Category Archives: Health & Fitness

A new normal

My Health & Fitness column in the Aiken Standard this week is about the problem of losing weight on a diet then gaining it back soon after the diet ends. Many people who lose weight go back to their “normal” way of eating. The problem is that the “normal” diet of most people is hardly normal at all and is certainly not consistent with maintaining weight loss. In the article I give an example of a man who loses 50 pounds but goes back to the way he ate before losing that weight. After losing weight, his energy (calorie) needs are lower than they were when he was heavier. As a result, he was eating 500 more calories each day than he needed to maintain his new lower weight. Predictably, he gained the weight back even though he exercised every day. What he needs is a new “normal” diet.

The reason for this has to do with total energy expenditure (TEE), a measure of how many calories a person needs to maintain their weight. TEE is determined by two major components: Resting metabolic rate (RMR)–what most people refer to as their “metabolism”– and the energy expended in activity. RMR is based on body size and sex; the energy of activity is based on how active you are, including occupational activity, exercise, and other activity.

TEE is useful because it represents the number of calories you need to eat to maintain your current weight, assuming your activity doesn’t change. It is also a good way to come up with a calorie goal for a diet. For example, if your TEE is 2500 calories/day and your diet is 1,500 calories/day you are cutting out 1,000 calories/day. This should lead to a weight loss of 2 pounds per week. I also use this information to help explain why someone isn’t losing weight at quickly as they expect. The culprit is usually that they are eating more than they think they are, likely because portion sizes are too big. (If you have done this, don’t feel bad. Estimating portion sizes and calories is challenging, even for “experts”)

RMR can be measured in a lab, but it is usually estimated using a complicated formula based on age, height, weight, and sex. Energy of activity can be estimated based on your usual level of physical activity. You can calculate your own total energy expenditure using the following equation below, which is super-simple but accurate enough for most purposes. More complicated equations can be used for research, but that isn’t necessary here.

Step 1: Calculate your RMR

RMR (calories/day) = weight (kg) x 24

(note: weight in kg = weight in pounds ÷ 2.2)

Step 2: Calculate TEE

TEE (calories/day) = RMR x activity level

Activity levels

  • Sedentary (mostly sitting with some light activity) = 1.4
  • Active (daily physical activity at work or daily moderate exercise) = 1.6
  • High active (heavy manual labor job or vigorous exercise) = 1.8
Example:
A 220 pound man (100 kg) who mostly sits at work but gets some activity each day, usually a short walk each evening (low active).
1. RMR = 100 kg x 24 = 2400 calories/day
2. TEE = 2400 calories/day x 1.4 = 3360 calories/day
You can also find an online tool to do these calculations for you. There are many, and although they might use slightly different formulas, the results will be about the same.

Exercise is Medicine

May is Exercise is Medicine month, so the topic for my Health & Fitness column in the Aiken Standard this week is information about the Exercise is Medicine initiative. A growing body of research suggests that the single best prescription any physician can give is for daily physical activity. But many (or most) physicians either do not make this recommendation or, if they do, do not provide the information or resources that patients need to embark on a program of regular activity. I will probably write about why this is the case — it’s not always the fault of the physician — and what can be done about it in a future column.

You can learn more about the Exercise is Medicine initiative here.

The best medicine

In my Aiken Standard Health & Fitness column last week I wrote about recent research that supports the use of obesity surgery, specifically gastric bypass surgery, for treating diabetes and other chronic conditions. It turns out that the surgery has beneficial health effects beyond weight loss. For some people, gastric bypass surgery may a reasonable option, especially if they have serious health conditions.

In my column this week I explain that surgery is not the only option and shouldn’t be the first choice for treatment. Since for almost everyone obesity is a lifestyle disease, it should be treated with lifestyle modification. Even if surgery is used, changing diet and activity habits is essential for maintaining weight loss. You can apply the same logic to medications used to control cholesterol and blood pressure. In most cases, diet and exercise would be sufficient on their own. But even if a drug is used, lifestyle modification is still an important part of the treatment. This is especially true considering the potentially serious side effects of many medications. Recent research suggests that some commonly used drugs to lower cholesterol (statins) can cause muscle damage and cognitive impairment.

Diet and exercise really are the best medicine!

A cure for diabetes?

I spend much of my time talking about the benefits of a healthy diet and regular exercise to anyone who will listen–and to some people who won’t. I usually include something about the fact that, for many conditions, lifestyle change is at least as effective as medical management, certainly for preventing diseases like diabetes, hypertension, and dyslipidemia. So it was with some reluctance that I jumped on the bandwagon with a growing number of surgeons who believe that bariatric (weight loss) surgery is an effective treatment for diabetes.  This was the topic of my Health & Fitness column in today’s Aiken Standard.

Let me be clear: This doesn’t mean that diet and exercise don’t work. In fact, successful long-term weight loss requires dietary modification and daily exercise, regardless of how the weight was lost. Ideally, diet and exercise would be the method that everyone uses to lose weight–it works, but only if people a faithful to the treatment. Unfortunately, most people are not, leading to the belief that diet and exercise don’t work. And for some who are extremely obese, it is unlikely that diet and exercise could produce results sufficient enough and quickly enough to treat serious health problems (including diabetes) that are likely in progress. For this reason, many turn to weight loss surgery for a quick fix.

For years I was skeptical, but a growing body of literature, including two recent studies in the New England Journal of Medicine, suggest that obesity surgery can “cure”diabetes. [you can read these studies here and here] The results of these studies show short term benefits, so it is unknown whether this is a permanent cure or not.

Either way, diet and exercise are necessary to maintain the weight loss in the long run as well as treating other health conditions. And a healthy diet, regular exercise, and maintaining a healthy body weight are  still the only ways to prevent diabetes. The bottom line is that the true benefits of weight loss surgery cannot be realized without lifestyle change. And if you adopted a healthy lifestyle from the beginning, you wouldn’t need to even consider obesity surgery.

If you are the podcast type, there is an excellent description of these recent studies as well as a discussion of the risks and benefits of obesity surgery from NPR’s Talk of the Nation.

Good for the Earth and Your Health

Earth Day is Sunday, April 22. While the focus is on protecting our natural environment, there are several things you can do that benefit your health, too.

Good for the Earth and health | Aiken Standard.