Monthly Archives: May 2015

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.