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I spend time in a city where people often have their cars parked by a valet. Indeed, I was told that if valet service was not offered at events, people would not come. "But there are parking garages only blocks away," I protested. "Can't they walk a few blocks?"
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. [1] 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. Reference: [1] http://atvb.ahajournals.org/content/ear ... 8.abstract | permalink | related link |   ( 3 / 160 )Losing weight should have a positive effect by mitigating health risks and improving overall well-being. And, of course, for anyone struggling with the consequences of being overweight, dropping those extra pounds restores energy, lowers both blood pressure cholesterol levels, and decreases stress on the bones and ligaments. But diets may take away more than pounds. There is evidence that diets can also take away bone strength. 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. | permalink | related link | ( 3 / 249 )Imagine once being thin, with a job, a home, and a social life and then, because of some painful changes in the neurochemistry of your brain, becoming fat, jobless and socially isolated. The combination of your medication, which is causing you to eat excessively, coupled with your isolation from companionship normally found in work and friends, causes you to gain 75 pounds or more. Your body is now unrecognizable. You find it hard to walk, let alone do the vigorous exercise you did before getting sick. Food is the only friend you have left. Now try going on a diet. It is usually hopeless. Fortunately, for the very many battling both mental illness and obesity, there may be some hope that they can restore their bodies to a lower, healthier weight and become fit. In a very important study, Dr. Gail Daumit and her colleagues at Johns Hopkins University School of Medicine, carried out an 18-month study with almost 300 seriously mentally ill patients to see if a multifaceted weight-loss intervention program might be successful. All the participants received basic nutritional information, but a test group also exercised together and attended weight-management support sessions. As reported in the New England Journal of Medicine, both groups lost weight, but the group that received exercise and support lost more. Perhaps the most important outcome of the study is that the participants no longer felt hopeless about their weight and how it changed their bodies. They learned how to make better food choices and to overcome reluctance to exercise in public. Most important, they realized that their many excess pounds could be lost. Some years ago, when I ran a weight-management center at a Harvard University-associated hospital, a psychiatrist and I carried out a small study with about 20 mentally ill patients to see whether similar types of interventions might help them lose weight. Early on it was apparent that the tried and true formula for losing pounds—eating lots of vegetables, low-fat dairy products, whole grains and lean protein along with regular exercise—wasn’t going to work. The participants lived alone, depended on buses to get to a supermarket, had very little money and aside from some volunteer jobs, little to do outside their homes. It was hard for them to carry heavy bundles like bulky vegetables, and when the weather was warm they didn’t like carrying perishables such as milk or raw chicken. It was easier for them to go to a neighborhood fast-food restaurant for their meals. And where could they exercise? When it was either very hot or very cold, they were stuck inside, and perceved that those who lived near community centers with exercise classes felt they would not be welcome if people knew they had serious mental illnesses. So they stayed home and watched television. Some had been employed at very high-level jobs before getting sick, but their lives now were empty of the work and activities that filled them previously. So our intervention, like that of Dr. Daumit’s program, included ways of helping them buy and carry home foods that were healthier than fast food. We also convinced them that they were capable of exercising. It turned out that dancing was one of the research participant’s favorite activities and, as one subject told us, “When I am dancing, I can close my eyes and remember what it was like before I got sick.” The most important aspect to help our research subject's, we theorized, was figuring out how to decrease their social isolation. Fortunately, most of the group lived close enough to each other so they could meet on a weekend to go for a walk, attend an outdoor concert in the summer, or the movies. Some decided to go to community center exercise classes together so they would not be embarrassed by going alone. Months after our program ended, they were still getting together. Nonetheless, weight loss did not come easily and some, who were hospitalized after the program ended, gave up trying. But as one of the volunteers in Dr. Daumit’s study said, even losing a few pounds was a victory. Helping those who are struggling with mental illness and obesity may require a team of nutritionists, trainers, and even social workers. Indeed, perhaps Departments of Psychiatry should develop their own weight-loss programs for the very many whose substantial weight gain is a direct consequence of the medications prescribed for their illness. Dr. Daumit’s study gives us hope that such programs may work. Any victory, however small, must be acknowledged and pursued for its repetition potential. | permalink | related link |  ( 3 / 321 )"No! I won't taste it... I hate cauliflower!" She pushed the white vegetable away from the other foods on the plate. "But just try it," I urged. "It doesn't taste like the stuff you get in school. I roasted it with lots of spices." My 22-year-old cousin then forked up a micro-piece of the vegetable and tasted it. "Not bad... maybe I will eat it." I thought of this scenario when reading about the struggle schools are going through to get their students to eat vegetables from the school lunch menu. As part of a campaign to reduce childhood obesity, the federal government established new guidelines for school lunches. Corndogs and other deep-fried foods are now replaced by lean protein, and students are asked to eat a vegetable or fruit and drink fat-free milk rather than sodas and sugar-filled juices. An article in the Miami Herald described the resistance and dismay of many students at seeing their beloved Pop-Tarts, potato chips and French fries replaced with salad bars, apple slices and brown rice. It is not clear who or what is getting filled up with these healthier choices of vegetables and fruits: the students or the trash cans. A student journalist from a high school in north Miami, for example, reported that the kids are eating the main course, but dumping the vegetables and fruits in the trash. As quoted in the newspaper, the student claimed that these foods are thrown away because they don't look appealing. Not surprisingly, it is the older students who reject the vegetable and fruit. Perhaps, like my cousin, they once ate some of these vegetables and found the texture and the taste at best boring, and more likely revolting. One taste of an overcooked, under-seasoned vegetable will eliminate any desire to try it again; it is easier simply to throw it away. Indeed, according to the newspaper report, the younger students are the ones most willing to try the foods on the new school menu. Perhaps because they have never tried them before? Who knows? But what seems to work with them is to allow them to sample the salads, fruits and vegetables at the beginning of the school year. It is important that at some point, before any of these kids grow up and have families of their own, vegetables and fruits become a basic component of their daily food intake. And if they are not eating these foods at home (many teens don't even eat meals at home, preferring to get their meals from fast-food franchises), then school is the first and last resort.Could the solution be to develop school lunch menus in which vegetables are concealed, or given more prominence and more taste? Concealing vegetables and indeed fruit is easy; every mother with a child who won't eat carrots or peas knows how to cook these and other vegetables in a spaghetti sauce or pureed soup or slow-cooked stew. Muffins and breads are wonderful foods in which to hide vegetables and fruit. Carrot, apple, pumpkin, cranberry, zucchini bread or muffins could be added to the school lunch menu to meet the grain and vegetable or fruit requirements. Meatloaf and sloppy joes make good hiding places for vegetables, and smoothies are perfect for concealing any fruit that can be blended into yogurt. At home, my son used to call my baked breakfast treats Wonder Muffins, as he and his sister would wonder aloud what I concealed in the batter. I never told. It is not always necessary to hide these essential food groups. If kids won't eat fresh fruit, they might eat it frozen. Frozen blueberries, thinly-sliced apples, pears, strawberries and peaches have a cold, crunchy, sweet flavor and are fun to eat. Bananas dipped in a fat-free chocolate sauce and then frozen are nutritious substitutes for ice cream, and frozen orange wedges taste as good as an orange popsicle. Increasing the chances that vegetables will be eaten and not thrown away, it's important that they both taste good and are fun to eat. Here are some suggestions to make this goal a consumable reality, in that your teens might actually make the Herculean effort to try: Lettuce wrapped around a mixture of well-seasoned chicken, or beef and vegetables; Thai or Chinese vegetables, meat, noodle vegetable dishes with appropriate spices; Spicy dipping sauces (low-calorie) for vegetables normally ignored such as string beans, carrot sticks, and cauliflower; Lasagna made with spinach and low-fat ricotta cheese; Thin slivers of roasted sweet potatoes will taste like French fries without the fat and with more vitamins; and Roasted cauliflower, broccoli, carrots, peppers and/or winter squash, when sprinkled with a small amount of melted cheese, are infinitely more appealing than the steamed or boiled variety. Indeed, almost every vegetable improves from roasting, including, I have been told, kale. One device to improve the odds of a new vegetable dish being consumed and not thrown away is to have someone serve tiny samples of a new dish before the students go through the line. One look at the sample tables in the warehouse bulk stores reveals that tasting a tiny amount of anything hooks a prospective consumer far more than having it plopped on a plate. Perhaps the school lunch ladies will be willing to multitask in the name of vitamins and good health, cajoling with samples in an effort to improve a vegetable's chances of being eaten. These techniques will hopefully work to change the food habits of many students. But even if a few students can stop eating Doritos for lunch and eat a lettuce wrap of chicken and vegetables instead, success will be achieved, one green at a time. | permalink | related link | ( 3 / 468 )We have been friends for more than 20 years and have shared much about our lives with one another. But despite being able to talk (and complain) about our spouses, rejoice or despair over our children, and support each other through work and family crises, there is one topic that neither of us touches: her weight. She was never thin but maybe a little too curvy in places during the early years of our friendship. Three pregnancies, a mother who died of a neurological disease, and job uncertainty added pounds to the curves. Now, weighing almost l00 pounds more than she should, she was recently diagnosed with high blood pressure and has difficulty walking up and down stairs because of her knees. Her excess weight is on her middle. It is difficult to hug her but more important, those many extra pounds on her mid-section are specifically linked to cardiovascular disease and diabetes. I had hoped that her physician would motivate (nag?) her into a diet when he wrote the prescription for her blood pressure medication. If he did, she never mentioned it. She only said that she hated taking pills but the doctor said she must, or risk a stroke. Of course I will say something about her weight issues; not to do so implies, at least in my own mind, that I do not care enough for our friendship to care enough for her health. But urging her to lose weight is hardly sufficient. She has been on diets before, they never last long and the weight is always regained. Like so many people who struggle constantly with their weight, my friend needs more than a diet. She knows exactly what to eat and what to avoid, how to measure her food, the importance of exercise, and the necessity to restrict fat and alcohol. She once told me, ”Don’t you think that if I could make myself eat right and exercise regularly, I would? I laugh and I cry at people who are preaching that message. They must assume that fat people don’t want to lose weight, and so deliberately make themselves eat too much and lie on a couch all day. ” When we finally did talk, seriously and honestly, about the medical consequences of her obesity, she confessed that she felt hopeless about losing her weight and assumed that she would, again, fail on a new diet. It was the distance she had to travel to reach her weight-loss goal that so discouraged her, she told me. “So why start something I know I can’t finish?” she concluded. “I rather not start.” Anticipatory disappointment is a killer of many a new diet, but I persisted. Our own discussion ended with my commitment to, “…traveling the distance…” to her weight-loss goal with her. She would need my support, encouragement and presence for the months to come. Inevitably, as with all dieters, she would become frustrated at a slow rate of weight loss, bored with her diet regimen, and/or find it difficult to exercise routinely. She would need my help in convincing her friends and family that she had no intention of going back to her previous weight, no matter how much they tempted her with fattening foods and excuses to stop exercising. Do people like my friend fail on diet after diet because after the novelty of the first month or so of the changed habits, and the joy in losing those first 10-15 pounds, they succumb to the realization that the diet is not going to be over tomorrow? Those people who applauded the initial weight loss may be indifferent to the dieter’s subsequent slower weight loss. Families rebel against a junk food–free kitchen, friends get tired of going to restaurants that serve only fish and bok choy, and relatives are offended that their special high-calorie holiday dishes are rejected by their dieting relative. Further resentment may develop when the dieter insists upon going off to the gym or taking a long walk, instead of staying home and baking cookies. Plus weight-loss programs, including many bariatric surgery clinics, do not put the effort into intensively supporting the dieter after the first year or even earlier. Perhaps what is needed are weight-loss programs specifically designed to sustain the dieter through the middle and end range of the diet program. Their goal would be to keep the dieter committed to losing weight, no matter how long it takes. New foods might be introduced to decrease boredom, and new exercises taught as the dieter becomes more fit and has increased stamina. Clothing, hair style and make-up advice could be offered to reveal and enhance the slimmer figure. But most important, the diet program would function as a cheering squad, supporting the dieter slogging through those final months of weight loss. Weight loss interventionists could learn from those who cheer the middle- of-the-pack marathon runners with, “Way to go and looking good!” Maybe this should even be the name of the program. | permalink | related link | ( 3 / 604 )Next |
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