Archive for the ‘Weight loss and maintenance’ Category

Parents, remember these numbers: 5210

July 29, 2012

Five-two-one-zero (5210) is a reminder of what our children need each day in order to be healthy. Here is the breakdown:

5    = Five or more servings of fruits and vegetables

2    = No more than two hours of recreational screen time (no screen time under 2 yrs old)

1    = At least one hour of physical activity

0    = Zero servings of sugary drinks (drink water and fat-free or 1% milk instead)

[To remember the numbers I think “five to ten”]

For more information see http://www.letsgo.org

Here is a short video to use as a teaching tool for children: http://youtu.be/TluNJeM6HAI

Here is a more detailed video for help in designing a 5210 program in a community: https://vimeo.com/29985972

Best diets according to expert panel

January 8, 2012

This is an interesting listing and ranking of 25 potential diets according to a panel of experts and published in US News (here and here). The six top-rated diets overall are:

Dash Diet

DASH was developed to fight high blood pressure, not as an all-purpose diet. But it certainly looked like an all-star to our panel of experts, who gave it high marks for its nutritional completeness, safety, ability to prevent or control diabetes, and role in supporting heart health. Though obscure, it beat out a field full of better-known diets.

TLC diet

Therapeutic Lifestyle Changes, or TLC, is a very solid diet plan created by the National Institutes of Health. It has no major weaknesses, and it’s particularly good at promoting cardiovascular health. One expert described it as a “very healthful, complete, safe diet.” But it requires a “do-it-yourself” approach, in contrast to the hand-holding provided by some commercial diets.

Mayo Clinic Diet

This is the Mayo Clinic’s take on how to make healthy eating a lifelong habit. It earned especially high ratings from our experts for its nutrition and safety and as a tool against diabetes. Experts found it moderately effective for weight loss.

Mediterranean Diet

With its emphasis on fruits and vegetables, olive oil, fish, and other healthy fare, the Mediterranean diet is eminently sensible. And experts’ assessments of it were resoundingly positive, giving this diet an edge over many competitors.

Weight Watchers

Weight Watchers is a smart, effective diet. It surpassed other commercial diet plans in multiple areas, including short- and long-term weight loss and how easy it is to follow. It’s also nutritionally sound and safe, according to experts. Among its pluses: An emphasis on group support, lots of fruits and vegetables, and room for occasional indulgences.

Volumetrics

Volumetrics outperformed its competitors in many categories. It earned particularly high marks for being safe and nutritious, and experts said it could have a positive effect on heart health and diabetes. “This is an eating plan that everyone can benefit from,” one expert said.

My recommendation is to read my previous post (here) and then choose the diet that appeals to you most, with the intention of sticking to it for at least a year. After that, choose another. The point is to stick to some kind of eating plan for the rest of your life.

Diet advice for 2012 – from Cleveland Clinic

January 5, 2012

It’s  a new year and I resolve to write more blog posts this year than last. So, I’ll start with what is on many people’s minds now: which diet should I choose? Here is the latest from a respected source – Cleveland Clinic.

This New Year’s, losing weight will undoubtedly top many Americans’ list of resolutions – and it’s an important one. One reason? Heart disease is the main health threat caused by obesity. Make your efforts to slim down more successful this year by becoming wise to the “secret of calories!”  …

Just follow these 5 rules:

1. Understand the basic principal of dieting for weight loss. With all of the opposing diet plans forbidding carbohydrates or preaching against fat, it’s easy to see why confusion prevails. But, Cleveland Clinic experts say, recent studies comparing these different diets have found that the proportion of carbohydrates, proteins and fats in your diet do not influence weight loss. 

This means, in a nutshell, you can lose weight with any diet as long as you burn more calories than you take in. That’s the secret.

2. Know how many calories you need. Would you believe that of the half of Americans who are dieting at any given time, only 12 percent know how many calories they should consume daily? This number, which for adults ranges from 1,600 to 3,000 a day, depends on your age, gender and activity level. [Here is a useful daily calorie calculator]

3. Change your calorie intake to lose weight. If you want to lose weight, eat fewer calories than you burn. Eat 500 to 1,000 fewer calories per day and you will lose weight, often one to two pounds per week. But don’t be discouraged when weight loss begins to slow after a few weeks of dieting – this is a normal event as your body adjusts to your new diet. Keep watching calories and exercising and you will keep heading toward your weight loss goal!

4. Don’t be fooled by fad diets. More isn’t always better. In fact, it can be harmful. Any loss of more than two pounds a week is usually just water weight. Studies also show that the faster weight comes off, the quicker it is regained. Stick to a diet that has a goal of only one to two pounds weight loss a week [even better, in the long run, would be one pound per month].

5. Choose a diet you can live with. For your weight loss and weight maintenance efforts to succeed, you must continually manage your calories. No one diet is better than another. Studies show dieters tend to lose five to 10 pounds over the course of a year, regardless which diet they pick. What’s important is to pick a diet that works for you and that you can stick with. And if you’re not successful, pick a different diet next time.

Six small changes can help keep pounds off

January 14, 2011

This post is based on an article in the February 2011 issue of Consumer Reports magazine. The average middle-aged American gains 1 to 2 pounds per year. These six simple changes will at least help stop the weight gain, and may help you lose a few pounds.  Fad diets that promise more not only don’t work, most research shows they result in even more weight gain over the long run.

“Those who start with small changes often end up able to make more and bigger changes and lose more weight.”  James O. Hill, Ph.D. (University of Colorado)

1.  Stop drinking calories. Many drinks contain lots of calories.  Yet, when we consume calories in liquid form we don’t feel full or satisfied, so we eat just as much as we would without the beverage (or more, if the beverage contains alcohol or salt).  Calorie-free “diet” drinks do not cause weight gain, so are a better choice (but not as good as water).

2.  Eat more protein. Low-carb, high protein diets have proved surprisingly effective, especially in the short term. People who eat a higher proportion of their calories from protein end up consuming fewer calories overall. The bottom line is it can’t hurt to substitute a bit more lean protein for some of the fat and starches in your diet.

3.  Eat more fiber. “Fiber is the good guy of food,” according to the Consumer Reports article. “Grow the amount of vegetables on your plate and shrink everything else,” says Barbara Rolls, Ph.D. (Penn. State University).

4.  Lead yourself not into temptation. If there is an unhealthy food you crave, don’t have it where you can eat it impulsively.  See this post for more about the addictive properties of fat, salt and sugar in processed foods.

5.  Add 2000 steps per day. You can do this all at once, or divide it up, but the point is to get moving. See this post for more about exercise.

6.  Cut your screen time. This is related to number 5,  but is worth emphasizing because we spend more and more time seated in front of various screens (TV, computers, games).  Excessive screen time is correlated with more obesity and other health problems. For children, especially, it is important for parents to set limits on screen time, and to model by their own behavior how to stay active.

One more change: practice mindful eating. The best way to make this a habit is to write down everything you eat (keep a food log or diary).  If you do this, you will lose (or stop gaining) weight.

Do you know a fat person?

July 20, 2010

Call them obese, huge or fat — the stigma won’t go away. And I’m not sure it should.  Obesity is bad for a person’s health, bad for the planet, bad for fellow airline passengers, and even bad for babies born to obese mothers (which, in turn, is bad for the economy; see NYTimes article).  When something causes this many personal and social problems we usually assume it is not a good thing to have or be.

“But,” some say, “we mustn’t blame the victim.  Obesity isn’t a weakness or a fault; it’s genetic. When we stigmatize people, they suffer even more, and may even avoid seeking help.” There is a kernel of truth to this concern, but it distracts us from the main point: obesity can and should be eliminated over time, through more research, and through attacking many known contributing factors (factors such as the  marketing and subsidizing of unhealthy foods).

The most active researchers who advocate against “weight bias” and “weight stigma” (Kelly Brownell and Rebecca Puhl at Yale, for example) also tell us that the obesity epidemic is growing and the health consequences are horrible.  They do not claim the problem is due to a change in genetics.  People can do a lot to prevent and even treat obesity, without altering genes (see many of my posts in this blog).

An anti-obesity program in Singapore that targeted overweight children was discontinued because of concern about stigma, even though the program was effective (reducing the percentage of overweight children from 14% to 9.5% in fourteen years — 1992 – 2006; click here for more information). I don’t know what should have been done in this case; there are no easy answers.

Outright discrimination against people based on appearance is generally wrong, and fat people should be treated sensitively and humanely, no matter what caused their affliction.  (Many equate stigma with discrimination, but I see a difference between the two concepts.)

Whether or not it reduces stigma, television has recently upped its focus on obesity by producing such shows as “Drop Dead Diva,” “Huge,” “Mike and Molly,” and, of course, “The Biggest Loser.”  A new series starts next month, “Too Fat for Fifteen: Fighting Back,” and at least one other obesity-related series is in the works. See this article for a discussion of how obesity is being addressed on TV.

[The photo at the top of this post is from ABC Family’s series “Huge”]

What do you want? A three part question.

June 6, 2010

Many years ago, when I was a young psychiatry resident, I went through a period of great confusion, in my personal life and as a neophyte professional. A trusted friend, a psychologist who was older and wiser than me, looked me straight in the eyes and demanded my full attention before asking me, in a tone fraught with meaning, “What do you want?”  I sat there in stunned silence, my mind suddenly clear of the jumble of racing thoughts that had prompted her question.  Instead, I had only one thought, echoing in my mind and making my head hurt:  What, indeed, did I want?

Now, decades later, I often think of that moment and smile at the simplicity of the question and the obviousness of the answer.  But it took me years of trial and error to really grasp the import of the question.  What I want depends on the unstated part of the question:  Right now, in this moment?  Or, in the near future?  Or, in the long run?

For example, if I am at a restaurant surrounded by people I enjoy and having a grand time, do I really want to order another martini?  It would taste good, and the rush would certainly feel good.  But, past experience tells me I would not sleep well that night, and would feel less than my best the next day.  In the long run, if I regularly doubled my alcohol intake, I might put on some unwanted pounds and suffer other negative consequences.  I have never regretted NOT having a second martini, but have often regretted having one.  So the answer is obvious: No, I do not want another martini, thank you.

Little decisions mount up to big ones.  And big ones, of course, may come at us all at once, as in “Do I want chemotherapy?  Do I want to marry this person? Do I want a divorce? Do I want to adopt a baby?”  I contend the same three parts apply: immediate gratification, short range implications, long term likelihoods. We may have to delay the decision pending some research, or the counsel of others.

What makes this point worth writing about is that so often, in my psychiatric practice and in my life, I have seen people fooled into thinking what they WANT is immediate gratification.  The denial of that (saying “No, thanks” to the offer of a second martini) is not seen as what they want, but as what they SHOULD do, or what they KNOW, but not what they WANT.  That, to me, is ridiculous, because there is no reason to define what we want, really-honestly-deeply want, as simply what is tempting in the moment.

Stating our decisions as what we WANT is a way of taking full responsibility for ourselves. That is why I say so often in this blog that the secret to happy, healthy living (at least that part we control) is re-framing our thinking from what we should do, to what we want to do — in the moment, for the short term, and for the long run.  Striking a balance among the three versions of “want” can be tricky; no one promised it would be easy.  Do you WANT that bag of french fries, or don’t you?  What about that puppy?

Why “Eat only when you’re hungry” won’t work

May 15, 2010

During a recent social event, the conversation turned to weight loss and dieting. One of the women said she read a new book and it had “the answer” to her problem of weight gain: eat only when you’re hungry.  Many books and weight loss plans, in fact, emphasize this point, offering various tips and methods to define “hungry” and help the reader learn what kind of hunger, exactly, they should satisfy and what kinds they should ignore.  The worst books (in my opinion) give the message that people gain weight because of various psychological or “spiritual” hungers that we try to assuage with food.  There is little to no consistent science to back up these claims, and I believe the message does much harm, because it implies an almost magical answer to the problem  of overeating.  When it inevitably fails to work, the victim of this propaganda is left with yet another cycle of failed dieting and increased weight.

As recently as hundreds of years ago, most people did need hunger as a cue to begin eating, because their days were full of physical labor and food was not always readily available.  But, in recent decades, this situation has changed dramatically.  Now, most have relatively low levels of physical activity and the availability of food has increased exponentially — to the point where there is a glut of high calorie, low cost “food” in our faces continually.  We rarely get hungry in the old sense of the word, because these cleverly marketed and subsidized foods (high in sugar, salt and/or fat) overwhelm our biological regulatory systems.  Instead, we develop cravings and hungers triggered by environmental cues and implanted “beliefs” from our culture, no longer based on biological requirements.  In a sense, we get “addicted” to unhealthy foods and lose our ability to trust our hunger.

So, what can we do?  Easy — and difficult.  Train ourselves to ignore these contrived temptations; limit our exposure to them (most importantly, protect our children from them!).  Learn what a healthy lifestyle looks like and adopt it.  Avoid frequently eating “addictive” foods containing large amounts of  sugar, salt and fat.  And advocate, loudly and often, for changes in our culture so that fruits, vegetables and other unprocessed foods are cheaper and more available than the junk food that now receives so many economic advantages.

For more information and tips, check out these links:

Food Industry Pursues the Strategy of Big Tobacco

Coping with the obesity epidemic

Ending overeating

Overeating leads to more overeating

What does 200 calories look like?

Do not — DO NOT — deprive yourself

Mindful eating vs. mindless munching

Weight Management for Your Life: Ten Steps to Prepare You for Adopting a Healthy Lifestyle

I recommend Nutrition Action Health Letter, available by subscription from the non-profit CSPI (regarding today’s post: see the May, 2010, cover story “How the Food Industry Drives Us to Eat” featuring an interview with Yale’s Dr. Kelly Brownell).

P.S.  I have not posted in the last 3 months for several reasons, one of which is having surgery and recovering.  I’m fine now, though.

Lose weight with your iPhone

November 8, 2009

iphone scale

If you own an iPhone (or iPod Touch), this simple program will help you maintain or lose weight, if that is your goal. Even if you don’t own one of these devices, the basic approach of this program may give you some good ideas. David Pogue of the New York Times writes:

Lose It! This beautifully designed weight-loss app has an astounding number of followers, if the outpouring of enthusiasm on Twitter is any indication. You tap to record everything you eat. It’s actually kind of fun, because the program contains every food item you can imagine, including brand-name packaged food and restaurant-chain menus. For each one, the app lists the complete nutritional information.

You also indicate what exercise you get each day, using a similarly complete list of activities. Finally, you tap in your weight each day. Probably because the app focuses you so well on staying true to your goals, its fans say it truly works. (Free)

You may read the New York Times article here. And you can download the app and read more about it here.

Ending overeating

July 7, 2009

Kessler overeating

A very important new book (The End of Overeating: Taking Control of the Insatiable American Appetite by David Kessler) accurately describes major factors contributing to the obesity epidemic: cleverly formulated manufactured food designed to seduce us into overeating, addictive ingredients (salt, sugar and fat) which act like nicotine in cigarettes to keep us coming back for more, a profit driven system of marketing and government subsidies which works against our best interests, and the loss of boundaries limiting when and how much we eat. It is indeed frightening to think that a 2-year-old’s appetite “knows” to shut down when enough calories have been consumed, but by the time that child is four (in our culture) there is often a loss of that self-control mechanism.

Kessler’s solutions include re-training our minds to devalue unhealthy processed foods loaded with the Big Three (salt, sugar, fat); reforming our policies and practices which encourage this vicious cycle; and doing much more to educate people as to what they are consuming (such as requiring nutritional information in restaurants).

I agree with all this, but take issue with some of the concepts Kessler promotes. My main complaint is he oversimplifies the issue of food containing salt, sugar and fat by using an addiction model. Too much of these ingredients is indeed unhealthy, but a simple addiction model will not work.

Another problem is his use of the term “real food” (see NPR interview) which is a vague concept, at best. Many seemingly real foods contain salt, sugar and fat (either naturally, or because of the way they are produced), and not all “manufactured” foods are bad (e.g., some fish farmed in a sustainable way are better for us than some “wild-caught” fish). I can buy a chicken that has been doctored with added salt and fat, or I can buy one (usually smaller and more expensive) which has been grown almost organically. To the average consumer, both seem “real.” Also, I can buy “sea salt” and “unrefined real sugar” and think I am getting something healthier than standard table salt and corn syrup, but the bottom line (sodium and calories) may be exactly the same.

Finally, he promotes a black vs. white dichotomy between a disease-like state we cannot directly control (“conditioned hypereating”) and old fashioned willpower, telling us “it is not our fault” that we overeat. Fault, per se, may not be the issue; rather, we should learn ways to increase our resistance to external cues and marketing, educate ourselves about nutrition and portion size, and practice coping skills to enhance self-regulation. I have written about this at length elsewhere.

Learning self-control and delay of gratification

May 22, 2009

New Yorker marshmallows

A now classic psychology experiment from the late 1960s demonstrated that four-year-old children who were able to delay the gratification of eating a marshmallow became more successful in later years than children who could not exercise as much self-control. In an update of the research on this topic, Jonah Lehrer (writing in The New Yorker recently) quotes the original researcher and many others discussing how we learn to control our brains when it comes to resisting temptation and applying ourselves to a task (such as controlling what we eat or exercising more).

The marshmallow researcher, Walter Mischel, says, “Once you realize that willpower is just a matter of learning how to control your attention and thoughts, you can really begin to increase it.”

Teaching children (and adults) simple ways to master their thoughts and behavior (through “strategic allocation of attention”) may be a crucial ingredient in increasing success in many activities.  For example, the children who were successful in resisting the marshmallow temptation

distracted themselves by covering their eyes, pretending to play hide-and-seek underneath the desk, or singing songs from “Sesame Street.” Their desire wasn’t defeated—it was merely forgotten. “If you’re thinking about the marshmallow and how delicious it is, then you’re going to eat it,” Mischel says. “The key is to avoid thinking about it in the first place.”

Mischel and other researchers are very interested in studying the people who have become “high-delaying adults” (exercising self-control) even though, as children, they failed the marshmallow test.

Some researchers (e.g., John Jonides at University of Michigan, and others) are focusing on the exact locations and functions in the brain associated with self-control and delay of gratification:

Yale University researchers found that delaying gratification involves an area of the brain, the anterior prefrontal cortex, that is known to be involved in abstract problem-solving and keeping track of goals.  … The brain scan findings from 103 subjects suggest that delaying gratification involves the ability to imagine a future event clearly, said Jeremy Gray, a Yale psychology professor and coauthor of the study in the September [2008] edition of the journal Psychological Science. You need “a sort of ‘far-sightedness,’ to put it in a single word,” he said. [reference]

Mischel, the original marshmallow researcher, adds:

The key to delaying gratification may lie in the ability to “cool the hot stimulus,” he said in a telephone interview.

Over and over, research is showing that the trick is to shift activity from “hot,” more primitive areas deep in the brain to “cool,” more rational areas mainly in the higher centers of the brain, he said.

There are many ways to cool a hot stimulus, said Mischel, who is president of the Association for Psychological Science. Say you are determined to resist the chocolate cake at a restaurant. You must distract yourself from the waiter’s dessert tray. You can also focus on long-term consequences and make them “hot” – by vividly imagining your future tummy and hip bulges – or think of the cake in the cooler abstract, as a thing that will make you fat and clog your arteries.

In the marshmallow test, he said, “the same child who can’t wait a minute if they’re thinking about how yummy and chewy the marshmallow is can wait for 20 minutes if they’re thinking of the marshmallow as being puffy like a cotton ball or like a cloud floating in the sky.” [reference]

A large-scale study is now underway, involving hundreds of schoolchildren in Philadelphia, Seattle, and New York City, to see if self-control skills can be taught.

More resources: