“I thought of going to your weight-loss clinic,” she added before resuming her eating. “Frankly, though, what I need is a marriage counselor, not a diet program.”
Abigail (not her name) then briefly outlined the stresses that caused her to reach for food continually: Her husband had not earned any money for years and was not interested in looking for a paying job. He wrote books that he self-published and claimed that he was too busy to participate in the logistics of running the house. In addition to holding a full-time job with unpaid overtime, Abigail had to pay bills, do the taxes, clean, cook, shop, and, of course, take care of the children. She sputtered when she told me that her husband even expected her to visit his father who was recovering from a heart attack because he, the son, didn’t have the time.
The husband, who was also considerably overweight, insisted on large, fattening meals along with snacks that he could munch on while he wrote.
“So who also eats the snacks? Who eats all the leftovers? You can see them on me: They are all on my hips and stomach, “she said. “It is easier to eat than to fight with him about everything.”
In the interests of self disclosure, I heard only her side of the story. And who knows, maybe her husband’s obesity could also be generated by his own dissatisfaction with his marriage and his life. Nevertheless, I agreed with Abigail that simply going off to a Weight Watcher’s meeting or getting private diet counseling was not going to solve her weight problems. She knew why she was overeating, but felt equally helpless about solving her weight and her marital problems.
Overeating is often the symptom that something is wrong with some aspect of one’s life. Unfortunately, diet advice to bring the overeater back to a normal weight overlooks the causes of the excessive food intake or offers no help in preventing it other than suggesting the use of will power.
Losing weight should not be deferred until the stresses and triggers that caused overeating are identified and removed. Someone like Abigail, who is so overweight as to make her vulnerable to a variety of health problems, should not wait until the problems with her husband, along with her exhaustion, stress and anger are resolved. But, as she said, she needed a marriage counselor (or life coach or psychologist) as much as a diet plan to be successful in losing weight.
One of the benefits of a slow weight-loss program is to allow enough time, perhaps a year or more, to work on the problems that caused the overeating. Abigail’s problems were complex, and she needed to look at her restrictions and priorities anew, so that she felt entitled to eat foods that allowed her to lose weight and take time to exercise. But how could Abigail shift her palate to better nutritional choices? Could she do this within the confines of her marriage? She needed professional guidance, and not a diet counselor, to help her answer that question. But I convinced her that as long as she stopped gaining weight and started to lose, albeit slowly, she would have the time to work out the answers. And perhaps as she lost weight, she would gain a happier life.
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But what if the deterioration of the body is due to mental illness? What if the loss of muscle strength and muscle wasting is due to weeks or even months of inactivity because of the extreme fatigue and weakness that may accompany depression and anxiety? What if an individual is so depressed that moving from a bed to a chair seems too hard, and as a consequence, the lack of days or weeks of physical activity brings about muscle loss and weakness?
Several years ago a woman who had been coming to our weight-management center at a Harvard-associated psychiatric hospital suddenly disappeared. Several weeks later, when her severe depression lifted, she came back and told us that she was unable even to make phone calls during the worst days. The trainer who had been working with her in our program’s exercise routine noticed that she had lost stamina, was unable to do her previous aerobic and strength-building exercise routine, and had trouble with her balance. The days of simply not moving had taken its toll.
She was fortunate, however. The trainer knew what her body was capable of doing before she became depressed and was therefore able to help her regain her former level of fitness.
But what about others whose mental illness causes them to experience periods of physical inactivity as severe as those suffered by someone recovering from injury, infection, chemotherapy or heart disease? Do their therapists recognize the physical debilitation caused by their mental illness? Are the patients given nutritional advice to help them restore lost muscle mass, and are they referred to physical therapists or trainers to restore their lost physical fitness?
While I suspect that these patients are given appropriate medication and therapeutic counseling. But I also suspect that the counseling does not include recommendations as to how to increase muscle mass, increase stamina or improve their balance (a particular problem if the medications make them dizzy).
Because of my decade-long interest in reversing weight gain caused by antidepressants, I have heard from many who have experienced this problem. Most people who contact me write that their medications increased food intake and subsequently their weight. But some insist that they are not eating any differently, and yet their weight increases anyway. They ask if the drugs might be slowing down their metabolism? Unfortunately I am not aware of any studies that compared metabolic rate before and during treatment with antidepressants and mood stabilizers (drugs used for bipolar illness) to see if indeed such drugs decreased metabolic rate. But perhaps if their metabolism is slower, it is not due to the drugs, but due a decrease in muscle mass? Muscles are the greatest users of calories in our body. Thus prolonged inactivity during a depressive episode might deplete muscle mass as readily as it does when someone is forced to stay in bed because of a serious infection or complication of surgery. If so, this would account for a drop in metabolism and subsequent weight gain without a change in food intake?
Fortunately, as anyone who has had a broken limb or bad flu knows, it is possible to reverse muscle loss by exercise and sufficient protein intake. (Women should be sure to eat at least 55-60 grams, and males 75-80 grams, of protein each day.) The same program will work for people who are recovering from mental illness. And if prolonged physical activity has caused major muscle weakness and loss of balance, it should be possible to enlist the service of physical therapist to start the recovery process. It may take time, but certainly will be successful, if given the support it needs.
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Eating ice cream -- or its close cousins gelato, frozen yogurt, sorbet or soft serve -- is a seasonal treat (like buying the first bunch of daffodils or tulips), and as such should not be denied just because one is on a diet. And unless the dieter is following a program that forbids eating any sweet, creamy food that is cold on the tongue, it should be possible to fold the calories from one of these frozen delights into the day's calorie count without inhibiting weight loss. The key seems to be sticking to a half-cup serving size and avoiding the tempting but truly fattening sundaes and added high-fat ingredients.
Should you choose gelato over ice cream? Frozen yogurt, be it Greek or not, over ice cream? Perhaps soft serve versus hard ice cream? It turns out that the calorie count for all of these products hovers around 200 for a half-cup. Unless you are eating a fat-free, sugar-free item that is mostly air and filler, the difference is really in taste and texture.
Gelato is the Italian version of ice cream. It is sweet and creamy, and if you find a gelato store, you will be dazzled by the array of colors and flavors. Gelato has somewhat fewer calories than ice cream; an average half-cup serving has 150 calories versus 200 from regular ice cream because it contains less butterfat. However, it actually tastes creamier. The reason is that much less air is beaten into the mixture, giving it a denser mouth feel. In fact, it is so dense, it is impossible to eat quickly, thus extending the enjoyable experience of eating it.
What about frozen yogurt instead of ice cream? Or Greek frozen yogurt? Although it seems reasonable to assume that the frozen yogurts are less caloric, the caloric difference between them and ice cream may be unimportant. Ben & Jerry's Cherry Garcia Ice Cream (half-cup) is 240 calories, while the company's Raspberry Fudge Chunk Greek Frozen Yogurt (half-cup) is also 200 calories and its Fudge Brownie Frozen (non-Greek) Yogurt (half-cup) is 180 calories. If your frozen Greek yogurt scoop drips while you are eating it, the calories may end up the same.
Sorbet has fewer calories, around 150 per cup, and most flavors are fat-free. However, chocolate and coconut sorbet do contain some fat and are higher in calories. The calorie contents of soft-serve ice cream that comes out of a nozzle and can be whirled into a tower with a little comma on the top may vary much more. For example, soft-serve JP Licks has 150 calories for a half-cup, while Tasti D-Lite is considerably less, mainly because it contains very little fat but lots of gum and other thickening agents. But, if you add hot fudge topping and whipped cream to even light soft-serve ice cream, the calories bounce up to well over 300 a half-cup serving.
The problem with all these calculations is the serving size. The calorie counts depend on the size of the scoop, and also on whether a cone or cup is dipped in a fudge coating and/or cookies, nuts and candy are added into the mixture.
It is hard to imagine how the six-inch-high ice cream lapped up by the man in the suit could fit into a half-cup serving. A half a cup is not a very large measure. Indeed, even so-called kiddie cones seem to come in larger sizes than a half-cup. A few years ago, Good Housekeeping surveyed serving sizes of ice cream around New York City and found no consistency in the amount scooped. Maybe it depends on how tired the wrist of the server is so that by the end of the day, less is put into the cone or cup than when the server comes to work.
Perhaps the most strategic approach to indulging in ice cream or other frozen delights while dieting, is to be cautious in what you choose. Kiddie-size cones or cups will approximate the half-cup serving size, and if you choose low-fat ice cream or frozen yogurt, you should be eating no more than 200 calories, more or less. Avoid waffle cones; they have 120 calories compared to 17 in a regular cone and 20 in a sugar cone. As yummy and tempting as they are, don't pick ice cream stuffed with chocolate, caramel, nuts, cookie dough and peanut butter -- and no hot fudge sauce.
The pleasure of an ice cream in the summer should come from the combination of warm sun on your skin and cold ice cream on your tongue. And that should be enough.
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The answer was an overwhelming, "No!"
I thought of this while scanning a summary of a major study looking at the impact of running and walking on various measures of health such as blood pressure, cholesterol, diabetes, and heart disease. The study, recently released online in the journal of Arteriosclerosis, Thrombosis and Vascular Biology, reported the same health benefits for walkers and runners if they expended the same amount of energy while exercising.  This study, which lasted six years, enrolled 33,060 runners and 15,045 walkers who were dedicated to exercising. Records were kept of the amount of metabolic energy ("MET") expended by the volunteers when they were running or briskly walking, and then comparatively analyzed.
The results of the study are good and bad news for those of us who wonder what type of exercise is best for our health. Runners and walkers whose exercise used up the same METs had the low risk of developing diabetes and cardiovascular problems. That is the good news. But the sort of bad news is that runners expended more energy per unit mile they ran than walkers covering the same distance, and this translated into better health outcomes.
The reason for this discrepancy is that running is a less efficient way of moving, and so mile for mile, the runner burns up more energy than the walker. (Unless the walker is dragging a Great Dane or stubborn dachshund on a leash.) According to one of the authors, Paul Williams, a walker would have to cover 4.3 miles at a brisk pace to use the same amount of METs as a person running three miles.
What this study seems to say is that if your exercise of choice is walking, it has to be more than a stroll around the block if substantial health benefits are to be achieved. Indeed, the walk ought to be fast and long for the exercise to produce, over time, a substantial decrease in the risk of cardiovascular problems or diabetes.
But who is going to spend two or three hours a day walking? Obviously even the dedicated walkers in the study did not spend the extra time walking necessary to use up as much energy as the runners did in a shorter amount of time.
And what about those who would not even consider walking more than a block or two to their destination? Those, who like many residents of Los Angeles, for example, insist on having a valet drive their cars to the parking garage so they don't have to walk. Or people all over the country that pull up to the door of the restaurant, or the mall to avoid more steps than necessary? I see this even with well-meaning friends who always offer me a ride home after a lecture or meeting and are surprised when I refuse, saying that it is only a 10 or 15 minute walk.
The results of this major study are compelling as predictors of health risk. Yet how can they be translated into behavioral change? There has to be a cultural shift away from instant convenience, e.g., the valet, or saving a few minutes of time (the ride rather than the walk) or comfort. Rather than being annoyed at having to walk a few blocks because you couldn't park your car next to the door of the restaurant, be pleased at yet another opportunity to rack up a higher MET and consequently burn a few calories.
Moreover, if we are going to suggest dedicated walking as the exercise of choice for health benefits, then it has to have some pleasurable aspects to it. Otherwise it will be abandoned as a passing fancy. Here are some ways of making walking tolerable, and perhaps even enjoyable:
1. Map out your route using Google map or other GPS supported directions. Know how far you are going and when it is time to go further, use your GPS or map to plan another longer route. You are not a goldfish restricted to moving around in the equivalent of a glass bowl.
2. Consider buying walking sticks. They should come with rubber bottoms so they hit the pavement softly and give you support. The length has to be adjustable and the hand holds comfortable. Walking sticks, aka hiking poles, make your arms move as well as your legs, are useful for going up and down hills (this is why hikers use them), and for older walkers help with balance. Also, they make you look athletic.
3. Triumph over walking boredom by walking with a friend, chatting on the phone with people whom you otherwise do not have time to call during the work day, or listening to lectures or books on your iPod. (I listened to an excellent lecture course on the history of the Civil War while dragging the aforementioned dachshund on his daily rounds.)
4. Activate a pedometer on your phone, iPod or wrist device so you really know how many miles you have covered.
5. Remind yourself to keep up the pace... for a healthy heart you must walk briskly.
6. Take water and dress appropriately. A small knapsack is useful for holding layers that you take off as you get warm or put on if the weather should suddenly change.
Or simply enjoy. Turn off your phone and enjoy the fresh air.
 http://atvb.ahajournals.org/content/ear ... 8.abstract
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A few years ago, a study from Rutgers University revealed some worrisome findings on bone health. After only six weeks, the bones of the women on a weight-loss diet were not absorbing as much calcium as women who were not dieting, even though the dieting women were taking an additional 1,000-mg calcium supplement. Since these women were post-menopausal, the researchers suggested that dieting itself might make older women more vulnerable to fragile and easily breakable bones.
Since many weight-loss plans don't emphasize the need to consume calcium-rich dairy products (Weight Watchers is an exception), the obvious answer to the prevention of weakening bones is taking a calcium supplement. After all, haven't women been told for years that supplements are a reliable source of calcium, especially for people who may not eat dairy products (like vegans or people who don't like foods that come from milk)?
Now it looks like calcium supplements are out, and calcium-rich foods are in.
Jane Brody recently discussed the latest information about the benefits and risks of calcium supplementation in the New York Times Science Section. She reported that the United States Preventive Services Task Force reviewed over 130 studies on whether calcium and vitamin D supplements prevent bone fractures. Their conclusion: They don't. It turns out that calcium from food is substantially more effective in promoting bone health than calcium taken as a supplement. Moreover, some reports have now pointed to a significant link between calcium supplements and an increased risk of heart attacks.
This information that calcium supplements are not as reliable as food in maintaining bone health removes the safety net that many women depend on. This is especially true for dieters because knowing that you, the dieter, could swallow a couple of calcium pills made you confident that you were getting enough of this vital mineral, even if you stopped eating dairy products to save some calories.
So now what do you do?
The first thing is to know how much calcium you should be taking into your body every day. Women and men under 51 need 1,000 mg a day. Women need 200 more mg over 51, so their daily intake should be 1,200 mg. No one yet knows why weight loss should increase the need for calcium, but there is useful information about the best way to get your bones to absorb this mineral:
You should not eat more than 500 mg of calcium at any one time, because that seems to be the maximum amount that a body can process per ingestion;
Sunshine, or other sources of vitamin D, are necessary for calcium absorption. If your skin is not exposed to vitamin-D-enhancing sunshine, do take a supplement or eat vitamin-D-fortified foods (cod liver oil, of course the worst-tasting, is probably the best source);
Caffeine in coffee and chocolate, as well as caffeinated energy drinks and sodas, increase the loss of calcium from the body. Don't overdo it on the caffeine or else your bones may become too weak to support your energized body;
Just because a food contains calcium doesn't mean it will be absorbed by your body. Whole grains, peanuts, soybeans and most leafy green vegetables like spinach contain compounds that stick to calcium and prevent the mineral from entering your body. Kale, mustard greens and collard greens are exceptions, as they don't contain the calcium-grabbing compounds. (Tofu, which is made from soy, will yield up calcium if it is processed with calcium sulfate and nigari. FYI: Nigari is the Japanese name for magnesium chloride. Both compounds are responsible for the formation of the solid part or block or the tofu.)
Read food labels. How else can you decide between cow, soy, almond, and rice milk? They all vary in calcium content and calories, and some of these dairy milk-like beverages are now fortified with more calcium than they were just a few years ago. Many foods that normally are calcium-free, such as orange juice and Total cereal, are also now calcium-fortified. If you put orange juice on your cereal in the morning (as my lactose-intolerant friend does), you may consume most of your calcium needs at breakfast; and to conclude,
Convenience and calcium needs may conflict. Not all calcium-rich foods fit into your lifestyle, and dieting further limits what you can eat. Boiled kale and tofu burgers may not be foods you are going to prepare when you return from work at 8 p.m., so have alternatives available. Cottage cheese, yogurt and part-skim ricotta cheese are all low-calorie calcium sources, and can be blended into smoothies, pasta, soups, or used as toppings for calcium-fortified toaster waffles. Milk-based fish chowders are an excellent source of calcium, and if made with fat-free or low-fat milk, can easily fit into a dieter's menu plan. Lasagna layered with low-fat ricotta cheese or cottage cheese and steamed kale can be made ahead of time, frozen in mealtime portions, and then heated up for a quick dinner. And if you can spare the calories, one-half cup of frozen Greek yogurt provides 15 percent of your daily calcium requirement (about 150 mg of calcium) and tastes good, too.
Even though dieting may make you vulnerable to bone loss if you don't take these dietary precautions, remember that diets often have a beneficial effect on bone strength. Exercise, that other component of weight-loss programs, is essential in strengthening bones. Indeed, physical activity is essential to prevent, as well as reverse, bone loss. And if you do burn off enough calories, you really can eat that frozen Greek yogurt without guilt.
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