Tag Archives: weight loss

When normal isn’t normal.

Posted on June 25, 2014 | Leave a comment

The typical American is overweight, doesn’t get enough exercise, eats too few vegetables and fruits, too much sugar, and too many calories. Unfortunately, we have come to consider this combination as “normal.” While this situation may be common, it is definitely not normal. This is the topic of my Health & Fitness column in the Aiken Standard this week.

For most measures of health, a normal value is consistent with good health. A “normal” blood pressure is in a range that is associated with a low risk of stroke, for example. Someone with LDL (bad) cholesterol that is considered “above normal” has a greater risk of heart attack than a person with a normal LDL value.

But for many health indicators, having a normal value is not the norm. According to the most recent recommendations, a normal blood pressure is less than 120/80 mmHg. However, nearly 60% of adults have a blood pressure that is above normal, meaning they have hypertension or prehypertension.

A person who has a body mass index (BMI) in the normal range, between 18.5 and 24.9 kg/m2, is considered to be at a healthy body weight. But two-thirds of adults are overweight, with a BMI above the normal range. Similarly, participating in regular exercise should be considered normal. But it’s not, since fewer than half of adults meet minimum recommendations for physical activity.

The problem is that the term “normal” is frequently used to refer to what is typical, rather than what is healthy. Obesity is so common that a person who is at a healthy weight may look out-of-place. So many people look for ways to avoid physical activity that a person who walks instead of drives is considered abnormal. The person who comes away from a buffet with a less-than-full plate or who has a salad for dinner often gets strange looks. One of the reasons that people get noticed for doing these things is because they stand out from the crowd.

In reality, though, many of the health behaviors we consider to be abnormal—regular exercise, a healthy diet, or a lean physique—are, historically, completely normal. Until relatively recently, most everyone was active much of the day and spent little time being sedentary. Likewise, the consumption of the processed foods that are such a big part of our current diet was rare even a few decades ago.

It is likely that, by considering unhealthy behaviors to be normal, we have created a situation that discourages people from adopting a healthy lifestyle. As anyone who has tried to change their health habits knows, it can be a challenge, especially if everyone else maintains their typical eating and activity pattern. It’s not easy to be “the one” who only eats healthy food or who takes time to exercise every day.

Maybe we need to redefine normal health behaviors to reflect what is healthy rather than what is most common. When walking or biking rather than driving becomes the norm there will be greater incentive to provide safe places for pedestrians and cyclists to travel. When a healthy diet is considered normal it is more likely that restaurants will offer more nutritious options.

In the end, we would all benefit from changing our definition of normal. And a normal diet and activity pattern will go a long way to promoting a normal BMI, blood pressure, and cholesterol.

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Feeling the pressure

Posted on May 20, 2014 | 1 comment

May is National High Blood Pressure Education Month, a time to raise awareness about the diagnosis, health effects, and treatment of high blood pressure, also called hypertension. This is important because approximately 70 million U.S. adults have hypertension. Of those, almost 40% don’t even know it, which means they are not seeking treatment.

Another 30% have prehypertension, blood pressure that is above normal but does not meet the criteria for hypertension. Prehypertension is appropriately named since most people with this diagnosis eventually develop hypertension—unless they take steps to lower their blood pressure.

High blood pressure is a contributing factor to many heart attacks and strokes and is associated with type 2 diabetes, heart failure, and kidney disease. Hypertension is called the “silent killer” because it often has no symptoms yet it leads to serious health outcomes.

Here are some steps to help you celebrate National High Blood Pressure Education Month:

1. Know your numbers

Your blood pressure includes two numbers, both measured in millimeters of mercury (mmHg). The top number, systolic, is the pressure in your arteries while your heart is contracting and pumping blood. The bottom number is the diastolic pressure, which occurs between beats when the heart is relaxed. Both numbers are important for assessing your risk of health problems.

Normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic. Blood pressure that is 140 mmHg and higher or 90 mmHg and higher is considered hypertension. If your blood pressure is between 120–139 mmHg systolic or 80–89 mmHg diastolic, you have prehypertension.

2. Get it down

If your blood pressure is above normal you should take treatment seriously. Lifestyle changes including eating a healthy diet, regular physical activity, weight control, and quitting smoking are all effective and essential for lowering blood pressure.

There are also several good medications that your doctor can prescribe to lower your blood pressure. Take them as directed and don’t forget that they are designed to work with healthy lifestyle habits.

3. Keep it down

The aim, of course, isn’t simply to reduce your blood pressure using drugs. Your ultimate goal should be to keep your blood pressure low without relying on medications, all of which have at least some negative side effects.

The best way to maintain a normal blood pressure is through daily exercise, eating a healthy diet, losing weight if you are overweight, and quitting smoking. A good place to start is the DASH diet, which is high in fruits, vegetables, and fiber and low in sodium and added sugar.

The DASH diet has been shown to lower blood pressure and lead to weight loss. It is also consistent with recommendations to prevent and treat many other health problems, including diabetes and high cholesterol.

Since blood pressure tends to increase with age, even if you have normal blood pressure you should take steps to prevent high blood pressure in the future. Adopting a lifestyle that includes daily physical activity, healthy eating habits, managing stress, and not smoking is essential for preventing high blood pressure.

Additionally, these same health habits will help you prevent most other chronic disease including diabetes, heart disease, and many cancers. It turns out that celebrating National High Blood Pressure Education Month can also help you celebrate good health in general.

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Stealthy Healthy Eating

Posted on May 6, 2014 | Leave a comment

My Health & Fitness column in the Aiken Standard this week is about the many processed foods that include added nutrients, primarily vitamins, minerals, and fiber, to make them healthier. While this seems like a good thing—helping people get enough essential nutrients, even if they eat a poor diet—there are drawbacks to using these foods instead of eating actual food that contains these nutrients.

What if there was a way to get the benefits of eating vegetables without having to eat any vegetables? This may be a dream for millions of American children and adults who don’t eat enough vegetables.

Thanks to creative food processing, the healthy components of vegetables can be added to many foods, including soda, candy bars, and other sweets. Books and websites contain recipes for adding pureed vegetables to brownies and other baked goods. There is even a new line of prepackaged pureed vegetables to use!

The recommended intake of vegetables ranges from one cup per day for young children to 3 cups for adults. A simpler guideline is to fill half of your plate with fruits and vegetables at each meal. The goal should be to eat a variety of vegetables throughout the week.

There are plenty of good reasons for people to eat vegetables. Most vegetables are a low-calorie source of essential vitamins and minerals. The dietary fiber found in vegetables (and fruits and whole grains) plays a role in maintaining a healthy body weight, lowering cholesterol, and reducing the risk of some cancers.

Fiber is increasingly added to processed foods including granola bars and energy bars. It is possible to get up to half of your daily recommended intake of fiber by eating a single Fiber One bar. That is the equivalent of a cup or more of most vegetables! Considering that many of these snacks are essentially candy bars, they are a tasty way to get fiber.

Vitamins and minerals have long been available as supplements and added to certain foods, including products made from grains like pasta and bread. But now you can get vitamins in many soft drinks, many of which have as much sugar as soda. And calcium is added to a variety of foods from breakfast cereals to snacks.

There are, of course, some benefits of doing this. People who don’t eat a healthy diet can get enough essential nutrients through these products. Some of these foods are low in calories so they can help people who are trying to lose weight.

While these “hidden” nutrients may seem like a good solution for people who don’t eat enough vegetables, this form of stealthy healthy eating may have some negative consequences.

These processed foods may be high in sugar, fat, and calories which could contribute to weight gain. The fact that these foods are designed to taste good—many include chocolate—may lead people to overeat. Aside from excess calories, eating far too much fiber could cause GI discomfort or other health problems.

More concerning, though, is the fact that these foods set an expectation that healthy foods should be sweet. This is particularly problematic in children, who may avoid eating vegetables (and other healthy foods) in favor of sweet drinks and snacks that contain the same nutrients.

Additionally, getting vitamins, minerals, and fiber through processed foods keeps people from learning how to make healthy choices and prepare real food. This has consequences for developing healthy eating habits in both children and adults.

Focusing on getting individual nutrients over eating a variety of healthy foods is thought to be an important cause of the current obesity epidemic. Relying on processed foods with added vitamins, minerals, and fiber may be doing more harm than good to your health.

The bottom line is that you should get your nutrients from real food and balance what you eat with daily physical activity. Remember, good health comes from making smart choices, not from a bottle or a box!

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Worried about low T? Lose some W!

Posted on April 30, 2014 | Leave a comment

I heard a story on Morning Edition on NPR on my way to work on Monday about low testosterone levels in men.

“Low T,” as it is called, seems to be increasingly common in men. This has led to a huge increase in the sale of prescription drugs and non-prescription supplements designed to increase testosterone levels in men, whether they need it or not. To be sure, some men do need testosterone therapy, but it seems that many more don’t, but use it anyway. Testosterone therapy is not without risks and can increase the risk of heart attack.

Back to the NPR story…The doctor quoted in the story, Dr. Ronald Tamler, said that,“the most common reason for low testosterone in my practice, I find, is obesity.”  He goes on to explain that excess fat can alter the balance of hormones, reducing testosterone and increasing estradiol. His research shows that weight loss (via surgery) is the most effective way to treat “low T.”

So maybe the solution to low T isn’t to (always) worry about replacing T. Many times the answer may be to lose some W!

 

 

 

 

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How to win at losing: What to do when your diet ends.

Posted on April 28, 2014 | 1 comment

In the past few weeks several community and fitness center-based weight loss programs have ended. Since many diets and exercise programs last 12–15 weeks, this time of year marks the end of many programs. During this time many people have met personal weight loss goals through individual diets and “biggest loser” type programs. (I have written about competition-type weight loss programs in the past here and elsewhere.)

One of these is the Team Lean program at the Y. This year over 1,600 people from the Aiken and Augusta area participated in this 12-week program that included weekly education sessions and weigh-ins, a strong group dynamic, and monitoring to prevent rapid, unhealthy weight loss. The average participant lost almost 10% of their body weight, which is sufficient to promote improvements in blood pressure, cholesterol, and diabetes.

This level of weight loss is common among people who participate in individual or group programs. But the real challenge is to maintain that weight loss after the program ends. Many people have successfully met their weight loss goal only to gain the weight back later. In fact, some people do it every year, losing and regaining the same 10 (or 20 or 30) pounds over and over.

Losing weight is challenging, to be sure. But maintaining weight loss can be even more challenging. Many people think that they are finished once their diet or weight loss program ends. The truth is that the end of the diet marks the beginning of the next phase: keeping the weight off. This is the topic of my Health & Fitness column in the Aiken Standard this week.

There is a practical reason why this happens. In order to lose weight and keep it off people need to learn a whole new lifestyle involving what, when, why, and how they eat as well as daily exercise. These lifestyle changes are difficult to make and can take months or years to fully adopt. In many cases, the weight loss program ends before people make lasting behavior changes and revert to their old habits.

While there are literally hundreds of diets and weight loss programs to choose from, “weight maintenance” programs are far less common. The good news is that following the advice of people who are successful at losing weight and keeping it off can help you maintain your weight loss.

The National Weight Control Registry (NWCR) is a collection of information submitted by individuals who have succeeded at long-term weight loss. These “successful losers” have lost an average of 66 pounds and kept it off for over five years, with some losing as much as 300 pounds! Best of all, they share the secrets of their success.

It turns out that they lost weight through a variety of diets and programs. Nearly half lost weight on their own and the other the other half followed of some type of program. Regardless, almost all of them increased their physical activity and modified their diet, suggesting that diet and exercise together are important for successful weight loss.

There is also variety in how NWCR members keep the weight off. Most report continuing to maintain a low-calorie, low-fat diet and doing high levels of activity. Almost 80% eat breakfast every day, 75% weigh themselves at least once a week, over 60% watch less than 10 hours of TV per week, and 90% exercise, on average, about 1 hour per day.

Many people worry whether they are following the “best” diet or weight loss program. The specific diet may not be as important as what you do when it ends. Notice that the majority of successful losers still control what they eat and nearly all exercise each day. This suggests that going back to the way you ate before you lost weight is unrealistic. And if you aren’t exercising, at least walking, every day already, now is a good time to start.

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Subway’s identity problem (and why it matters).

Posted on March 3, 2014 | Leave a comment

If you are looking for a healthy place to eat lunch, chances are you will think of Subway. More than any other fast food restaurant, Subway has developed a reputation for being a healthy choice, consistent with losing weight and an active lifestyle. While you can get healthy food at Subway, you may end up eating a meal that is similar to traditional fast food in terms of calories, fat, and sodium.

This “identity problem” — Is it a healthy option to regular fast food? Or just an alternative to fast food? —  is the topic of my Health & Fitness column in the Aiken Standard this week.  This matters, of course, because you may well be fooling yourself into thinking you are making healthy choices when you aren’t.

Subway has long been thought of a healthy alternative to traditional fast food. This is largely due to a menu that has fresh-looking sandwiches rather than burgers and fries. Food at Subway looks healthy. This image is enhanced by a marketing strategy that associates Subway with health and wellness, something they seem to do better than any other fast food chain. Advertisements featuring former Olympians were abundant during the winter Olympics television broadcasts and the continuing association with Jared Fogle, who lost nearly 250 pounds by drastically changing his diet—including eating at Subway—and becoming more active strengthen this image.

The Subway menu does include several sandwiches designated as Fresh Fit choices that are low in fat and calories and could contain a full serving of vegetables. If you read the fine print you will see that this is true if you order a 6-inch sandwich on plain bread with meat and veggies, but no condiments or cheese. Adding mayo, sauces, and cheese or substituting another bread will increase the calories and fat in the sandwich. But, if you make smart choices, select a healthy side such as apple slices, and have water, unsweet tea, or another calorie-free drink, you can get a healthy, low-calorie meal.

However, that does not mean that all of the sandwiches at Subway are good choices if you want limit calories or fat. One of the sandwiches featured currently is the Fritos chicken enchilada sandwich, which is served exactly as it sounds: shredded chicken topped with enchilada sauce and Fritos chips. But if it comes from Subway it must be healthy, right?

Wrong! If you look at the nutrition information you will find that this sandwich has 580 calories, 26 grams of fat (which account for 40% of the calories), and 1170 milligrams of sodium (nearly half of what you should get in a whole day). The best traditional fast food comparison is the Big Mac at McDonald’s, which has 550 calories, 29 grams of fat, and 970 milligrams of sodium. Considering that many people eat at Subway in an effort to avoid the fat and calories of fast food, this would not be a good choice.

The point is that while you can get a healthy meal at Subway, many menus items are as high in fat, calories, and sodium as food at other fast food restaurants. The image that Subway has carefully cultivated likely conceals this fact, leading people to think they are eating a healthy meal when, in reality, they are not. It is also possible to get a meal at McDonald’s and many other fast food restaurants that is nutritionally similar to the healthier sandwiches at Subway.

This is a good lesson, since menus at many restaurants include a “healthy choices” section. Keep in mind that food that appears to be healthy may not be and that a restaurant typically thought of as a poor choice may have healthy menu items. The trick is to check out the nutrition information and make smart choices.

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Honesty is the best policy

Posted on January 27, 2014 | Leave a comment

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

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 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 and 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 (for 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!

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Eat smart, move more, chill out

Posted on January 13, 2014 | 1 comment

The goal of being “more healthy” is a good one, but can include an almost endless list dietary, activity, and other behavioral changes. Some people may feel overwhelmed and unsure of where to begin. Furthermore, there is a perception that you have to implement all of the changes simultaneously or follow a complicated diet or exercise program in order to see results.

But it doesn’t need to be this way. My Health & Fitness column in the Aiken Standard this week outlines a few simple guidelines that have the potential to lead to significant improvements in health, fitness, and wellbeing. Not only are these things you can implement right now, but they are scalable, so the more you do, the bigger the benefits.

1. Eat smart.Healthy eating isn’t necessarily about eating less or avoiding certain foods, it’s about making smart choices when you shop, cook, or eat out. Many problems with the typical American diet probably have to do with the fact that we tend to eat heavily processed, calorie-dense foods. The major difference between what we eat now and what most people ate before the current obesity epidemic is the processing our food undergoes.

You can eat smart by focusing on eating real food—fresh and minimally processed plants and animals—instead of the processed and pre-packaged food that is so common in restaurants and in meals we eat at home. That isn’t to say that all processed food is necessarily unhealthy, but it would be wise to shift the balance toward more real food.

This isn’t necessarily new advice…it was featured on the cover of a popular book in 2009, after all. But this message seems to have gotten lost in the chaos of health claims made by manufacturers in advertisements and on food labels.

You can do this right now by having a piece of fresh fruit, some nuts, or vegetables for a snack. Later, you can make most of your food purchases from the perimeter of the grocery store, and less from the aisles in the middle.

2. Move more. Most people spend too much time sitting and not enough time moving. In fact, the amount of time someone sits during the day has nearly as much impact on their health as their exercise habits. So, step one is to sit less.

Next, move more, which means just that—finding ways to be active during the day. This includes simple things like standing rather than sitting when you talk on the phone, taking the stairs instead of the elevator, and getting up off the couch during commercials. It also includes dedicating time every day for structured exercise or other activity like yard work, house work, or taking the dog for a walk. Every little bit helps, but aim for a minimum of 30 minutes per day.

Right now you are probably sitting, so stand up and stretch or move around a little. Later, go for a walk or do something active around your house.

3. Chill Out. With so much emphasis placed on diet and exercise, the health effects of stress are often overlooked. Chronic stress can have serious emotional, psychological, and physiological effects that lead to or exacerbate many health problems. While it is impossible to avoid all stress in life, minimizing stressors and managing the way you respond to stress can have important benefits.

Exercise is one good way to manage your feelings of stress as well as the effects it has on your body. Yoga has long been recommended to help reduce and control stress, but all types of exercise can help. Managing time better, including getting enough sleep, is helpful for many people.

Right now you can close your eyes and take a few deep breaths to relax. Later, spend some time doing something you enjoy.

So, if you are feeling overwhelmed by complicated and confusing health recommendations, keep it simple: eat smart, move more, and chill out!

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Just in time–New Year’s resolutions that will actually help you achieve your goals.

Posted on December 31, 2013 | Leave a comment

There are just a few more hours until you have to get started on your New Year’s resolutions.

There are also a few more hours to make New Year’s resolutions, if you are a procrastinator.

The most common resolutions are changes to improve health, including quitting smoking, losing weight, and starting an exercise program. Many people who make these–and other–resolutions get off to a good start, but most will end up failing to meet their goals.

While there are many reasons why people don’t keep their resolutions, part of the problem might be that these should not be the only New Year’s resolutions you make. Resolutions should be the things you need to do to achieve your goals, not the goal itself. Here is an example:

Losing 20 pounds is a good goal for many people. But what that really means is learning about a healthy way to eat, shopping for and preparing appropriate meals, finding time to exercise each day, and focusing on turning these behaviors into lasting habits. In this example, learning how to shop for and prepare healthy meals would make an excellent resolution that would lead toward the goal of losing 20 pounds.

The idea of making resolutions that are steps in the process leading toward a goal instead of the goal itself is the topic of my Health & Fitness column in the Aiken Standard this week. Here are a few resolutions that can help you achieve your health improvement goals, whatever they may be:

Be realistic
Many people fail to keep their New Year’s resolutions simply because they don’t set realistic goals or aren’t realistic about what it will take to meet those goals. For example, running a marathon is an ambitious goal for almost everyone, especially someone who doesn’t exercise at all. It is possible that someone could get in shape to run a marathon, but it will take a long time. A resolution to work up to jogging five days per week, with a goal of completing a 10 k run is more realistic and achievable.

Focus on learning
Making most health behavior changes involve learning as much as doing. Something as simple as eating a healthier meals requires learning about the nutrients that make some foods healthier than others, learning to read food labels to select healthy foods, and learning how to cook and prepare healthy meals. If your resolution is to learn about healthy meals you will be able to achieve that goal and be well on your way to eating a healthier diet.

Manage your time
Most health improvement projects require taking time to learn about, implement, and maintain those healthy behaviors. A major reason the people fail to really get started with or sustain a weight loss or exercise program is time. If you resolve to manage your time to include exercise or meal preparation in your daily schedule you will be much more likely to meet your goals. Trying to add these new activities as “extras” to your already busy day will inevitably lead to them getting squeezed out.

Plan ahead
Most people already know that changing health behaviors can be challenging, even under the best circumstances. It’s no wonder that holidays, travel, and other life events can complicate or even derail an otherwise successful diet or exercise program. Make it your resolution to think about what you can do before, during, and after these (and other) disruptions to your routine to keep yourself on track. Planning ahead and thinking “what if” can make the difference between giving up and catching up on your diet or exercise program after a vacation.

Have a happy and healthy New Year!

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Weight loss and exercise project management

Posted on November 18, 2013 | Leave a comment

Almost everyone who starts a weight loss of exercise program does so with good intentions. Many get off to a good start and see beneficial results, at least initially. Unfortunately, long-term success is uncommon.

There are myriad reasons for this, but the way people manage their weight loss and exercise efforts is certainly among them. Think about it: when someone takes on a new diet or exercise program it is usually added to their typical routine. The problem with this approach  is that most people are busy, and there is little extra time in their day. As a consequence, the diet and exercise doesn’t get the time or attention is needs in order for people to be successful.

This is where the lessons of good project management can be helpful. In the workplace a major project is usually accomplished though defining the scope to the project, appropriate goal setting, allocation of resources (including time), and a mechanism to assess progress.

But many people who approach projects this way at work tend not to apply this process to health improvement projects at home. The result is poor planning, setting unrealistic goals, and failure to allocate appropriate resources, including time.

Especially time. Time to set goals, time to plan and prepare meals,  time to exercise, and, perhaps most important, time to assess and adjust the plan along the way.

Many of these problems could be avoided through the same good project management techniques that would be used at work. The idea of treating weight loss, exercise, and other health improvements as a project is the topic of my Health & Fitness column in the Aiken Standard this week.

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