Being on a weight loss diet can be annoying.  It's tough to have rules to follow, frustrating to face restrictions, and maddening to cheat when you promised yourself that you wouldn't.  But as annoying as that diet can be, it can also provide an underlying sense of relief.  Once you hit your stride, you are following a plan.  The anxieties caused by an overwhelming number of food choices are tamped down.  You've got a roadmap to follow.

In my medical practice, we offer the option of beginning weight loss with two weeks on a diet of pre-made liquids and bars.  Although we don't push for this choice, most people elect it.  They tell us that they have a feeling of freedom when they don't have to make any food decisions at all.  They also enjoy a sense of putting distance between themselves and the way they used to eat.  They like having a plan, even a very restrictive one.

Studies show that weight loss is achievable on virtually any diet, as long as that diet is followed very consistently.  This conclusion might lead you to believe that all diets are equal.  But there is an important piece of information missing.  What allows consistency to happen?  Is it possible that some people can't follow a given diet because it does not fit them properly?  We know that this is true. For example, people who are pre-diabetic or insulin resistant may find the Atkins diet easy to follow because it takes insulin out of the picture.  Smaller people with normal insulin, on the other hand, might find it very difficult to adhere to a diet that is so low in carbohydrate.   

Each of these points, the importance of having a roadmap and the importance of that map fitting your personal needs, has major implications for your success…not only during weight loss but after weight loss as well.  Once you enter maintenance, experience has shown that you are headed for failure if you don't have a well thought-out plan and if that plan doesn't match up with your needs.

Most people don't like to think of themselves as continuing "on a diet" after they finish losing weight.  (And by the way, no one ever thinks they are finished losing or is ever completely happy with the weight they've achieved.  So let's just say we are talking about a plan you need once your body has given up whatever weight it is able to get rid of at this particular time).  Since in America we use the word “diet” to mean weight loss, we have to give the post weight-loss plan another kind of name.  Let's call it a personal Food Constitution.

Unlike diet books, Food Constitution books are not to be found 50 deep in your local Barnes and Noble.  No one cares much about publishing something about how to construct this most important of documents.  (Refuse to Regain is one exception.  You might also look at the Thin for Life books for ideas) As I was told by my book agent, publishers are only interested in books that solve problems.  Once weight is lost, she said, most people think they don't have a problem any more.  At first, I didn't believe her.  But now I do.  We still have a lot of work to do in order to convince people that the heavy lifting begins with the end of dieting.

So, you will have to be your own Thomas Jefferson figuring out the self-imposed rules and safeguards that keep your personal union strong.   Like the framers, you should seek to produce a plan that can work for many years, albeit with a few amendments.  And the plan should make you proud.

So how to begin?  Here are my suggestions, but remember, each plan will be different and personal to your needs:

1. Start with Your Endpoints

What do you want to preserve and protect?  It may be weight.  But it also may be a new, lower Hemoglobin A1c, a life without blood pressure medicine, a commitment to supporting local agriculture, or a desire to be more organic. Your constitution is not just a way of eating, it's a way of being which will reflect who you are for some time to come.  When you defend this plan to others, you want to be proud of what it says about you. 

2. Look to the Diet That Created Your Weight Loss

In general, the diet that got you to the dance is the one that, with some tweaks, will work to maintain your loss.  This is not to say that you can't go a completely different way in maintenance, but this is an easy and reasonable starting point.  Spend several months expanding your weight loss diet slightly and gradually.  Be extremely careful about carbohydrates.  I'm not going to reiterate my personal biases in detail, but suffice if to say that carbs create insulin which creates fat and many carbs tend to trigger addictive food responses. 

Create default menus, meals which you know you like, which don't cause weight gain and which you can make easily.  While working on these basic menus, consider food timing as well.  Are you someone who needs frequent snacks to get through the day?  Slot them in.  I personally recommend creating some food-free periods each day that last at least 2-3 hours.  This allows the body to use some of the food you've stored.  If you decide to do this, figure out when these periods fit best for you.

If you don’t like your weight loss diet or feel it is unhealthy to continue, see the next suggestion.

3. Start Spare

If you are starting from scratch, start basic.  In the beginning, eat mostly vegetables, low fat animal proteins (lean meat, poultry, fish, eggs and low fat dairy), fruits and nuts.   Make the vegetable part bigger than the animal and fruit part.  Practice eating this way and see if you can get comfortable right there.  If not, experiment with some add-ons.  Be very careful with adding back if you are someone who had any of the markers of insulin resistance.  These include: weight mostly in the belly, high blood pressure, borderline or high blood sugar, high triglycerides, low good cholesterol.  People who are insulin resistant should really, truly stay away from starches and sugars lest their problem swiftly recur.  Similarly, if you are someone who has had an inflammatory condition (like rheumatoid arthritis, inflammatory bowel or multiple sclerosis for example), I would think twice about the re-introduction of grains.  If you do decide to broaden your diet, start with beans, lentils and other legumes.  Try a sweet potato here and there.  See if the scale stays stable.  It’s hard for me to give you direction on grains as I am not a fan, but if you go that route, watch the scale closely and look for any inflammatory issues like eczema, joint aches, etc.  There are certainly those who can tolerate grains, but I’m not convinced that people who have been overweight in the past are among them.  If you are doing fine and staying weight stable, then grains would seem to work for you.

4.  Consider the Use of Calorie Labeled Foods and Meal Replacements

While I advocate a maintenance diet that avoids most processed foods, there are still benefits to using pre-labeled foods in your daily plan.  Many people take one meal out and replace it with a yogurt, nutrition bar, or liquid supplement. These foods allow for complete control of calories and knocking one meal out makes life a lot easier.  

5.  Find Your NTTs

Non Triggering Treats are foods that are sweet, savory or even a bit salty that feel like fun but don’t throw you under the bus.  A regular ice cream bar might send you off on a binge, but a Weight Watcher’s ice cream sandwich might not.  You might concoct your own NTT (one of my patient’s loves smooshing frozen blueberries in low fat creamer and splenda) and discover that it does the trick when you simply have to eat something during American Idol.  Every long term eating plan needs some NTTs.  Work on a list.

The most important tip I can give you for how to eat after weight loss is this one:  Do it With Conviction!  Successful maintainers have, for the most part, undergone what I call a Food Conversion.  They believe something different about how to eat than they did before and the change is pretty radical.  The period directly following weight loss is critical, because new maintainers do not have this sense of belief just yet.  It’s something that comes as you learn to enjoy your new diet and see its benefits:  sort of like an arranged marriage that blossoms into love.  So don’t go running back to your old lover---the standard American diet---just yet.  Give the new one a chance.  He or she may look a little geeky right now, but there’s a powerful magic lying beneath that unassuming exterior.  Don’t you want to find out what it is?

Since 1980, the US Department of Agriculture has been producing dietary guidelines for the American people.  These guidelines and the infamous "Food Pyramid" which illustrates them serve as the backbone for our country's dietary advice, a kind of gospel of nutritional correctness.  The guidelines are announced every five years with great fanfare (2010 Guidelines).  The committee cites the latest research and announces its findings with great seriousness.  This task has taken on an even greater urgency in recent years.  The reason is simple.  In the 30 years since the first Dietary Guidelines were released, Americans have become alarmingly more fat and more sick than at any time in their past. 

Those food geeks who (like me) watched today's press conference were treated to the opening remarks of Secretary of Agriculture Tom Vilsack, who immediately stated that prior to getting his current job, he had never read the dietary guidelines personally.  He then solemnly confessed that having read the guidelines, he and his wife had experienced a life change.  Following this bit of revelation, he proceeded to state with great certainty that weight is controlled by one thing: calories in/ calories out.  I counted six repetitions of this mantra during his several minute introduction. It was clear from the very outset where we were headed.

And indeed, that's exactly where we went.  In 2010, the USDA has come to the stunning conclusion that we should eat fewer calories than we burn.  Further, we can achieve this by eating less and exercising more.  In addition, we should eat less saturated fat and trans fat, more fruits and vegetables, fewer sweets and more whole grains.  We should eat no more than 300 mg. of cholesterol daily.  We should choose more low fat dairy products.  About the only thing that is actually new in the 2010 Guidelines is a tougher recommendation on salt restriction: 2300 mg. per day for those under 50 and 1500 mg. per day for those over 50 or with high blood pressure.

Yet reading the reaction to these guidelines, one would think that the USDA had done something cataclysmically.  Here's what the LA Times reported:

"I’m in shock," writes Marion Nestle, an author and New York University professor who has followed these proceedings and written about the politics of them for years: 
 
"The new guidelines recognize that obesity is the number one public health nutrition problem in America and actually give good advice about what to do about it: eat less and eat better. For the first time, the guidelines make it clear that eating less is a priority."   

Yes dear readers, sadly it is amazing that the USDA suggested that we actually eat less.  Previous committees have been so influenced by the food industry that they were afraid to come right out and suggest we should cut back on food.  That's why earlier guidelines were heavy on language like, "choose more fruits and vegetables" and light on recommendations like "stop with the Ring Ding already".  So OK, I get it.  Marion Nestle is stunned that the USDA finally had the guts to suggest we cut back.  But let me ask you; is there anyone in today's America who doesn't actually know that we have to eat less?  Was this a revelation to Tom Vilsack when he saw those guidelines for the very first time?  I mean, honestly!

Instead of being impressed by the oh-so-subtle changes in the new guidelines, we should be taking a good hard look at why no one pays any attention to them.  Maybe it's because they are ponderous, over scientific, impossible to follow, boring, and ultimately don't lead to dietary success (at least as far as weight control is concerned).

Our dietary guidelines show an enormous lack of imagination, both in the way that science is interpreted and in the way they are marketed to the public.  What follows is my own (admittedly highly biased) critique of selected sections and some thoughts about how to make dietary information more relevant. 

The report which accompanies our new guidelines begins this way:

"Although there is no single “American” or “Western” diet, average American food patterns currently bear little resemblance to the diet recommended in the 2005 Dietary Guidelines for Americans."

In other words, the recommended guidelines have been completely ineffective.  Rather than simply restating the guidelines, we should be asking why they don't work.  I believe there are several obvious reasons.  The first is that the extremely seductive messages sent by the food industry (continually and at great expense) have won out.  Food is fun and Americans are simply not convinced in any serious way that their habits are extremely dangerous.  While the USDA timidly suggests that we should eat less, they take but a tiny swipe at the food industry, it's practices and it's methods.  There is a small section on the "Obesogenic Environment" and it opens with the following statement: 

"Ultimately, individuals choose the type and amount of food they eat and how physically active they are. However, choices are often limited by what is available in a person’s environment, including stores, restaurants, schools, and worksites."

There follow two paragraphs, one about the increasing calories available in our food supply and one about the research suggesting that BMI increases with the number of fast food meals eaten weekly.  That's it.  Ultimately, as the lead-in states, it's up to the individual.  The continued refusal of the Guidelines committee to lay any blame at the feet of the food industry weakens their conclusions.  I think we all realize that, other than lack of willpower, there is another, enormous, overwhelming influence on why Americans eat poorly that is never discussed.

A second reason that the Guidelines are ignored by most Americans is that a lot of them don't translate in the real world.  Here, for example, is one of the Key Recommendations:  

Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. 

I talk to people about how they eat every single day.  I can assure you that not a one is actually figuring out how many calories come out to 10 per cent of their total and then further calculating how to replace their saturated fatty intake with polyunsaturates.  No one lives this way.  Haven't we figured that out by now???  If you actually decided to read the guidelines, you'd be skipping advice that read this way.

Here's another example.  The committee writes of their decision to give up the concept of "discretionary calories", a term that was part of the 2005 Guidelines:

"The 2005 DGAC defined the term “discretionary calorie allowance” as “the difference between total energy requirements and the energy consumed to meet recommended nutrient intakes” (DGAC, 2004). Discretionary calories were intended to represent the calories available for consumption only after meeting nutrient recommendations and without exceeding total energy needs. Unfortunately, this concept has been difficult to translate into meaningful consumer education".

Gee.  You think?

The third reason that I think the Guidelines fail to be compelling is that a great many Americans do not actually feel that they need better nutrition. On the whole, we are a pretty well fed country.  What many would like to get from the Guidelines, however, is a way to control their weight.   On this point, the Guidelines are a failure and so, in my opinion, many people ignore them.  (Just to clarify: Obviously nutritional guidelines are important on other levels.  I am not suggesting we abandon them.)

Here is a dream I have.  One bright day, a bunch of nutritional thinkers wake up each with the same thought.  ‘You know, we've been telling people to eat less and exercise more for 30 years and we've got a hugely overweight country.  Everyone is coming down with diabetes.  The kids are fat.  Heck, even our pets are fat.  Wait a minute!  Wait a cotton-picking minute!!!  Maybe we're giving the wrong advice.  Maybe we should think about other explanations, other reasons we might be gaining weight, other ways to solve the problem.’  They convene a summit and brainstorm for weeks on end. Then they try something different.

Just a dream.

Instead, here is what we get:

"Calories consumed must equal calories expended for a person to maintain the same body weight. Consuming more calories than expended will result in weight gain. Conversely, consuming fewer calories than expended will result in weight loss. This can be achieved over time by eating fewer calories, being more physically active, or, best of all, a combination of the two."

Where have I heard this before?  It would be great if it were true.  Unfortunately, the efficiency of the body prevents this from being more than a short term solution.  This simplistic statement completely avoids the real truth which is that almost everyone who loses weight regains it.  It does not take into account the fact that it is the automatic caloric balancing mechanism of the body that decides about weight.  We are for the most part unable to balance our calories by force of will.  How long can you breathe willfully before the automatic mechanism designed into your genes takes over?  In my world view, we need to heal the mechanism that balances our calories naturally, not try to overwhelm it with counting and marathons.

As our country ages, more and more of us have gotten fat and have tried to lose weight.  The simple "solution" above rings hollow.  It hasn't worked for most of us, yet we keep being told that it must and if it doesn't, the fault is ours.  Interestingly, soon after making the statement above, the Guidelines Report voices this vexing contradiction:

"Maintaining a healthy body weight and preventing excess weight gain throughout the lifespan are highly preferable to losing weight after weight gain. Once a person becomes obese, reducing body weight back to a healthy range requires significant effort over a span of time, even years."

If it is true that weight loss is simply a function of cutting calories and exercising more, why does it become more difficult after one has been obese (as it surely does)?  The fact that this is true suggests that something becomes disordered or "broken" once weight is gained and that it is this process, and not simple calorie balance, that is at the heart of the problem.  This is what I personally believe, but this possibility is rarely discussed.

So we are left with this summary Key Recommendation:

"Maintain appropriate calorie balance during each stage of life—childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age."

Since these ineffective suggestions for weight reduction have been available in every issue of Family Circle for the past 25 years, it is no wonder the 2010 Dietary Guidelines for Americans are kind of a snooze.

How then to improve matters?

Short of having my dream become reality, I have a few ideas.

1.  Get the Guidelines out of the hands of the USDA. 

Since major criticisms have always involved the fact the USDA supports agriculture and therefore cannot honestly produce tough guidelines, why not move this task elsewhere?  How about the Department of Health or the NIH?  The NIH especially has a reputation for good science and protecting the public welfare.  And they don't have to worry about what the milk or beef industry has to say.

2. SIMPLIFY. A LOT. 

I hate the fact that eating has become about counts, percents, and nutrients.  You know, it's really just about food.  Detailed info is fine for dieticians, nutrition enthusiasts, and researchers, but the rest of us need simple rules.  You already know what I would say:  Eat like your ancient ancestors did.  Therefore, whenever you can, avoid things made in factories.  Eat mostly lean animal meats and poultry, fish, seafood, eggs, vegetables and fruits, nuts and berries. I prefer to emphasize the plant side of that equation.  If you tolerate dairy and don't gain weight, it's probably ok.  Minimize grains or avoid completely (including things made from grain flour like pasta and bread, cakes and so on). Beans and other legumes depend on what they do to your weight.  Don't eat sugar.  Someone else could make up a similarly simply set of rules.  They might not be mine, but they'd be easier to follow than what we've got.

3. Make Being Healthy Compelling

We can't convince people that eating well and staying lean is important unless they truly understand the dangers associated with bad eating.  The internet could be a great and inexpensive educational tool for showing what livers full of fat look like, how fatty liver leads to scarring and cirrhosis, what happens to the inside of your blood vessels when your sugar gets too high, and how fat in the gut gets invaded by nasty inflammatory cells and pours out deadly chemicals into the blood.  Kids should get this information in school and it should be repeated periodically.  I will always remember that in medical school, the few students who still smoked dropped the habit pronto after we saw actual samples of lungs filled with tumors and emphysema.  Our body remains a mystery because the interior is hidden from view, but now we have the tools to show people what is actually going on inside of them.  We should use them.

4. Take on the Food Industry

These guidelines are tedious because they only talk about the many things that we must do.  Balance this, get enough of that, reduce something else.  It's like being told you should be well-behaved and polite when you know that the moment you leave school the class bully is going to beat you up.  Worse, when you tell the teacher, she blames YOU!  If government agencies are going to tell us what to do, they have to tell the food producers what to do as well.  There's no point in trying to play the game on a playing field that isn't level and I think most of us are tired of it.

Phew.  It felt good to get that off my chest. Now that I'm done ranting, I'm off to eat some grapes.  I have no idea how many calories I ate today, yesterday or last week.  I only know that since I stopped eating sugar, starch and processed food, my weight balances itself and my nutrition seems to be very comfortably on auto-pilot.  

Sponsor: The American Heart Association

American Heart Month is a time to battle cardiovascular disease and educate Americans on what we can do to live heart-healthy lives.

Heart disease, including stroke, is the leading cause of death for men and women in the United States.

You are at higher risk of heart disease if you are:

• A woman age 55 or older
• A man age 45 or older
• Or a person with a family history of early heart disease

Heart disease can be prevented. To keep your heart healthy:

• Watch your weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Get active and eat healthy.
• Talk to your doctor about taking aspirin every day if you are a man over the age of 45 or a woman over 55.
• Manage stress.

Get Involved

Take action to promote heart health.

1. Celebrate National Wear Red Day (February 4, 2011) to raise awareness about women and heart disease. Encourage everyone in your community to wear red on National Wear Red Day and use the tools provided in the toolkit to learn how they can protect themselves and their loved ones from heart disease. Visit Go Red for
   Women  for more information.
2. Host an American Heart Month event at local schools, health centers, libraries, etc. Work with local recreation and fitness centers to spread the word about the importance of physical activity to prevent heart disease.
3. Contact your local Red Cross to host a CPR training event in your community. Urge local community members to learn CPR and AED (Automated External Defibrillator). These skills can help save the life of someone who has sudden cardiac arrest.
4. Host a 20-minute group walk around your office at lunch time.
5. Conduct a cooking demonstration using a heart-healthy recipe.

Adapted from the American Heart Association.
Contact theAmerican Heart Association  at inquiries@heart.org for more information and materials.

Start Here

• Heart Disease Risk Questionnaire (Siteman Cancer Center)
• Also available in Spanish  
• Heart Disease (Centers for Disease Control and Prevention)
• Your Guide to Living Well with Heart Disease [ (National Heart, Lung, and Blood Institute)

Overviews

• Heart and Vascular Diseases (National Heart, Lung, and Blood Institute)
• Heart Disease (Mayo Foundation for Medical Education and Research)

Diagnosis/Symptoms

• Cardiac Catheterization (National Heart, Lung, and Blood Institute)
• Cardiac CT (National Heart, Lung, and Blood Institute)
• Cardiac MRI (National Heart, Lung, and Blood Institute)
• Coronary Angiography and Possible Angioplasty (Patient Education Institute)  Also available in Spanish  
• Diagnostic Tests and Procedures (Texas Heart Institute)  Also available in Spanish  
• Echocardiogram (Patient Education Institute)  Also available in Spanish  
• Echocardiography Stress Test (Patient Education Institute)  Also available in Spanish  
• Echocardiography (National Heart, Lung, and Blood Institute)
• Electrocardiogram (EKG or ECG) (National Heart, Lung, and Blood Institute)
• Heart Disease: Tests (American Association for Clinical Chemistry)
• Nuclear Heart Scan (National Heart, Lung, and Blood Institute)
• Stress Testing (National Heart, Lung, and Blood Institute)
• Transesophageal Echocardiography (National Heart, Lung, and Blood Institute)

Treatment

• Cardiac Medications (American Heart Association)
• Implantable Medical Devices (American Heart Association)
• MedlinePlus: Blood Thinners (National Library of Medicine)  Also available in Spanish  
• MedlinePlus: Heart Surgery (National Library of Medicine)  Also available in Spanish  
• Ventricular Assist Device (National Heart, Lung, and Blood Institute)

Health Check Tools

• Heart Disease Risk Questionnaire (Siteman Cancer Center)  Also available in Spanish  
• Palpitations (DSHI Systems)  

Tutorials

• Coronary Angiography and Possible Angioplasty (Patient Education Institute)  Also available in Spanish  
• Echocardiogram (Patient Education Institute)  Also available in Spanish  
• Echocardiography Stress Test (Patient Education Institute)  Also available in Spanish  

 Videos

• Blood flow  - Encyclopedia  Also available in Spanish  
• Cardiovascular system - Encyclopedia  Also available in Spanish  
• If I Had - A Family History of Heart Disease (Insidermedicine)
• Sleep Deprivation and Cardiovascular Risk (Harvard Medical School)
• Transesophageal Echocardiogram (TEE) (OR-Live) - One hour program - 2/17/2009

Games

Play the Electrocardiogram Game (Nobel Foundation) 

Anatomy/Physiology

• Heart Anatomy (Texas Heart Institute)  Also available in Spanish  
• How the Heart Works (National Heart, Lung, and Blood Institute)

Sources:           www.healthfinder.gov

                        www.medlineplus.gov

For more information, please contact the Lake Health Resource Center Librarians.

Let's get the off-putting facts out of the way first.  Metabolism slows down with age meaning that your body burns fewer calories each day.  Prior to menopause, estrogen directs fat storage into the hips and thighs.  Once estrogen is gone, storage can occur preferentially in the belly creating the famed "mena-pot".

While these things are true, they don't have to mean anything.  Is it possible to lose weight and keep it off later in life?  Absolutely.

Over the years, some of my most successful long term weight patients have been over 60.  When new clients tell me that they are worried about their inability to lose because of age, I show them a picture of my mother who had a major weight loss in her mid 80s and continues to control her weight now at 92.  Because of two bad knees, exercise was out.  She also has an under active thyroid.  Weight loss has always been tough for her.  Nevertheless, she did it without a problem. 

The post-fifty weight loss issue is only a challenge if you misunderstand the basics.  If you believe that weight loss and maintenance is achieved by starving and running the marathon, you will be justified in seeing major impediments at older ages.  Many people give up on trying to stay at a healthy weight because of just such thinking.   It's common to hear this one: "Oh well.  I'm in menopause now so weight gain is inevitable."

Let's return to the basics, because these fundamentals become even more important when someone is older or post-menopausal.  Overweight occurs when your body stores fat (that's a normal physiologic function) and then is unable to burn it off again (that's not normal).  If everything is going just right, your fat cells should be open at all times, able to store fat and then release it again when it is needed for momentary energy needs. If you are making a lot of the hormone insulin, your calories will go into fat storage but they won't be able to get out.  It's a one way valve.  If you drop insulin levels, fat flows freely out of the fat cells.  (And let me remind you once again that what starts insulin going is eating sugar, starches or grain).

One of the most important considerations for those over 50 is not lowered metabolism, but that fact that we become increasingly insulin resistant with age.  Insulin resistance means that we make more insulin when we eat carbs than we used to and that insulin levels tend to stay higher throughout the day.  Thus, more trapped fat; more difficulty losing.

For those with weight problems over 50, the adoption of a diet that eliminates carbohydrate (except for fruits and vegetables), is key.  Understood this way, you can see that the number of calories burned a day (metabolism) is secondary to the way calories are utilized.  Essentially, you cannot utilize calories properly is you are making alot of insulin.  Similarly, the fact that excess fat in post menopausal women lands in the belly is unimportant.  Our aim is to avoid storing excess fat in the first place.  Thus, where is goes is immaterial.

Here's one piece of very good news.  I have found that it is often more possible for my patients over 50 to make the necessary changes in their eating habits than it is for younger patients.  If you have been eating bread, pasta, potatoes and sweets for a whole lifetime, it's often now possible to take a "been there, done that" attitude.  At 50 plus, all of us become concerned about our longevity and more specifically, about living out the rest of our years in optimal health.  With the greater knowledge we have, and with a lifetime of having accomplished things already behind us, it suddenly becomes ok to try something new.  Then too, the more mature we are, the less interest we have in conforming.  This makes it easier to tell friends and family that we simply don't eat certain foods any more.

About ten years ago, on our annual family visit to the Bahamas, I had a sudden insight into what might be causing obesity.  I had been treating obese patients for some years and had been watching them relapse.  I also was watching the frustrating progress of my own weight.  I had always been thin, but during my forties I had grown twenty pounds heavier despite my usual schedule of five-day-a-week high intensity aerobics.  The annual diet that preceded our vacation was no longer working and the few pounds that I was able to knock off came rushing back within a week or two of our return. 

In 1992, Don and I had moved to a country property.  Both of us had grown up in the crowded suburbs of New York City and longed for some contact with plants and other living things.  I, particularly, had always wanted animals.  About the best we were able to do in our small row house in Jersey City was provide shelter to a parakeet, a series of hamsters and some goldfish.   Now (thanks to my industrious and long-suffering husband) we became the caretakers of sheep, goats, horses, donkeys, turkeys, chickens, a dog, a parrot and a whole host of cats. As it happens in these situations, these animals gave us much more than we ever gave them.  The learning curve involved in their care was steep and the knowledge they imparted was fascinating.   

Our horses grew lean and shiny-coated on their summer grass, but became sluggish and fat-bellied when fed “sweet feed” (a molasses coated mix of grains).  Our golden retriever ran exhausting loops around our farm, but got fat on a standard dog food and as a result of eating morsels of feed that were dropped by the horses.   In an effort to slim him down, I learned of the “Bones and Raw Food” movement favored by some dog enthusiasts.  The idea was to re-acclimate dogs to foods that were more natural to them genetically.  I switched him, with excellent effect, to a dog food that paid attention the original nutrient balance of canines.   Our cat’s veterinarian was also invested in the idea of feeding cats the diet they were most genetically programmed to eat. 

Interestingly, our animals didn’t get fat from eating too much or exercising too little.  They were never overfed.  In fact, it took a startlingly small amount of the wrong foods to cause overweight.  Who would imagine that a 1200 pound horse could grow a big fat belly from an extra half a coffee can of grain a day?  Who would predict that a horse that size could graze on pasture all day and all night and remain as lean as Secretariat?  Who indeed?  Those who knew anything at all about horses!

It was with these new experiences swirling in my subconscious that I had a moment of sudden clarity in the Bahamas.  I remember that I was about to have breakfast at the hotel buffet.  I was making my usual calculations:  if I ate that chocolate muffin now and skipped lunch, maybe I’d be ok having my favorite chocolate mousse for dinner.   I plopped down into my seat feeling the irritating scrape of two fat thighs rubbing together.  Looking out through the windows onto the beach, it all came together over the turquoise blue of the sea.   Those palms were growing here, not in Cleveland, because they had certain programmed requirements.  The trim seagulls trolling the sand were looking for their particular diet of fish.  Our horses ate grass and stayed in perfect weight balance.  What I, their caretaker, was eating had absolutely nothing to do with what was natural to my organism: the human organism.  Even without researching it further, this seemed immediately obvious. 

I sat there and remembered the day that one of our high school teachers, a smoker, lectured us on the dangers of nicotine.  He lit a cigarette, took a deep drag, and exhaled through a clean, white handkerchief he had pulled from his pocket.  A dirty, yellow ring formed immediately, staining the white cloth.  “But if you know smoking does that,” we insisted, “why are you still doing it?”  With only a moment’s hesitation, he replied.  “I’m not going to anymore.”  He took the packet of cigarettes from his shirt pocket, ripped it in half and threw it in the garbage pail by his desk.  It was his moment of clarity.  He never smoked again.

I pulled myself out of my chair and approached the buffet feeling a strange and similar commitment.  It was fascinating.  What was likely to be “human” food?  The eggs?  Probably.  Some meat?  Likely.  The grits and butter?  I wasn’t sure.  But I would find out.  And I soon did, contacting various experts on original forms of human diet and researching what I discovered was already a well-established dietary approach for many.  

In the past ten years, nothing has occurred either in terms of my personal or professional experience that has changed this basic tenet.  We are healthiest when we eat a diet that is familiar to our ancient genes.  We also will lose excess fat and remain lean if we do so.

But ten more years has added the benefit of additional observation in the real world.  For many years, particularly in the mid twentieth century, we humans stayed lean on diets that were full of hot dogs, apple pie, hamburgers, ice cream and devil dogs.   Yes, but we exercised more …right?   Not on my block, where staying out till 8 pm in the summer meant sitting on your stoop and playing aggressive, calorie consuming sports like “hit the penny” and potsy. 

So, new observation number one is that something has changed.  While we’ve probably always been best served by eating a close approximation of the original human diet, we used to be able to get away with cheating quite a bit.  Now we can’t anymore.  Why not?  The possible candidates are legion.  An environmental exposure to some toxin or chemical.  A small change in the way our genes are expressed which may be stimulated while we are in utero (epigenetic change).  An increase in the load of fructose or some other specific substance or additive in our diet.  The reaching of a specific threshold, beyond which our bodies can’t tolerate fake food.    It would be interesting to know, but it almost doesn’t matter.  If you want to win at hide and seek---don’t ask why you’re still at large----just  high tail it back to base and yell, “Home Free All!”  That base--- and I hope you’re headed there---is our original diet. 

Observation number two is that many people use “low carb diet” as a shorthand for the original human diet.  And this is not a bad way to look at it, but it misses some fine points.   I personally adhere to the belief that we get fat because we start to store and trap fat inappropriately.   Since insulin is the primary hormone that controls fat storage, I favor the belief that this problem occurs when insulin gets out of control and stops working properly.    If we drop most carbs out of the diet, leaving only carbs like veggies and low sugar fruits,  our insulin falls back into the low range and fat can be released and gotten rid of.  Fat also can’t be stored if insulin is low.   The original human diet is low in carbohydrate because it lacked all grains and most sugars, so there is an approximation there.   However, the idea of eating more originally is to avoid other potential pitfalls of the modern diet, not just obesity.  For this reason, I also advocated eating animal proteins that look more original…meaning have more omega 3 and fewer omega 6 fats.  We can do this more easily today with the availability of grass fed meats and free range poultry.   We also may want to pay attention to modern additives like growth hormones and antibiotics—certainly not ancient.

Observation three is that we get fat because we are “stuck on fill”.  I’ve used that term before to mean that the system (controlled primarily by insulin) that decides if we will burn food or fill the fat cells with it is actually stuck like a jammed valve.  This valve can get stuck when we eat too much modern food laden with carbs.  But it also can get stuck through forced overfeeding.  We can essentially eat ourselves sick.   As most of you know, I loathe the blame placing that goes on around overweight.  I’ve been known to wade into discussions with verbal guns blazing when I hear these words, “I don’t know why fat people can’t just stop eating!”   Being fat means having a storage disorder that triggers more hunger.  Whether this is because big insulin surges are making hunger or because all of the needed energy is trapped in fat cells and the body needs more food to go on, we’re not sure.  Whatever the cause, for most overweight people, reducing fat mass by lowering carb intake (and therefore insulin) will get rid of the big hunger.   The last ten years have taught me, though, that there is a subpopulation of people who do eat strictly for emotional reasons.  Once they become overweight or obese, the problem is intensified and the weight gain can be large and rapid.   I think it’s important to recognize this because the treatment for this particular group of people should include therapy.  Having said this, I have found that 80% of the overweight people I see in my office think that they eat emotionally. They’re right.  We all do. Eating emotionally in the United States of 2011 is a given.  But is it their major problem or just a sidebar?  Until you have tried a diet that lowers insulin significantly and have given hunger levels a chance to abate, it is hard to know why you are eating.  You may find that your drive to eat is more biological and less psychological than you thought.

Observation four is that serious maintainers must stop playing with addictive substances…and by this I mean sugar and starch.  I have a number of patients who actually use the word “play” when describing their mini-binges with doughnuts and potato chips.   What they don’t realize is that the food is playing them, not the reverse.  Insulin stimulating foods are seriously addictive.  Enough so that several of the new obesity drugs in the pipeline rely on the same mechanisms that block other addictions like those to heroin and nicotine.  Since we don’t want to remove everything pleasurable from our diet, it is vital to establish a number of things that give you a carb-like “hit” but without the after-cravings.  I have referred to these in previous posts as NTTs or Non Triggering Treats.  

So in summary:  as 2011 begins, here’s where I’m sitting.  We are fat because a problem in our fat storage mechanism which “gets stuck” and diverts too many of our calories into fat cells, trapping them there.  This process can be reversed and permanently bypassed by getting rid of starches and sugars in the diet.  You should continue to eat vegetables and low sugar fruits.  Most people will be able to eat low fat dairy (milk products do stimulate insulin, but don’t seem to be an issue for many).  I personally don’t eat grains, whole or otherwise.   I also avoid legumes like starchy beans.  

The fat storage problem we so easily acquire in today’s world is like the first push on a stack of collapsing dominoes.  It throws off blood pressure, messes up cholesterol, inflames the insides of your arteries, exposes you to intensified cancer risk, and creates diabetes.  Reverse this disorder and you reverse all the others along with it. 

I remain open to new studies, new information and new ideas.   As of January 2011, I believe that the basic concept as I’ve described it makes sense both scientifically and experientially.  It works.  I’ve seen it.  I live it.  Each of you will find your own variations.  I wish you health and success.

Happy New Year to all!

Imagine if you will, a world in which all of our current assumptions about what makes us fat are erased. It's hard to do, because we are all so certain that we get fat from eating too much.  That little tune has been played for us every day of our lives in excruciating repetition.  We are so brainwashed that we've never stopped to consider whether it's true.
Suppose what makes us fat is not what we are eating but something that gets disordered in our fat cells? 
Suppose these cells, because of a hormonal imbalance or disrupted signal, start to suck in too much fat and get out of control?  Imagine now that these voracious cells not only gobble up everything we eat but jealously lock all that energy up, thus making it unavailable to the rest of the body.  Under the rules of normal physiology, our fat cells release fat whenever it's needed for momentary energy needs.  But not anymore.  Not this rogue fat.  This misbehaving fat isn't releasing anything.

Imagine now that you set out to walk from your bedroom to your living room.  You ate a half hour ago, but now everything you ate is locked away in your fat cells where the rest of you can't get to it.   What fuel is going to power you?  Your brain directs you to eat, pronto!   How can you be hungry again you wonder.  How can you have such little will power?  Why can't you just forget about food?  What's wrong with you anyway?

Far fetched?  Not at all.   For years, scientists have made various animals fat by manipulating their hormones or operating on certain areas of their brains.   These manipulations have created a disorder in fat storage such that fat is inappropriately sucked into the fat cells.  Animals will often eat more to compensate for the fact that their other cells are starving, or they may stop moving around to avoid burning calories they don't have.  In the case of certain rats who are genetically manipulated to be obese, starving them still leaves them fat.  Their fat is not available for burning, so instead they burn up their muscles and vital organs until they die, still with fatty tissue intact.  All of this is well documented in the Taubes book I've recently been referencing, Why We Get Fat and What To Do About It.  The example of the genetically doomed rats will undoubtedly leave some wondering whether they too are genetically engineered to be fat no matter what they do.  While there may be a tiny fraction of us with some unavoidable genetic variance, we can be fairly assured that this is rare.  We know this because obesity rates were  low until just recently.  Genetic variations of the required magnitude would not have occurred in the past 20-30 years.
In his book, Taubes discusses concepts developed by Julius Bauer, a German geneticist and endocrinologist, in the late 1920s.

"Bauer considered the fat tissue in obesity akin to malignant tumors.  Both have their own agendas, he explained.  Tumors are driven to grow and spread and will do so with little relation to how much the person who has that tumor might be eating or exercising.  In those who are predisposed to grow obese, fat tissue is driven to grow, to expand with fat, and it will accomplish this goal, just as the tumor does, with little concern about what the rest of the body might be doing."

The abnormal (fat) tissue seizes on foodstuffs, even in the case of under-nutrition, Bauer wrote in 1929. "It maintains its stock, and may increase it independent of the requirements of the organism.  A sort of anarchy exists; the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism."

Ever have that anarchy feeling?  There's probably a good reason that this fat thing seems to be so out of control....make so little sense.

While there are many signals and hormonal components that regulate food intake, the primary hormone that puts fat into the fat cells is insulin.  Many overweight people are making way too much insulin, a problem that leads fat cells to avidly store and trap too much fat.  The overproduction of insulin is usually the result a insulin resistance, a situation in which muscle cells become deaf to insulin while fat remains responsive.  This insulin resistance may start once we have eaten too many starches and sugars, or as the result of developing in the womb of a mother who ate many S foods, or simply as a result of aging.  Some people have a tendency toward it and other don't.   Whatever the cause, though, once the cycle gets started, the fatty tissue goes rogue, expands beyond the needs of the body, creating hunger and stealing energy from other bodily cells.
We can respond by starving ourselves, but we may wind up like the rats who burned up their muscles because their fat was entrapped and couldn't be released for body needs.  I often notice that people on low calorie vegetarian diets (which rely on grains, breads, etc..) have an emaciated appearance, as if they are losing muscle mass.  I caution that this is strictly an unscientific observation, but it would make sense if they are losing weight while still eating a diet with significant insulin stimulus.  Again, using nothing but subjective observation, I note that our patients who have lost large amounts of weight on low carb, low insulin diets look very well balanced---often as if they had never been heavy.
If fat is a rogue that gets out of control as a result of disordered insulin signaling, guess what?  Being overweight is not the fault of your weak will or your big appetite.  It's just the other way around.  Your inability to stop eating or tendency to store fat easily is a side effect of the chaos imposed by a run away tissue.
If we know this and work to get rid of excess insulin secretion, relief is in sight.  Fat will again flow freely from fat cells and hunger levels will decline.  If we remain in a low insulin state, it will be very difficult for the body to find a way to store fat again.  We will have tamed the beast. 
But ultimately, will power does factor in.  We still have to have the strength to turn our backs on the starchy-sugary diet that's created all of this.  Can you do it?  You can. 

For most people, the prospect of meeting a favorite movie star or sports hero would set the heart aflutter.  Call me a nutrition geek, but I get palpitations from meeting the researchers and authors whose work on obesity I revere. 

Several years ago, a friend from residency, who is now chief of endocrinology at a major academic center, invited me to meet Gary Taubes; the author of "Good Calories, Bad Calories".  Taubes is a science writer with a long track record of producing sophisticated and meticulously researched articles for Science, the NY Times, and other highly respected publications.  In recent years, he had become especially interested in the science of obesity; writing a number of controversial articles that supported carbohydrate restriction and called into question the conventional wisdom of low-fat eating.  "Good Calories, Bad Calories" was the  a book that collected all the research that supported his contention (and mine) that the idea of controlling weight by eating less than you burn is insanely simplistic and that it is insulin-stimulating foods that cause weight gain and illness.  A dense, lengthy book (the paperback version is 640 pages), GCBC defeated many readers.  For me though, every page was a "eureka" moment packed full of research that supported everything I had learned clinically in more than 20 years of working with overweight patients. It became my bible, my favorite book, my go-to reference, the book that had my back.  The pages of my copy were so underlined, annotated, and studded with stars, arrows, and exclamation points as to be barely readable.

The day that I was to travel to the east coast to meet Gary Taubes dawned to reveal an old-fashioned Cleveland blizzard.  I was booked to fly on a small regional jet and believe me, I'm a nervous flyer.  Normally, I would have taken one look out the window at the wind and snow and cancelled my flight.  Instead, I tucked my trusty GCBC under my arm, packed an overnight bag and headed across icy, unplowed roads to the airport.  I sat on the tarmac as our tiny plane (one of those that bounces and creaks across the runway) was doused with pink and green de-icing fluid.  Moments later, the snow was once again accumulating on the windows and the wings were bouncing in the wind.  Was I nuts?  This was definitely a form of temporary insanity.  But moments later, we ascended shakily into the sky, broke through the clouds and continued on to Philadelphia where a cold sun was shining. 

At the university, I greeted my old friend and he ushered me into a large lecture hall where Taubes had just begun what was to be a long and detailed talk.  The assembled crowd was composed of serious academic researchers in the field of diabetes and obesity.  They listened politely and asked many questions, but seemed skeptical.  Taubes answered each question with a wealth of data and a great deal of patience.  It was clear that he was used to speaking to doctors and other scientists, most of whom had spent the past twenty to thirty years believing that dietary fat was the great villain.  I understood his position well.  My practical experience with obese patients was often ignored by peers who listened politely to what I had to say but went on to advise their patients that they eat "moderately”, follow a "low fat diet" and eat lots of "healthy carbs".

After the lecture, I had the great opportunity of spending an hour or so in discussion with my friend and Gary Taubes.  Naturally, I had him sign my copy of GCBC.  The inscription reads:  "This is the most annotated copy of my book I've ever seen."  Later, we all had dinner with other members of the department.  Gary and I avoided carbs while the others ate the rolls, ordered potatoes and (in some cases) fretted about their inability to lose weight.

In the years since the publication of Good Calories, Bad Calories, I have recommended it to many people but few have been able to wade through it and pretty much no one has enjoyed it with the blind excitement that I have.  Apparently, this was a common scenario and now Taubes has produced a scaled down version of his master work called "Why We Get Fat and What to Do About It" (Knopf).  While it (intentionally) lacks the intensive attention to research that characterizes GCBC, it does an excellent job of giving readers the basics.  I recommend it.  And if you are intrigued by what you read, I would suggest going on to GCBC to fill in the blanks. 

The bottom line? It is the overproduction of the hormone insulin that makes us fat.  This overproduction comes from two sources:  eating too many foods that require insulin for processing (the starches and sugars), and the overproduction of insulin that results from body cells that become "resistant" through aging or eating too many S Foods.  Dietary fat and protein do not stimulate insulin.  Consumed alone they cannot make us fat.  Most importantly, insulin prevents us from using the fat in our fat cells as fuel.  We are thus always running on sugar.  We crave more when we run out and we never get into fat burning mode.  We are built to run on the fat in our fat cells as a major fuel.  Most of us can't use it.

This knowledge is the currency of my world.  It is obvious to those of us who "do" weight loss as a career.  It has even---finally---become obvious to entrenched diet programs like Weight Watchers, who recently revamped its point system to reflect the fact that all calories are not alike.  Some make you fat. Others don't.

For those with limited patience or someone who can only borrow “Why We Get Fat" for a day, I particularly recommend the second section of the book called "Adiposity 101".  These facts are well presented and give you a good introduction to the problems created by insulin.  (A similar discussion can also be found in the third chapter of Refuse to Regain on Metabolic Syndrome).

One of the points that Taubes makes repeatedly is that nutritionists and doctors remain entrenched regarding their thinking about weight loss.  They insist that you can lose weight by eating less and exercising more when this formula has been an ineffective proposition for 95% of those who try.  It simply doesn't hold up long term.  He acknowledges that obesity doctors understand his thesis and support it and that docs who don't treat obesity are unwilling to listen to those who do.  That's true.  But it is also true that those who write about and research obesity, but don't treat it, are not privy to the daily observations of this knowledge in practice.  So let me add some brief critiques of what is otherwise an excellent book.

1. Genetically Consistent vs. High Fat, Low Carb

Taubes touches briefly on the wisdom of eating foods that are like the foods eaten by our ancient ancestors.  Theoretically, these are the foods to which we are best adapted.  Following that, however, he pins the blame for obesity on carbohydrates and exonerates fat and protein.  I agree unequivocally with his blame placing, however I remain very circumspect about the sources of our fat and protein.  Taubes is fond of bacon and steak.  I wouldn't have a problem with this if it were not for the fact that the meat we produce today is very nutritionally distinct from the meat we've always "known" how to eat.  Bacon contains carcinogenic nitrites and other preservatives.  Corn fed beef has a reversed profile of omega 6 to omega 3 fatty acids when compared to the meat of animals that graze.  If we hypothesize that we get sick from eating a diet full of carbs because we are not genetically prepared to eat large amounts of carbs, how can we ignore the fact that eating meat that is very modern in composition may be equally damaging?  The way I see it, logic leads me to believe that we get both fat and sick when we eat fuels that our body is not prepared to process genetically.  Trying to get as close as possible to original food sources makes the most sense.  There is no research on this by the way other than voluminous observation of hunter gatherer tribes that survived into modernity and were absent modern diseases.

2. How to Lose Weight

Many of the sources consulted by Taubes in this book suggest an Atkins-style diet for weight loss.  There are also many obesity clinics that still use something called the "Protein-Sparing Modified Fast".  This is essentially an extreme Atkins diet that has patients eat small amounts of mostly chicken, eggs and certain cheeses.  While these diets do cause weight loss, they also can lead to complications of dehydration, dizziness, and potassium and salt depletion.  We have found them to be completely unnecessary and I can't understand why people persist in using them.  Our diet has many more grams of carbohydrate than Atkins or the PSMF.  Our patients eat one piece of fruit and a lot of vegetables and salad each day.  It works beautifully and we achieve large weight losses.  We have rarely had a patient who is resistant.  In other words, it is very possible to lower insulin levels enough to get brisk weight loss without going to total carb elimination.  You just have to know which carbs to avoid and how much to include.

3. Calorie Lowering for Weight Loss

One of Taubes' interests is establishing a study that would document that fact that people on the Atkins diet could eat enormous numbers of calories yet still lose weight.  This would prove that weight loss isn't about the amount of calories at all, but is about how the body uses the calories it gets.  In other words, does it burn up the calories and get rid of them or does it store them?  In the practical world of the weight loss clinic, however, we have found that to get weight loss, patients need to get calories low.  Having tried the Atkins diet myself many times, I found that my calories were automatically limited by the boring nature of eating only meat and cheese.  I don't know if Taubes is right about his belief, but it seems beside the point.  Eating huge amounts of fat and protein doesn't feel good to many people, and weight loss can easily be gotten on a low insulin diet of about 1200-1400 calories that suppresses appetite as a side benefit. 

4. Exercise

Taubes makes the very interesting point that obese people are sedentary not because they are lazy, but because their energy stores are locked up (insulin traps fat energy and makes it inaccessible).  They simply don't have enough energy to exercise and therefore don't want to.  I agree with this.  Our patients who lose weight become much more interested in moving. You only need to read a few weight loss blogs to see how frequently obese, sedentary people turn into avid exercisers, even marathoners. Taubes discounts exercise as an important factor in weight loss.  So do I.  However, I still stick to my guns when stating that exercise is crucial for weight maintenance.  I don't know the technicalities of why it works, but we can suppose that it keeps the muscles efficient in their use of calories and allows for the whole bodily machine to run better.  Exercise is like the oil or lubricant for our metabolic system.  Keep it going. 

I highly recommend that you take a look at "Why We Get Fat" and see if it doesn't get you thinking.  I hope you will come out believing that restructuring your diet to permanently rid yourself of the bulk of your grains and carbs is the true solution for permanent weight control.   It has worked for me and it has worked for all of those I've been able to convert.    

National Birth Defects Prevention Month is a time to raise awareness of birth defects and promote healthy pregnancies.

 A birth defect is a problem that happens while a baby is developing in the mother’s body. One out of every 33 babies in the United States is born with a birth defect.

 A birth defect may affect how the body looks, works, or both. Some birth defects like cleft lip or neural tube defects are structural problems that can be easy to see. To find others, like heart defects, doctors use special tests. Birth defects can vary from mild to severe. Some result from exposures to medicines or chemicals. For example, alcohol abuse can cause fetal alcohol syndrome. Infections during pregnancy can also result in birth defects. For most birth defects, the cause is unknown.

 Some birth defects can be fatal. Babies with birth defects may need surgery or other medical treatments. Today, doctors can diagnose many birth defects in the womb. This enables them to treat or even correct some problems before the baby is born.

Quick Guide to Healthy Living

• Have a Healthy Pregnancy
• Get Enough Folic Acid
• Talk with Your Doctor About Newborn Screening

Personal Health Tools

• Pregnancy Quiz
• MyPyramid Plan for Moms

Overviews

• 10 Things You Need to Know about Birth Defects (Centers for Disease Control and Prevention)
• Birth Defects (Nemours Foundation)
• Reducing Your Risk of Birth Defects  American College of Obstetricians and Gynecologists)

Diagnosis/Symptoms

• Amniocentesis (March of Dimes Birth Defects Foundation)
• Chorionic Villus Sampling (CVS) (March of Dimes Birth Defects Foundation)

Prevention/Screening

• Folic Acid Questions and Answers (Centers for Disease Control and Prevention)
• Maternal Blood Screening (March of Dimes Birth Defects Foundation)
• Prenatal Tests (Nemours Foundation)
• Screening for Birth Defects (American College of Obstetricians and Gynecologists)

Coping

• When Your Baby Has a Birth Defect (Nemours Foundation)

 Organizations

• March of Dimes Birth Defects Foundation  
• National Center on Birth Defects and Developmental Disabilities (Centers for Disease Control and Prevention)
• Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities
• Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities Birth Defects: Frequently Asked Questions (FAQs)
• Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention & Health Promotion: Maternal and Infant Health
• National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Birth Defects

Sources:           www.healthfinder.gov
                             www.medlineplus.gov

For more information, please contact the Lake Health Resource Center Librarians.

If you are overweight, you are not alone. Sixty-six percent of adults in the U.S. are overweight or obese. Achieving a healthy weight can help you control your cholesterol, blood pressure and blood sugar. It might also help you prevent weight-related diseases, such as heart disease, diabetes, arthritis and some cancers.

Eating too much or not being physically active enough will make you overweight. To maintain your weight, the calories you eat must equal the energy you burn. To lose weight, you must use more calories than you eat. A weight-control strategy might include:

1. Choosing low-fat, low-calorie foods
2. Eating smaller portions
3. Drinking water instead of sugary drinks
4. Being physically active

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

• Choosing a Safe and Successful Weight-Loss Program  (National Institute of Diabetes and Digestive and Kidney Diseases)
• Weight Loss for Life (National Institute of Diabetes and Digestive and Kidney Diseases)
• Weight Management (Patient Education Institute)

Lake Health is leading the way to help individuals achieve safe weight loss that produces long-term solutions. We are dedicated to helping our patients lose weight and change their lifestyles. Weight loss and maintenance are very complex and options for treatment should be individualized. Our menu of specialized programs includes:

• Weight Management
• Weight 4 Life
• Physician Supervised Weight Loss(OPTIFAST)
• Medical Nutrition Therapy

For more information on any of these services, please call the Wellness Institute at 440-375-8153.

Overviews

• Better Health and You: Tips for Adults (National Institute of Diabetes and Digestive and Kidney Diseases)
• Overweight, Obesity, and Weight Loss (National Women's Health Information Center)
• Weight Loss: 6 Strategies for Success (Mayo Foundation for Medical Education and Research)
• What It Takes to Lose Weight  (American Academy of Family Physicians)

Latest News

• Dieting Resolution Works Best When Done in Stages (12/28/2010, HealthDay)
• Fish Oil Won't Accelerate Weight Loss (12/24/2010, Reuters Health)
• Meal Replacements Don't Help Obese Teens Slim Down (12/17/2010, Reuters Health)
• Trials Use Technology to Help Young Adults Achieve Healthy Weights  (11/29/2010, National Heart, Lung, and Blood Institute)
• FDA Recommends Against the Continued Use of Meridia (sibutramine) (10/08/2010, Food and Drug Administration)
• More News on Weight Control  

Diagnosis/Symptoms

• Assessing Your Weight and Health Risk  (National Heart, Lung, and Blood Institute)

Alternative Therapy

• Holistic Weight-Loss Strategies (American Psychological Association)
• Hoodia  (National Center for Complementary and Alternative Medicine)
• Over-the-Counter Weight-Loss Pills: Do They Work? (Mayo Foundation for Medical Education and Research)

Nutrition

• Eat More, Weigh Less? (Centers for Disease Control and Prevention)
• Fast Food: 5 Ways to Healthier Meals (Mayo Foundation for Medical Education and Research)
• Healthy Eating Starts with Healthy Food Shopping  (National Heart, Lung, and Blood Institute)
• Just Enough for You: About Food Portions  (National Institute of Diabetes and Digestive and Kidney Diseases)
• Key to Nutrition: A Diversified Portfolio (Dept. of Health and Human Services, Office of Minority Health)
• Snacks: How They Fit into Your Weight-Loss Plan (Mayo Foundation for Medical Education and Research)
• Weight-Loss and Nutrition Myths: How Much Do You Really Know? (National Institute of Diabetes and Digestive and Kidney Diseases)

Coping

• Weight Loss Tip: First, Make Sure You're Ready (Mayo Foundation for Medical Education and Research)
• Weight-Loss Help: Gain Control of Emotional Eating (Mayo Foundation for Medical Education and Research) 

Disease Management

• Guide to Behavior Change  (National Heart, Lung, and Blood Institute)
• Physical Activity and Weight Control  (National Institute of Diabetes and Digestive and Kidney Diseases)
• Health Check Tools
• Calculate Your Body Mass Index  (National Heart, Lung, and Blood Institute)
• Interactive Menu Planner  (National Heart, Lung, and Blood Institute)
• Make Your Calories Count (Food and Drug Administration)
• Portion Distortion! Do You Know How Food Portions Have Changed in 20 Years?  (National Heart, Lung, and Blood Institute)

Tutorials

• Weight Management (Patient Education Institute)

Videos

• Watch Your Weight! (Healthy Roads Media)

Statistics

• FastStats: Overweight (National Center for Health Statistics)
• Prevalence of Underweight Among Adults Aged 20 Years and Over (National Center for Health Statistics) 

Children

• Childhood Obesity: Make Weight Loss a Family Affair(Mayo Foundation for Medical Education and Research)
• Is Dieting OK for Kids? (Nemours Foundation)
• Keeping Portions Under Control (Nemours Foundation)
• Your Child's Weight (Nemours Foundation)

Teenagers

• 5 Ways to Reach (and Maintain!) a Healthy Weight (Nemours Foundation)
• Deal with Diets (Nemours Foundation)
• Emotional Eating (Nemours Foundation)
• How Can I Lose Weight Safely? (Nemours Foundation)
• Should I Gain Weight? (Nemours Foundation)
• Take Charge of Your Health: A Teenager's Guide to Better Health  (National Institute of Diabetes and Digestive and Kidney Diseases)
• What's the Right Weight for My Height? (Nemours Foundation)

Men

• Getting on Track: Physical Activity and Healthy Eating for Men  (National Institute of Diabetes and Digestive and Kidney Diseases)

Women

• Fit and Fabulous As You Mature  (National Institute of Diabetes and Digestive and Kidney Diseases)
• Weight Gain After Menopause (Mayo Foundation for Medical Education and Research)
• Young Woman's Guide to Losing Weight the Safe Way (American Osteopathic Association) 

Seniors

• Eldercare at Home: Weight Loss and Nutrition Problems (AGS Foundation for Health in Aging)

Source: www.medlineplus.gov

If you would like more information, please contact a Lake Health Professional Librarian

Let's get serious.  How many people do you know who are---right at this moment---resolving to lose weight after January 1st?  Judging by the utter flood of TV commercials for Jenny Craig, Weight Watchers et al, that began right after Christmas, I'd say that the weight loss industry is thinking it's pretty much everybody.   

The New Year's resolution is a charming little tradition.  For a few days, we spend time reassessing our priorities and vowing to right our wrongs, fix what's broken.  But by January 3rd or 4th, life returns to business as usual and most of us have already forgotten our end of the year introspection.  Weight loss, in particular, doesn't respond well to resolution.  What is does respond well to is…planning.

Losing a goodly amount of weight is complicated business.  Our first mistake is to underestimate it.  On the other hand, if we size up the challenge correctly, there are a number of things we can do to vastly increase our chances of success.  So if you want to lost weight this year or if you know someone else who does, here's a battle plan:

1. Forget the January 1st Date!

You should only start a weight loss plan when you have everything in place.  Setting an arbitrary date like January 1st simply because the year changed from 2010 to 2011 is a bad idea.  Instead, allow for several weeks to get everything set up.  Set a "Quit Date" sometime later in the month.  This is what smokers are encouraged to do when they give up cigarettes and it can work for you too.  Pick a date that has some meaning to you (maybe it's the same number date as your birthday or anniversary, or maybe you just like the combination of digits). 

2. Pick Your Strategy 

Most people who start diets do so with only a vague idea of "cutting back" or "eating less junk".  The most effective diets are easy-to-follow plans that restrict food fairly severely and have simple rules.  Research has shown that most diets work---if they are followed strictly.  Your job is to figure out which type of diet you can follow to the letter.  Can you stick with Atkins the whole way, just fat and protein?  Would you do better with a Weight Watchers approach? Are you someone who is more likely to lose if you commit some money to the process?  Do you know that when you diet on your own you quickly lose focus?  Maybe you need to attend a group or see a dietician for accountability.  Do you have a friend or relative who has lost a lot of weight using a particular approach?  Should you interview them to see if that might work for you?

As a basis for starting this process, I can tell you what works for our patients.  We put them on a high quality meal replacement (either bars or protein shakes) during the day and have them eat a Primarian style meal for dinner.  This meal consists of a moderate serving of skinless poultry, very lean meat, or fish, a large salad with non fat dressing, a large serving of green vegetables (steamed, broiled or roasted) and a piece of fruit.  They generally finish the day with a low fat dairy product, like sugar free pudding or low cal yogurt.  We get excellent, consistent weight loss with this regimen but of course, in addition, our patients are checking in with us weekly.  Without trying to be too self-promoting, I will add that my book, Refuse to Regain, contains an eating plan in the middle.  Many people who have switched to this type of eating have lost between 30 and 50 pounds, so this might be another option.

IMPORTANT NOTE: Many people who have weight issues are on medications, frequently for diabetes, hypertension, and cholesterol.  Often these medicines need adjustment when food intake changes.  If you are on medicines and plan to diet significantly, make sure you check with a doctor or dietician prior to starting.  This is especially true for anyone on medicines to lower blood sugar or on diuretic pills.  These can be dangerous when combined with diets.

Once you have decided on your strategy, get everything set.  Make an appointment to begin on your appointed date or purchase your shakes and bars.  Or get your diet plan printed out or buy the appropriate books.  Put everything in one area and get it ready to go.

3. Set Up Your Exercise

While vigorous exercise is most helpful for weight maintenance, mild to moderate exercise will assist in keeping you honest during weight loss.  If you can do more as you go along, fine.  If not, don't sweat it, as long as you are losing.  Most importantly, don't exercise to the point where hunger knocks you off your 100% commitment to your diet plan.

Prior to your Quit Date, figure out how and when you will exercise.  If you are very out of shape, I recommend starting with short bouts (maybe 15 minutes or so) a few times a week.  Don't push it.  Your body is not used to exercise yet.  If you choose walking, figure out a place to walk in both good and bad weather.  If you choose classes like aerobics or spinning, register yourself so that you've committed the money.  If you choose a gym, see if you can hook up with a trainer for the first month just to keep things interesting.  If you choose exercise videos: find them and rent them.  Get everything in place.

4. Purge Your Environment

Just prior to your Quit Date it is very important that you purge non-diet foods from your home and office environment.  Get a big bag and have a throw-away or give-away party.  During the early phases of your diet, strong hormonal signals will be flowing from your brain that will lead you to late night searches for hidden potato chips.  Make sure that they are not there to be found.  Enlist the help of your family.  Tell them that they will have to eat these foods outside the home (or hide them from you...not to be eaten in front of you) for the duration.  Tell them not to give in to your pleas for these foods even if you resort to bribery, coercion, and other trickery!

5. Declare Your Intentions

I have found that the people who do best on diets are those who tell everyone what they are doing.  Many patients tend to want to hide the fact that they are trying to lose.  "It's nobody's business," they say.  Or, "I don't want people asking me a lot of questions."  Naturally, this is your own decision, but generally it seems to be the case that those who boldly declare that they're out to change the way they eat seem to take the commitment more seriously.  After all, they've made a statement.  It's tougher to renege on a promise you've made publicly.  Yes, friends may watch, ask questions, and judge, but you can deal with it.

6. Buddy Up

Most people don't really believe it, but weight loss is tough.  You'll need someone to help you keep going, to praise you and to cheer you on.  Spouses are great, if you can recruit them to work as a team and if you can resist the temptation to give in when they say, "Honey...how about we have the popcorn just this once?"  A friend who is truly serious about losing weight might be even better.  Weight Watchers groups have been an inspiring source for many.  Dieticians can be great.  Hey, there are even a few good diet docs out there!  Some people use their personal trainers as cheerleaders.  Recruit your team and have it ready on day one.

7. Keep a Record

This isn't just a diet.  It's a serious journey through a new landscape.  Take verbal pictures (and maybe some real pictures too).  Get yourself a nice leather notebook or one with a beautiful cover.  Get yourself a comfortable pen.  Put everything in one place and have it ready to go.  Write a little bit about your journey each day.  You don't have to write down everything you eat (unless you want to), but write a bit about how you felt, what was tough, what was fun, what got you down. 

I have one patient who took a picture of herself in the same clothes in the same place every single week throughout her 100 pound weight loss.  What a visual story that makes!

OK!  NOW you're ready to go.  Forget January 1st.  Your Quit Date may be later in January or it may not come until April, July or November.  The important thing is that you will have thought it through.  You will be prepared and you've given this tough challenge the attention it needs to achieve a successful result.  After all, what we're searching for is not simply a Happy New Year.  It's more a Happy New Life.