Tag Archives: gaining weight

Honesty is the best policy when it comes to your health

Have you ever justified your weight by saying you are “big-boned”? What about your eating and exercise habits? How often do you really eat out? How many days did you actually get to the gym last month? Are you being honest with yourself when it comes to your health? And are you asking others to be honest with you?

Being honest about your health is the topic of my Health & Fitness column in the Aiken Standard this week.


Being honest with yourself is essential for initiating health behavior changes and setting good goals. For example, someone who tells themselves they need to lose “a few pounds” may really need to lose much more and may not take their weight loss as seriously as they should. Convincing yourself that you are doing more exercise than you really are may mean that you won’t see the fitness or weight loss results you were expecting.

This type of self-deception is easy to do. Take body weight for example. The current standard for determining if you are at a healthy weight is body mass index (BMI), calculated from your weight and height (kg/m2). It requires a bit of math, so using a mobile app or online calculator is a good idea.

A BMI between 18.5 and 24.9 is considered normal, 25-29.9 is overweight, and if your BMI is 30 or higher, you are classified as obese. To put this in perspective, a BMI of 30 is equivalent to about 25–30 pounds of excess fat.

Let’s say your BMI puts you in the obese category, suggesting you should lose weight. But then you think about an article you read about how BMI isn’t accurate because you can be considered obese if you have excess muscle, not fat. And then there was the story on the news suggesting that it is okay to be obese as long as you are physically fit. So, maybe you don’t need to worry about your weight!

See how easy it is to tell yourself that you don’t really need to lose weight? In reality, BMI is an accurate method of assessing your body fatness; the inaccuracies reported in the news almost always involve athletes or people with lots of muscle mass developed through physical labor. Be honest…is that really you? It’s also true that people who are fit and fat can be healthier than people who are thin and sedentary, but it requires a lot of exercise to reach that level of fitness. Again, are you really that fit?

Probably the best test is to take a good look in the mirror and be honest about what you see. Try to “pinch an inch” of fat around your belly. One inch isn’t necessarily a problem, but take notice if you can pinch a handful of fat. Measuring your waist circumference (or looking at your pants size) can give you the same information. People who have a high BMI because of extra muscle, like athletes, have thin waists. If your waist circumference is greater than 35 inches ( women) or 40 inches (men), you have excess fat.

This honesty also applies to others, including your doctor. Many physicians are reluctant to discuss weight and weight loss with their patients, and many patients don’t want to hear what they interpret as a personal attack. Don’t be one of those patients! Ask your doctor for an honest assessment about your weight and the impact it might have on your health.

This is a real problem. According to one report, only 39 percent of obese people surveyed had ever been told by a health care provider that they were obese.     To help combat this problem, the American Medical Association has developed resources to help physicians better communicate with patients about their weight.

Making changes to diet and activity habits is a difficult process, to be sure. Telling yourself that you don’t need to make them only delays getting started and can lead to poor health in the meantime. When it comes to your health, honesty is the best policy!


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

Just in time…tips to prevent holiday weight gain.

Thanksgiving is this week which means the holiday season is upon us. It is a time for spending time with family and friends, shopping, and eating. The bad news is that weight gain between Thanksgiving and the new year is a very real possibility. The good news is that the typical holiday weight gain is less than you might think. The even better news is that this weight gain can be prevented.


First, the bad news. Research shows that, on average, people gain about one pound during the holidays. Even subjects who said they were trying to lose weight over the holidays ended up gaining about 0.5 pounds on average. The problem is that this extra weight is not lost during the spring or summer, meaning that holiday weight gain is a major contributor to the gradual increase in weight, about one pound per year, most people experience over time.

Now for the good news: The weight gain that typically occurs during the holidays can be prevented. Since people tend to gain less than one pound, even small modifications to activity or diet can make a difference. Here are some strategies:

  1. Stay active. The average holiday weight gain could be prevented by walking about one mile, or about 20 minutes, per day. Since time may be a factor, you can turn a shopping trip into a chance to be active by taking an extra lap around the mall or parking further away in the parking lot. Go for a walk before or after a family meal or party—and take your family and friends with you.
  1. Stay away from the food. Most holiday parties include lots of food, and usually not the healthiest choices. You can reduce the amount you eat by limiting your time near the food—literally, fill your plate and move away from the food. Using a smaller plate will reduce the amount of food you take, too. Getting rid of the candy dish on your desk at work or the plate of treats on the countertop at home are also smart ideas.
  1. Don’t drink your calories. Alcoholic beverages, soda, and juice all contain calories and can add up to a big part of your total calorie intake. For example, egg nog can contain over 300 calories per glass. This doesn’t mean you can’t enjoy your favorite drinks, but enjoy them in moderation.
  1. Plan ahead. If you are trying to watch what you eat, have a healthy snack before you go to a party. You will feel less hungry so you will probably be less inclined to eat as much. If you are bringing a dish to the party, make it something healthy that you like.
  1. Focus on family and friends, not food. The holidays are a time to enjoy special meals and events with family and friends, and that should be your focus. You should enjoy your favorite foods and drinks, just do it in moderation.

You can prevent holiday weight gain by watching what you eat and staying active. It is easier to keep the weight off than it is to lose it later, so a little extra effort now is worth it in the long run. Considering that many people plan to exercise and lose weight after the holidays, you could get a jump start on your New Year’s resolutions along with making this a happy and healthy holiday season.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drbrianparr@gmail.com | http://twitter.com/drbrianparr

 

Exercise, like all prescriptions, only works if you use it as directed.

Earlier this week  I wrote about the Exercise is Medicine initiative and why physicians should prescribe exercise to all of their patients.

Despite the widely-known benefits of exercise, many physicians—and people in general—believe that chronic health conditions should be managed using medications, not  proper nutrition and physical activity. This is a misguided approach considering that weight gain and health conditions related to weight gain  accumulate over a period of years, resulting from eating too much combined with low levels of activity.

One reason that physicians are hesitant to prescribe exercise (and, similarly, good nutrition) is that in their experience, it doesn’t work. What they mean is that the results they see after recommending lifestyle modifications are typically not sufficient. So the assumption made by doctors and patients is that lifestyle modifications don’t work. But this is not necessarily the case

This debate comparing lifestyle modification with medical management of chronic diseases is familiar. Consider statins, the popular lipid-lowering medications that are currently among the most-prescribed drugs (examples include Lipitor, Zocor, Crestor and Vytorin). The effect of statin drugs on lowering blood lipids is significant in most patients. This, together with clever marketing to both patients and physicians, explains why they are so widely used.

It is possible to lower blood lipids as much as statins by carefully controlling diet and regular exercise, but it is difficult. How difficult depends on the individual, but everyone would agree that successful lifestyle modification takes more effort and dedication than taking a pill. In order for any treatment to work, it has to be followed. A patient who doesn’t follow their diet or exercise program is no different from a patient who doesn’t take their medication as directed. In both cases, the response to the treatment will fall short of expectations.

If someone didn’t take their statin medication and their blood cholesterol didn’t go down, no one would label the drug a failure. The medication may well have worked if the patient took it. But people routinely claim that diet and exercise don’t work, when the real problem is that these treatments aren’t followed. This could be because the patients weren’t provided with appropriate and actionable information or because they didn’t faithfully follow the instructions they were given.

The problem isn’t that lifestyle modification isn’t effective, it’s that people don’t implement healthy changes for the long-term. Whereas a statin drug results in rapid changes, the benefits of behavior change are realized more slowly. This can lead to the incorrect conclusion that diet and exercise aren’t working, even though they are.

In reality, medication can be part of a treatment plan, but should not be the only prescription.  Long-term health benefits come from changing eating and activity patterns. Medications should be used as a  “jump start” to treating a condition, with a goal of developing a new way of eating and regular activity as the long-term treatment.

For example, medications like statins can lower cholesterol quickly. Then, lifestyle changes can keep the cholesterol down, reducing the need for the drug. Since side effects depend on the dose and duration of treatment, this approach would reduce the risk of potentially dangerous side effects.

For many patients, lifestyle changes are effective on their own, meaning the medication isn’t necessary. And consider this: maintaining a healthy body weight, proper nutrition, and regular exercise has been proven to be the best—and at this point, only—way to prevent most of the health problems most of us will face. Good nutrition and physical activity really are the best medicine!

Driving yourself to the doctor.

Have you ever thought about how much time you spend in your car? On average, Americans face a 50-minute round-trip drive each day just for their jobs, and nearly thee-quarters of commuters drive alone. In suburban and metropolitan areas the commute can be much longer. Even in Aiken the average commute time is about 23 minutes. When you include driving to work, taking the kids to school, and doing errands, sitting in a car can easily account for an hour or more each day.

You can find the average commute time in your area using this really cool interactive map from WNYC.

You are probably very aware of the time you spend in the car. What you may not know is that sitting in your car can also have negative effects on your health and happiness. This is the conclusion of several studies that examined the relationship between commuting time and indicators of health. One of these studies suggests that vehicle miles traveled is a strong predictor of obesity. In another study, commuting a greater distance was associated with lower levels of physical activity and fitness as well as a higher waist circumference and blood pressure.

This makes sense because spending more time sitting in your car means you have less time to dedicate to being physically active, something we know is good for your health. Add to that the fact that driving is sedentary. There is accumulating evidence that spending more time sitting in the car, at work, or at home is a predictor of poor health, regardless of how active you are the rest of the day.

It gets worse. Many people eat in their cars during long commutes. Much of the time these “meals” consist of fast food and other prepackaged foods—not many people eat salads while they drive! Since these foods are typically of questionable nutritional quality and high in calories, this alone can contribute to obesity and poor health. The combination of inactivity and eating behind the wheel can easily shift the balance toward weight gain. Plus, eating while you drive is dangerous!

Beyond the direct impact on health through eating and activity behaviors, commuting alone in a car is a form of social isolation. Research suggests that this can lead to depression, itself an important factor leading to poor health.

The problems with long commute times are well established and easy to appreciate. Unfortunately, the solutions are not. Most people can’t move in order to have a shorter commute and relying on public transportation isn’t practical or even possible for many people, especially in our area. Replacing driving a car with active modes of transportation simply isn’t practical.

Aside from the time requirement—imagine how long a 25 minute drive would take on a bike or on foot!—our environment doesn’t adequately support active travel. Being able to walk or bike requires access to safe bike lanes and sidewalks that connect people’s homes to work, school, and other destinations. Even public transportation increases activity over driving and enhances social connections. Sadly, this infrastructure doesn’t exist in most communities, which were built to support cars, not people.

But we can take steps to undo some of the damage that so much driving can cause. Making activity at other times of the day a priority is a good start. This could include exercise at the gym, going for a walk, or even yard work or housework. When possible, replace car trips with walking or biking. Planning these activities with others can strengthen social connections as well as improve health and fitness. Finally, act as an advocate for changes in the community that will make active transportation more realistic.

Eat slow, then fast. How and when you eat may be as important as what you eat for weight control.

What you eat is an essential part of achieving and maintaining good health. What you may not know is that when and how you eat can be just as important. This is especially true if your goal is to lose weight.

My Health & Fitness column in the Aiken Standard this week describes  two ways that changing the way you eat can help you lose weight and keep it off. Neither of these are necessarily new ideas, but implementing them together may help you eat less.

First, eating more slowly can help you limit the amount of food you eat. Perhaps your mother admonished you to “slow down” at meals when you were young. This was good advice, for both practical and physiological reasons. In addition to controlling how much food you consume, eating more slowly is a good way to enjoy meals, both the food and the company, more fully.

You mother may also have told you to “chew your food.” too. This was probably to remind you to eat more slowly.  Almost 100 years ago Horace Fletcher recommended a process that involved chewing each bite of food 100 times. “Fletcherizing,” as it was called, was a way to reduce how much people ate, among other more dubious health claims.

There is a physiological reason to slow down, too. Your appetite is regulated by a host of factors, including the act of eating and the presence of food in your stomach. As you eat, your stomach fills. This triggers the release of hormones that signal your brain to reduce your appetite. The result is that as your stomach fills, you feel less hungry.

Once you start eating, it takes time for your stomach to release these hormones. Eating quickly, like many of us do, allows you to take in lots of calories before your brain gets the message that you are full. This is one factor that leads to overeating. But if you slow down at meals, you start to feel full before you eat as much. Research shows that this can lead to lower calorie intake during the meal.

Second, the time between meals may affect your metabolism in ways that result in less fat accumulation. Again, the concept of fasting between meals isn’t new, but recent research helps explain why eating less frequently may help prevent obesity and related conditions, including diabetes.

While this research was done using rats, the physiological concept may well apply to humans. In these studies, rats were put on a diet that included an overnight fast ranging from 8–12 hours. The researchers found that the rats that experienced a longer fasting period between meals had better insulin levels and less fat storage.

The reason for this seems to do with the gut microbiome, the bacteria that live in the intestine and play an important role in regulating metabolism. A longer period without food changes the nature of these good bacteria, promoting these benefits.

I first heard about this on Science Friday, which provides an excellent summary of this research.

It is unclear whether this same effect occurs in humans. Even without this evidence, adopting a fasting period between dinner and breakfast, which should be about 12 hours, seems prudent. At the very least, it will keep you from snacking in the evening, which almost certainly involves unhealthy choices.

An additional finding of this research is that the benefits of the 12-hour fast seem to persist, even through a day or two of more frequent eating. This is relevant, since many people do well to modify their eating habits during the week, but tend toward less restrained eating on the weekends. The fact that the benefits of an overnight fast most days of the week are maintained despite a “wild weekend” is good news!

The combination of what, when, and how you eat can make an important difference in how much you eat, the key to losing weight and keeping it off. As you try to make healthier food choices, consider eating more slowly and making dinner the end of your eating day.

The truth about holiday weight gain…and how to prevent it!

The holiday season has arrived. It is a time for shopping, spending time with family and friends, and eating, often too much. The bad news is that weight gain between Thanksgiving and the New Year is a very real possibility. The good news is that the typical holiday weight gain is less than you might think. The even better news is that this weight gain can be prevented, as I explain in my Health & Fitness column in the Aiken Standard this week

First, the bad news. Research shows that, on average, people gain about one pound during the holidays. Even subjects who said they were trying to lose weight over the holidays ended up gaining about 0.5 pounds on average. The problem is that this extra weight is not lost during the spring or summer, meaning that holiday weight gain is a major contributor to the gradual increase in weight (about one pound per year) most people experience over time.

Now for the good news: The weight gain that typically occurs during the holidays can be prevented. Since people tend to gain less than one pound, even small modifications to activity or diet can make a difference. Here are some strategies:

  1. Stay active. The average holiday weight gain could be prevented by walking about one mile, or about 20 minutes, per day. Since time may be a factor, you can turn a shopping trip into a chance to be active by taking an extra lap around the mall or parking farther away in the parking lot. Go for a walk before or after a family meal or party—take your family and friends with you.
  1. Don’t hang around the food. Most holiday parties include lots of food, and usually not the healthiest choices. You can reduce the amount you eat by limiting your time near the food—literally, fill your plate and move away from the food. Using a smaller plate will reduce the amount of food you take, too. Getting rid of the candy dish on your desk at work or the plate of treats on the countertop at home are also smart ideas.
  1. Don’t drink your calories. Alcoholic beverages, soda, and juice all contain calories and can add up to a big part of your total calorie intake. For example, egg nog can contain over 300 calories per glass. This doesn’t mean you can’t enjoy your favorite drinks, but enjoy them in moderation.
  1. Plan ahead. If you are trying to watch what you eat, have a healthy snack before you go to the party. You will feel less hungry so you will probably be less inclined to eat as much. If you are bringing a dish to the party make it something healthy that you like.
  1. Focus on family and friends, not food. The holidays are a time to enjoy meals and events with family and friends, and that should be your focus. You should enjoy your favorite foods and drinks, just do it in moderation.

You can prevent holiday weight gain by watching what you eat and staying active. It is easier to keep the weight off than it is to lose it later, so a little extra effort now is worth it in the long run. Considering that many people plan to exercise and lose weight after the holidays, you could get a head start on your New Year’s resolutions along with making this a happy and healthy holiday season.

Loosening our belts. Expanding waistlines means expanding health problems.

In a report published this week, researchers showed that the waistlines of Americans are still expanding. This is bad news, since excess fat, especially around the waist, has serious implications for our health. Fortunately, there is much we can do to lose weight and improve our health.

This is the topic of my Health & Fitness column in the Aiken Standard this week.

The study, published in the Journal of the American Medical Association, looked at the percentage of adults who had a high waist circumference (over 35 inches for women and over 40 inches for men). Overall, the average American added over one inch to their waist circumference over the past decade. As of 2012, over half of U.S. adults (51%) meet the criteria for abdominal obesity, compared to 46% in 2000.

Since excess muscle tends to compress the abdomen, this really does reflect an increase in fat around the waist, not the benefits of a national sit-up campaign. And it is the location of the fat that makes this worrisome. Excess fat around the waist includes both subcutaneous fat beneath the skin (what you can pinch) as well as visceral fat stored deep in the abdomen.

Excess visceral fat is associated with an increased risk of high blood pressure, type 2 diabetes, and heart disease, among other chronic conditions. The only way to determine how much visceral fat a person has is through an imaging test like a CT scan. (In my lab we can estimate visceral fat by making a few abdominal measurements.) The important point is that the bigger your waist circumference, the more visceral fat you likely have.

You may have heard of people’s body shapes described as “apple” or “pear.” Upper body obesity (apple), sometimes called android obesity because it is more common among men, is associated with a high waist circumference and visceral fat. Lower body, or gynoid, obesity (pear shape) tends to involve a narrower waist but more fat storage in the hips, thighs, and buttocks.

These body shapes become apparent when you measure both waist and hip circumferences. A high ratio between waist and hip measurements indicates more upper body fat; a low waist-to-hip ratio suggests lower body fat. That said, just measuring your waist circumference can give you the same information. A waist measurement greater than 40 inches for men and 35 inches for women indicates excess upper body—and visceral—fat.

There is no single explanation for why waist circumference has increased so much in the population. But it almost certainly has to do with a combination of individual factors including what foods we eat, how much we eat, and how active we are. The average American with an expanding waistline likely eats too much poor quality food and doesn’t get enough exercise.

These are exactly the same factors that, when reversed, can lead to fat loss. Indeed, research shows that even modest weight loss from a low-calorie diet and exercise can result in reduced body fat, including visceral fat. This is one reason why weight loss is effective for reducing high blood pressure and controlling blood glucose.

Even if you don’t lose weight, increasing your level of physical activity, particularly regular exercise, can offset some of the negative health effects of excess visceral fat. In addition to helping you lose weight, exercise can also help you maintain your waistline and prevent abdominal obesity.

The bottom line is that when your pants start to feel tight, they are trying to tell you something. Listen to them!