he would be three pounds lighter because he drank a diet soda. And I suspect that my not ordering a doughnut (although I wanted to) along with my coffee had more of an impact on my weight than putting that stuff from that blue packet in my coffee.

The writers of the petition reviewed the research literature on diet beverages and weight gain that seemed to confirm the need to remove the word diet from sugar-free beverages. Some studies such one published in the Yale Journal of Biology and Medicine in 2010 suggested that artificial sweeteners may contribute to weight gain, [2] and another in 2012 found that an association between artificially sweetened beverages and weight gain might exist in children. [3] But just because an association exists between two events doesn’t mean there is a causative relationship between them. I have a relative who drinks copious quantities of a caffeinated diet beverage because she hates coffee and tea, but wants to consume caffeine throughout the day. She doesn’t like the taste of the fructose-sweetened version of the caffeinated sodas; they taste too sweet to her. If I asked her whether she thought drinking so much diet soda would help her lose weight, her answer would be, “In my dreams.”

However, might diet beverages indirectly cause weight gain? Might the man in front of me at the fast food restaurant justify ordering dessert because his beverage contained no calories? Do we have less guilt at gobbling up a rich dessert because there is no sugar in our tea? Do we reach for the sugarless chocolate ice cream in the freezer without a thought to its calories because it is artificially sweetened?

There is another, more biologically-subtle, reason why so-called sugar-free foods might cause weight gain. Many people have a natural and unavoidable craving for carbohydrates, especially in the afternoon and/or evenings. The craving arises from their brains and is related to the brain’s need to make the neurotransmitter serotonin. Often the craving is accompanied by a small, but very real, deterioration in mood. Eating a carbohydrate, sweet or starchy, will restore serotonin levels and improve mood soon after the carbohydrate is digested. [4 ]If the craver attempts to satisfy this need to eat something sweet with something artificially sweetened, there will be no restoration of serotonin levels in the brain and no improvement in mood. So what happens? The craver may eventually give in to his or her craving, which was, of course, not satisfied by the diet beverage. Consequently, this person may scarf down a snack food that is sugary but also high in fat like a chocolate chip cookie, an ice cream cone, a candy bar, or a cupcake with three inches of frosting.

Perhaps if the craver satisfied the craving immediately by eating a low-calorie, mildly-sweet snack like graham crackers or licorice sticks rather than attempting to quell it with the diet beverage, the impulse to eat a fattening carbohydrate snack could have been curtailed.

It will be interesting to see what becomes of the petition. Since so many of us order a diet (fill in the blank) drink without giving a nanosecond’s thought to the word diet on the label, it may be very difficult for us to get used to another name. We tend to use the work Xerox instead of copy as in, “I will Xerox this” or Kleenex rather than facial tissue as in, “I have a Kleenex.” So I suspect we will continue to call artificially sweetened beverages diet, even though we know they are not.

1.) http://usrtk.org/sweeteners/diet-soda-fraud/