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.

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Five movies about teenagers

January 5, 2011

By chance, I watched five movies in the past few weeks about teenagers, four of them girls. I can’t say I have any new insights into the teenage mind (for that, I suggest you at least read this), but here are my very brief reviews:

World’s Greatest Dad” stars Robin Williams and is R rated, for good reason.  It is an unexpectedly dark comedy and will no doubt offend some (e.g., those who don’t want to laugh when a teenager accidentally hangs himself during sexual stimulation).  I liked it a lot, though, and recommend it.

Hard Candy” is not a comedy, but is extremely dark.  Ellen Page and Patrick Wilson play the main characters, a 14-year-old and a much older “friend” she met online.  Both are outstanding in their roles and the low budget movie is very well made.  It earns its R rating for keeping you on the edge of your seat (if not under it) as the two play a cat and mouse game around the subject of pedophilia. Page in this role reminds me of Kathy Bates in “Misery” and Noomi Rapace in “The Girl With the Dragon Tattoo”.  I recommend it.

True Grit” is a remake of a classic, and also classic Coen brothers.  As in “Hard Candy” the main character is a 14-year-old girl who has an unusual amount of grit.  The dark comedy is definitely here, if you can find it in the bleak surroundings.

The teenage girl in “Winter’s Bone” is as gritty as any of the above.  The movie takes you to a geographical place and sub-culture you very likely have not visited before.  This is also an excellent R rated movie.

The fifth teenager-themed movie I saw was “Easy A” which has a good cast and has received positive reviews; I expected to like it.  The best I can say is it was mildly entertaining, if  you like silly and campy. I didn’t this time; thumbs down.

A sixth movie, “Precious” , also features a tough teenager.  I blogged about it earlier (here), so won’t count it in this group.

Make your New Year commitments now

December 16, 2010

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The problem with New Year’s Resolutions is that they are usually reactive and rarely work. By reactive, I mean they tend to be the result of a feeling that “I have overindulged” or “been bad” last year, so I will make amends this year.  This kind of thinking is self-defeating.  Diets don’t work, and Resolutions don’t work.

What does work is a full time commitment to practicing specific, realistic behaviors, such as setting a goal to walk 30 minutes a day, or to stop buying fat-and-sugar-laden snack foods to keep in the pantry.  An annual review and re-commitment can be helpful, but I suggest the best time to do this might be December rather than January.

Here is an excerpt from Weight Management for Your Life that may give you some idea why I think December, with all of its “special occasions,” would be a good time to review and renew your healthy-living plan:

If you have been successfully working on changing your eating and exercise patterns for some time, you will encounter situations where someone will say to you “This is a special occasion, so go ahead and eat that cake!” The cake is not the issue, but the implication behind the statement is. People observing your healthier lifestyle will assume you are in a constant state of self-deprivation, and will want to see you “loosen up.” It is important to them to feel okay about their own “indulgences.” The problem with your buying into that theory is that it discounts the fact that you already are eating (and exercising) the way you want to. You are not depriving yourself – in fact, by doing what you want, you are indulging yourself. Your ongoing healthy lifestyle is its own reward.
Another problem with going back to old unhealthy habits, even temporarily, is that such “special occasions” come up frequently: out-of-town trips, weddings, graduations, birthdays, holidays, cruises, office parties, etc. etc.  Add the special occasions with their special “indulgences” or “rewards” up over the course of a year and you have put on an unwanted five to ten pounds. … Special occasions are even more special when they don’t throw you off your chosen path.

Happy new year!

Willpower and Fun: a win-win combination

December 12, 2010

In a few weeks it will be January, and at least half the U.S. adult population will be groaning about how much they overdid the holiday spirit and how much they need to suffer to get back in shape. It doesn’t have to be that way.  Exercising willpower and self-control now can put you way ahead of the game later.  But how to do this and still have fun is the big question.

My take is there is no fun, in the long run, in acting as if there is no tomorrow.  This applies all year long, not just during a hectic holiday season.  Being mindful of the beauty and joy of this, and every other, season is what it takes to truly appreciate what we have.  Eating mindfully allows us to truly savor the good food.  Being fully present, and not rushed or distracted, when with friends and family enhances the good feelings (practicing mindfulness also helps combat depression; see here).  On the other hand, neglecting yourself (eating and drinking too much and not exercising) leads to bad feelings and regrets.

Willpower is a controversial topic, but should not be.  We all have it in varying degrees, and there is a lot we can do to get the most good out of it.  See these previous posts for some ideas.  Mainly, treat your willpower and self-control as a valuable but limited resource.  Don’t expose yourself to extreme amounts of temptation (see this study).  Strive for balance in your life, during holidays and all the rest of the time.  Finally, I suggest, don’t define “fun” as a continuous orgy of indulgence.  What is your definition of “fun”?

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”]

“Corny” isn’t necessarily bad — a book and a movie

June 9, 2010

I just read a book and saw a movie, and each had “corny” elements. But I highly recommend the book, and disagree with the critics who said the movie is terrible.  Corny, by the way, can be defined as “overly or simplistically sentimental” or as “trite and melodramatic.”

The book, The Guernsey Literary and Potato Peel Pie Society, does have a sentimental and predictable main plot triangle, but is very readable and takes you to a world you may not have known about.  It could be minimized as “chick lit,” but this male liked it a lot.

The movie, Sex and the City 2, could also be dismissed as predictable and overly dramatic fluff (as most critics have said), and it is mostly meant for SATC addicts.  However, it deals with several important issues (marriage, parenthood, menopause, women’s rights, sexuality, friendship) and some of the scenes illustrate these issues in memorable ways.  Many will hate it (especially since it is 2 1/2 hours long), but I didn’t.  I found the Abu Dhabi segment interesting; I suspect they accurately portrayed some of the cultural contradictions.  I won’t rate it highly for acting, and the conspicuous consumption (and product placement) can get sickening, so if you go, go with low expectations.

The main reason I decided to write a post about this is I want to defend “simplistic, trite, sentimental and melodramatic” a bit.  Life experiences and lessons learned can be corny, yet also profoundly meaningful.  Melodrama and sentimentality permeate our lives, and seeing them in the mirror of art (or entertainment) can make us uncomfortable.  “Trite” means over-used, and “banal” means commonplace, but the other sides of those coins (to use a trite phrase) are “familiar” and “universal.”  Do we only value that which is original and unique?

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?

How many times a day should we eat?

May 26, 2010

I stated in my last post that we cannot trust “hunger” as a cue for when to eat. But how do we know when it IS time to eat?  For me, and I suspect for many others, the three-meals-a-day “rule” works well.  In fact, I believe that for most people who struggle with weight control, eating more often, “grazing,” or snacking between meals only adds to the problem.

Now, many of you believe that six or more small meals per day, or three meals plus two or three snacks, is best (e.g., see comment by Personal Trainer on my last post).  And for some people there is a medical reason for eating more often than three times per day (e.g., people with dyspepsia, GERD, hypoglycemia, etc.).  Some of these medical indications are valid, and some are not.  I won’t get into that here.  What I do know is that the more we snack, the more likely we are to consume excess calories (see this research report).

A survey reported this year in the American Journal of Clinical Nutrition found that in the thirty years between the 1970s to the early 2000s, for adults and children, the average time between eating occasions shrank by one hour (most recently, 3 hours apart for adults and 3.5 hours apart for children).  Daily calories for both groups increased from roughly 2,090 in the 1970s to 2500 in the 2003 – 2006 period.

Calories from snacks more than doubled: for adults, from 200 calories per day in the 1970s to 470 calories in the recent time period; for children, from 240 to 500.  A significant portion of snack calories came from beverages.  It can be assumed that these numbers are underestimates, since surveys usually under-report the number of calories consumed.  [The above research was described in the May 2010 issue of Nutrition Action Health Letter]

It makes sense to me that the more often one eats, the more one is exposed to temptation and calories.  Also, we know that “willpower fatigue” occurs, so that the more often we have to decide what and how much to eat, the less “willpower” we are left with by the end of the day.

One known cause of overeating, which is also closely related to snacking, is “emotional eating.”  The solution to that problem is mindful eating, plus tending to emotional issues in a more appropriate way.

Personally, one of the most effective things I have done over the years to maintain my weight in a healthy range is to eliminate snacking.  It takes some getting used to — for example, eating dessert just before bed was a long time habit for me — but it really makes a difference.  And I haven’t developed hypoglycemia, insomnia, or any other health problem as a result.

If eating three daily meals (assuming the portions are reasonable and the food is mostly “healthy”) works to maintain weight, would two meals be even better?  Apparently not, according to several studies.  People who skip breakfast, for example, tend to weigh more than people who don’t.

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.

Sexual abuse of women and girls — a strange day

February 9, 2010

My day definitely had a theme, because I saw, heard, or read four different takes on it. The theme was sexual abuse of women and girls, starting with this column by Nicholas Kristof, progressing to the movie “Precious,” then listening to Eve Ensler talk about girls and the challenges they face, finally capping off my unusual day with another movie, “I Can Do Bad All by Myself.”  They all interacted in my mind, leading to the conclusion that it would help to have more discussion of this difficult topic.

Kristof, a New York Times columnist, often writes about abuse of women as it occurs in undeveloped countries; he may even be the go-to authority on the subject.

The movie “Precious” is nominated for best picture this year, and should be a strong contender.  Despite what you may have heard, “Precious” has an optimistic component and goes beyond simply being a horror story (photograph above is of the main character, Precious).

Eve Ensler began a discussion of what it means to be female with the wildly successful “Vagina Monologues,” and continues to champion the cause of openness and full discussion of women’s issues.

Finally, Tyler Perry adds humor (and singing!) to the mix, but nevertheless takes sexual abuse very seriously in “I Can Do Bad All by Myself.”  No Academy Award nominations for this one, but I liked it.

My hope for this brief post is that you check out some of these four examples, give the topic a lot of thought, and do what you can to make the world a kinder and better place.