Archive for May, 2008

Body shape is as important as weight

May 31, 2008

Are you an Apple, or a Pear?


Several recent studies and articles have highlighted how important WHERE we store fat is to our health. Excess weight is generally stored either in the abdominal area or in the hips, thighs, and buttocks, giving rise to the descriptive terms “Apple” and “Pear.” If you are an Apple (and these shapes appear to be partly determined by genes), you tend to have more visceral fat (fat around the abdominal organs) and this can lead to various diseases (type 2 diabetes, some types of cancer, heart problems, urinary problems, dementia, hypertension, and stroke). The only benefit to the Apple shape is lower risk of osteoporosis. Overweight men and post-menopausal women tend to be Apples. Also, smoking is associated with abdominal fat accumulation.

Pears are not as much at risk for the serious diseases listed above, but are more likely to suffer from osteoporosis, varicose veins, and cellulite. While a Pear can become an Apple, Apples do not morph into Pears.

The good news? Here is a quote from an excellent article on this topic in the U. C. Berkeley Wellness Letter (June, 2008):

While abdominal fat tends to accumulate faster than other fat, it also tends to come off faster. [More good news:] losing just 2 inches from the waist reduces coronary risk by 11% in men and 15% in women, according to one recent study.

Further information from Weight Management for Your Life:

Some research indicates that elevated waist circumference (Men: equal to or greater than 40 inches; Women: equal to or greater than 35 inches) is a more specific risk factor for some diseases, such as prediabetes, than weight or BMI. An increasing waist-to-hip ratio may be a better indicator of coronary artery calcification than either waist circumference or BMI.  Therefore, weight distribution, as opposed to weight alone or BMI, must be taken into consideration; belly weight (abdominal obesity, “visceral fat,” or “central adiposity”) is of most concern. [see also here]

Mindful eating vs. mindless munching

May 28, 2008

A recent article in The Wall Street Journal (May 13, 2008) provides an excellent overview of the growing body of information about “mindful eating.” Two quotes from the article will give you an idea of what all the excitement is about:

Chronic dieters in particular have trouble recognizing their internal cues, says Jean Kristeller, a psychologist at Indiana State, who pioneered mindful eating in the 1990s. “Diets set up rules around food and disconnect people even further from their own experiences of hunger and satiety and fullness,” she says.

“Try to eat one meal or one snack mindfully every day,” advises Jeffrey Greeson, a psychologist with the Duke program. “Even eating just the first few bites mindfully can help break the cycle of wolfing it down without paying any attention.”

The article highlights research which demonstrates that mindful eating can reduce binge eating. Research to test whether mindful eating can be taught in a way to help people lose weight or maintain a desired weight is underway.

Here are some more links to sites and books that discuss mindful eating and mindless munching:


The Center for Mindful Eating

The Mindless Method program (Dr. Wansink)

the CAMP System (Control, Attitudes, Mindful eating, Portions)

book: Mindless Eating: Why We Eat More Than We Think (by Brian Wansink)

helpful blog post on Emotional Eating and Mindful Eating

blog: Eat, Drink, and Be Mindful

book (by me): Weight Management for Your Life

There are many other resources and books about mindful eating, but these should get you started (I don’t have any direct experience with the programs listed above, but they look interesting; I do know Brian Wansink is an expert in the field of eating behavior).

I agree that mindful eating can be a powerful tool and one of several ways we can take more control over our lives and the decisions we make.

Please write a comment about your experience with mindful (or mindless) eating.

Just asking — 4 questions to ponder

May 27, 2008

One of the strongest influences on weight management and healthy lifestyle is drinking alcohol. I am not referring to the fact that moderate drinking has been shown to have some health benefits (cardiovascular). Rather, too much drinking adds unwanted pounds and negatively affects the brain, liver, and most other organ systems. So, how do you know if you drink “too much?” One of the simplest ways to begin to find out is to take a screening test, such as the RAPS4. Here it is:

RAPS4 (Remorse–Amnesia–Perform–Starter):

1. During the last year have you had a feeling of guilt or remorse after drinking?
2. During the last year has a friend or a family member ever told you about things you said or did while you were drinking that you could not remember?
3. During the last year have you failed to do what was normally expected from you because of drinking?
4. Do you sometime take a drink when you first get up in the morning?

A “yes” answer to at least one of the four questions suggests that your drinking is harmful to your health and well-being and may adversely affect your work and those around you.

If you answered “no” to all four questions, your drinking pattern is considered safe for most people and your results do not suggest that alcohol is harming your health.

You also may have a problem if alcohol is causing or aggravating any specific health problem or lab test.

Here is a more detailed online test, developed by Johns Hopkins University Hospital.

What should you do if you think you might be drinking too much? Well, you can cut down by setting an upper limit of drinks per day and days per week. Or, you can try going alcohol free for 2 months or so and see how you feel after this experiment before deciding whether and how much to drink in the future. If either of these experiments is too difficult, strongly consider getting an evaluation from an alcohol counselor or therapist.

To end this post on a lighter note, here is a comprehensive review of cures for hangovers, from The New Yorker magazine (May 26, 2008). Bottom line: there is little scientific evidence to support any of the claims, but it seems alternating alcoholic drinks with glasses of water helps in several ways: less alcohol consumed, fewer calories consumed, less chance of dehydration (which alcohol consumption can cause).

The opposite of Happy-Well, in movies and in life

May 25, 2008

I just watched the movie that won Best Picture of 2007: No Country for Old Men.” I also watched another big movie this week: “There Will be Blood.” What do these very dark and pessimistic movies have to do with this blog, which is focused on how to be happy and well? Well, as I wrote previously (Life and death in the movies), good and bad, life and death, are two sides of the same coin. In Aging Well, Harvard psychiatrist George Vaillant did not find that people who aged well had especially charmed lives free of stress and tragedy; rather, they were able to look at the glass of life as half-full rather than half-empty. They experienced deprivation and loss, but managed somehow to look at the positives. At the same time, denial of reality does not help one attain happiness and that is not what he is recommending. Nor am I.

Dark movies about evil people can jar us out of complacency and challenge us to dig deep to find something positive to hope for. In the case of both of these grim movies, one can come away appreciative that it was a movie, and not our own life. Depictions of evil, if done artistically and with a certain amount of irony, can themselves show goodness, in a paradoxical way.

I had not planned this, but it seems I will use movies to generate thoughts and feelings about life and viewing the glass as half-full. I love movies, and probably have seen 20 or 30 per year for the last 5 decades. (I have also read hundreds of books, but I find movies easier to use in discussion — partly because more people have seen them than may have read a particular book.) Some movies grab us intensely in a brief time, and that can be a powerful experience.

Disturbing movies can shake us and challenge us in a way that mostly happy movies do not (I loved “Juno” and “Enchanted,” for example, but did not feel particularly challenged by them). Other movies present a balanced view of good and evil, and affirm the better sides of our nature, while still challenging us with tragedy and loss (for example, the movies I discussed in my previous post).

Which other movies capture the hopefulness of positive attitudes in the face of adversity, loss, or despair?  Several come to mind immediately: “The Band’s Visit,” “The Station Agent,” “The Visitor,” “Walk on Water,”  and “Once.” I risk making enemies when I praise specific movies, because we all have such unique taste.

Of course, movies cannot really capture the stark contrasts of dark and light that most of us experience in real life. As a psychiatrist for many decades, as well as a person living a complex life, I have experienced tragedy and loss up close and very personal. But movies can be shared and discussed and can illustrate the kinds of profound dilemmas we experience in real life.

And some movies can help us “reframe” an event or response in a more positive way, or a way with more potential for hope, as described in Weight Management for Your Life:

When we consciously look at a glass as half full rather than half empty, we are doing what many therapists teach their patients to do: using willpower to reframe, or change a negative way of looking at a problem into one with positive features. This does not mean we should automatically tell a person who just lost a loved one, “Be happy, s/he is in a better place!” Usually, reframing is most useful when applied to our own situation. It should be done intelligently and sensitively, and the rule of thumb here is to reframe in a positive way unless there is a good reason not to. That is, do not use reframing as a way of putting on rose-colored glasses in order to deny or distort reality. A successful reframe is both potentially true (factual, realistic) and positive. “Half full” and “half empty” are both true, but only one is positive.

What we choose to eat affects us, and others

May 24, 2008

We often talk about our food choices in reference to our own personal health, yet how and what we eat has far wider implications. For a vivid illustration of what I am trying to say, click HERE.

One example of how our eating affects the planet is the staggering consequences of eating food from cows. Listen to this recent story on NPR titiled “Is it Better to Eat Locally or Eat Differently?“.

In this NPR story, Michael Pollan has a more humorous and pragmatic take on the food choice issue: “If You Can’t Say It, Don’t Eat It.” He strongly advocates not eating food that is highly processed.

For an excellent book on this subject that might cause you to think more about the food you eat and how it affects others, check out Harvest for Hope by Jane Goodall.

My take: The more aware I become of how we (on this planet) are all in it together, the more I consider these factors in planning what to eat and how and where to shop. I have cut back on beef and dairy products, try to buy food that has less processing and less packaging, and consider the conditions in which the food was farmed and prepared for sale. After reading Goodall’s book, for example, I am much more interested in what types of seafood are endangered and how and where the fish was caught or farmed.

For a related post, see Another Reason to Lose That Weight.

What is the role of willpower in losing weight?

May 23, 2008

Perhaps no single issue in the ongoing debate about how best to maintain a desired weight, and generally live a healthy life, is more controversial than the role of willpower. Many “experts” avoid the term altogether, and assure their readers and potential customers that willpower is an evil concept which blames the victim of unhealthy habits. I was very surprised, therefore, when I saw this article on willpower in the New York Times (“Tighten Your Belt, Strengthen Your Mind” April 2, 2008). Could it be there is something positive to say about the concept?

Here is an excerpt from Weight Managemet for Your Life regarding the role of willpower in weight management (pp. 26-27):

While it is beyond the scope of this book to discuss the many meanings over time of the terms “free will” and “intentionality,” and whether human beings actually possess any, I believe we are able to exercise freedom of choice and, in varying degrees, make unique decisions and valid commitments. Neuroimaging studies (“functional MRIs” which show brain activity as we perform tasks) demonstrate that conscious decision-making accounts for from twenty to fifty percent of brain activity, depending on the novelty and complexity of the task. Many of our everyday decisions are made in the pre-conscious mind – outside our immediate awareness, but readily brought into awareness. Thus, our willpower (also referred to as conscious volition, intentionality, or self-control) is a force we can call upon when necessary, and with some degree of freedom.

When people hear the term “willpower,” many envision Sisyphus, from Greek mythology, who was condemned to repeat forever the same meaningless task of pushing a rock up a mountain, only to see it roll down again. That is because we usually only pay attention to our own willpower when we are having problems applying it to a difficult task. The majority of the time we use it without even being aware of it, such as when we decide to watch TV instead of reading, or vice versa. In the following sections, I will suggest ways to make willpower more accessible in order to increase your effectiveness in getting what you really want out of life.

Life and death in the movies

May 23, 2008

I watched 3 movies in the past few weeks which deal with the essence of living and dying. The first was “The Diving Bell and the Butterfly” based on the autobiography of Jean-Dominique Bauby who was completely paralyzed from a stroke but survived long enough to write a book by blinking one eye. The movie certainly confronts the viewer with questions about the meaning of life. To me, it emphasized the importance of communication and creativity. It also showed how important compassion can be. The second movie was “The Savages,” a work of fiction about a family (mainly a brother and sister) dealing with the declilne and death of their father, who was not a very positive force in their lives. To me, this movie also explored the meaning of life and the relevance of compassion.

Finally, I watched “Into the Wild,” based on the true story of a young man who leaves his parents and sister to strike out on his own, without money or attachments. I felt I was confronting the very essence of what it means to be alive and was, once again, impressed with the compassion shown by various individuals. I recommend all 3 of these movies.

I believe that, in order to fully live life and find some measure of happiness and emotional well being, one must in some way confront the inevitability and finality of death, including one’s own mortality. Hopefully, by so doing, one learns the importance of caring for oneself and others and also learns to give and receive compassion.

The power of social networks to improve health

May 22, 2008

Quitting smoking and losing weight (if you are overweight) are perhaps the two most important behavior changes you can make to improve your health. A new article in today’s New England Journal of Medicine confirms what a previous article has shown: people we interact with in our social network (friends, spouse, co-workers, etc.) strongly affect our behavior when it comes to smoking and weight gain or loss. We also affect the other people in our network. Today’s article is titled “The Collective Dynamics of Smoking in a Large Social Network” by Christakis NA, Fowler JH (NEJM, Volume 358:2249-2258). The earlier article, and similar research, is described in Weight Management for Your Life (p. 79):

In 2007, an article appeared in the New England Journal of Medicine with the title “The Spread of Obesity in a Large Social Network over 32 Years” [N Engl J Med. 2007 Jul 26;357(4):370-9] The same day the article was published it made front page news. No previous research had focused so intensively on “the obesity epidemic” as a social network phenomenon. The main finding of this elaborate study was that friends have a highly significant influence on our weight, specifically whether we become obese. The effect of friendship was surprisingly large and exceeded the influence of siblings and spouse (whose influence was also significant). … The editorial in the NEJM accompanying the article put it this way: “As the article by Christakis and Fowler [the researchers] shows, … networks, in this case those that pertain to social influence, may have just as strong an impact on the development of obesity as the otherwise strong genetic effects.”

These studies provide exciting and compelling evidence in favor of the bio-psycho-social model for disease and wellness, meaning that biological (e.g., genetic), psychological (e.g., coping) and social (e.g., interpersonal and cultural) factors interact to produce health problems and all must be addressed in reversing or treating these problems.

Weight loss supplements and diet drugs

May 22, 2008

Should you take willow bark, or drink green tea, to help you lose weight? Here is an article summarizing the latest scientific thinking about food supplements and chemicals marketed as weight loss aids. You have to register (and may have to be a healthcare professional) at before viewing the article titled “The Skinny on Weight Loss Supplements: Fact or Fantasy?” at

This website has connections with the pharmaceutical industry, so may have a bias in favor of the benefits of drugs (which I do not share). The bottom line is that FDA approved Orlistat has minimal value as “an adjunct to a diet low in saturated fat.” All the other supplements mentioned (Bitter Orange, Chitosan, Chromium, Conjugated Linoleic Acid, Fiber, Green Tea, Guar Gum, Guarana, Hoodia, Hydroxycitric Acid, L-Carnitine, Natural Licorice, Usnic Acid, White Kidney Bean Extract, Willow Bark, Yohimbine) have minimal or no efficacy, and many can cause serious side effects. Of the group, White Kidney Bean Extract (a dietary “carb blocker” which delays or attenuates the absorption of starch and carbohydrates) had a small weight-loss effect in one study.

The article concludes: “Before recommending such products, clinicians should inform patients of potential risks as well as questionable benefits. Lifestyle modifications, such as caloric restriction and exercise, should always be the first-line treatment for obesity. However, clinicians should recognize the popularity of products currently on the market and the likelihood that their patients may be using them.”

My take: Always beware of quick and easy solutions to losing or maintaining weight. As yet, there are no really good weight-loss drugs or supplements, and all of them come with significant downsides (cost, side effects, unknown long-term effects, interaction with other drugs and supplements you may be taking). See my website for excerpts from my book and also click on Frequently Asked Questions to see more of my approach to weight management.


May 22, 2008

It gives me great pleasure, and not a little anxiety, to launch this blog, which I am calling Happy-Well in honor of George Vaillant, the Harvard psychiatrist/researcher who is the author of Aging Well.

In his book, Vaillant reports on the results of a long-term study where men and women were monitored for decades. Here is an exerpt from Weight Management for Your Life which further describes the study (p. 8):

Vaillant writes about factors that seem to predict which research subjects turn out to be Sad-Sick (including dead) and which Happy-Well. One description of the Happy-Well group highlights their “learning to live with neither too much desire and adventure nor too much caution and self-care. … Rather, successful aging means giving to others joyously whenever one is able, receiving from others gratefully whenever one needs it, and being greedy enough to develop one’s own self in between.” After reviewing the data on all 1406 subjects Dr. Vaillant was pleasantly surprised to learn that most of the significant predictors of positive outcome were things we have some measure of control over: “The protective factors … – a stable marriage, the ability to make lemonade from lemons, avoiding cigarettes, modest use of alcohol, regular exercise, high education, and maintaining normal weight – allow us to predict thirty years in the future.

As you will see by glancing at the categories list, I plan to comment on a variety of health and wellness related issues, particularly ones which we can affect by changing our behavior. I hope you read and benefit from my postings, and I look forward to hearing from you!