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Weight Loss

Help with Weight Loss and Nutrition

Most people in the United States are overweight.  Our excess weight raises our blood pressure, causes diabetes, wears out our joints, and causes heart attacks.  Obesity shortens our lives, and may be the main reason that our children’s generation may not live as long as our parents’. 

Losing weight, exercising regularly, and keeping it off are hard work.  But they are imperative for your physical and mental well being.  

A 3-5% weight loss is possible for many people.  Losing 5-10 pounds will improve blood pressure, cholesterol and blood sugar.  Greater weight loss provides even greater benefits, and can eliminate the need for medication for many chronic diseases.

Your Plate:

The FDA developed a graphic of a healthy ‘plate’ of food, but we really like the way Harvard adapted the FDA plate to make it even better:

Harvard has a website that details each portion, and their thoughts on the benefits of their modifications of the FDA plate:  http://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

Menu Changes:

Think about real changes you can commit to for the long term.  Some General Guidelines to get you eating better are:

·   Increase fruits & vegetables – people who eat mostly fruits and veggies don’t get fat;

·   Eat more whole grain carbohydrates- more fiber will fill you up faster;

·   Eat more legumes – lentils, black beans, chick peas- which are great protein sources;

·   Decrease meat in general, and whole-fat dairy (sour cream, mayo);

·   Decrease ‘refined’ carbs & simple sugars like white bread, chips, cookies, candy and chocolate; try to commit to one dessert a day or every other day? Buy the darkest chocolate you can - the bitter flavor means just 1 ounce can satisfy your sweet tooth.

·   Choose healthier fats, like avocados, olive oil, fish, flaxseed, nuts and seeds;

·   Eliminate fast food, sodas, juice, and other ‘empty’ calorie sources; consider a change to water as your only liquid;

·   Limit nightly beer or wine to just Friday or Saturday.

·   Try a 3 week trial off gluten, dairy or sugar to jump start weight loss.

·   Spend a few hours making healthy meals on the weekend that could be eaten later in the week or prepping produce into quick containers to grab on the go.

·   Really try to listen to your body. Eat when you are hungry. Do something else when you are not. Does your body need vegetables? Protein? Pay attention.

·   If you can make 90% of your foods be healthy, unprocessed foods, you are doing well!

·   Limit fast food to once a week.

·   Put 6-8 rubber bands on a water bottle and take 1 off every time you fill your water bottle that day.

Weight Math:

Weight gain and loss follow simple math.  If you eat 500 calories less than you burn every day for a week, you will lose 1 pound.  This is called “running a calorie deficit.” 

We try to avoid the word “diet” where you torture yourself to lose 20 pounds in a month.  It’s much better to sneak up on weight loss with slow, steady life-long changes.  Aiming to lose a pound a week is a great goal.  Trying to lose more will cause parts of your body will send out signals saying “we’re starving, eat something.”  That makes it harder to lose weight, and more likely you’ll weigh even more after you’re done. 

Generally a calorie allowance for weight loss is:

·   Men = 1500-1800 calories daily

·   Women =1200-1500 calories daily

From Newsweek magazine, 2003

Tracking your Calories:

Keep a food diary and get a sense of what calories are really going in.  Two great free options for weight-loss, with calorie and exercise tracking, are:

·   “Lose It”: free weight loss website and app as well as book (www.loseit.com)

·   "MyFitnessPal": free weight loss website or app for smart phone (www.myfitnesspal.com)

Nutrition Programs:

Diets like Atkins, Ornish, South Beach, Weight Watchers, or Zone focus on certain food types, and can help you run a calorie deficit.  But there is no difference in weight loss over 12 months with any of these well known diets.  Adhering to any diet is more important than the diet itself.  So choose one that fits your likes and your lifestyle.  Build your plan on changes you can realistically keep up for life, rather than on extraordinary, short-term sacrifices. 

ALL DIETS WORK IF YOU FOLLOW THEM! 

NO SINGLE DIET IS RIGHT FOR EVERYONE!

·   Atkins:  4 phases of dietary changes. High protein and fat. Very little carbohydrate. No sugar and no simple starches like potatoes, white bread, and rice.

·   Mediterranean:  generally a diet low in red meat, sugar, and saturated fat; and high in produce, nuts, olive oil and other healthy foods.

·   Nutrisystem: You pick from structured plans or customize your own meals of prepared food for pick up or delivery. Interactive tools, trackers, and community support included.  www.nutrisytem.com or 1-800-435-4074

·   Ornish: Developed by cardiologist Dean Ornish. Very few animal products, and extremely low fat (<10% of daily calories). Proven cardiovascular benefits.

·   Paleo:  If cavemen didn’t eat it, you shouldn’t either’.  No refined sugar, dairy, legumes, or grains.

·   South Beach:  Distinguishes between good and bad carbs and fats. Low carb, higher protein and healthy fats. Lots of veggies, fish, eggs, lean protein and low fat dairy.

·   Weight Watchers: A proven, decades-old program that includes customizable healthy food choices, a focus on fiber, and an easy-to-learn point program with support group options and on-line resources; http://www.weightwatchers.com or 1-800-651-6000

·   Zone:  Eat 3 meals & 2 snacks daily. Each meal should be 40% carbs, 30% protein, & 30% healthy fats.

Norton Weight Management Center:

Patients attend FREE seminar where they will then choose between surgical or medical weight management programs. All insurance is accepted. Offer lap-band bariatric surgery, gastric bypass, or a 12-week program that involves physicians, nurses nutritionists, and exercise team: 1000 Dupont Rd. Louisville, KY 40207   (502) 629-1234

Get Moving:

Physical inactivity is as big a health risk as smoking!  Sitting all day has come to be seen as normal behavior, but inactivity is a potent risk factor for heart disease regardless of weight, and contributes to 9% of premature deaths.

In order to lose weight, you have to get moving.  Any exercise is better than none, and more is better than less.  A general goal is 150 minutes a week of exercise.  You can accumulate this however you want, and FREQUENCY is more important than DURATION.  5-10 minute intervals throughout your day can work as well as longer, dedicated exercise sessions

Try fitting these into your day:

·   Take frequent short walks;

·   Walk/ cycle for transportation;

·   Use the stairs;

·   Avoid prolonged sitting;

·   Garden and work in the yard;

·   Jump into household chores tasks

When deciding on exercise make sure your plan is S M A R T:

·   Specific- set real goals – total # of steps in a week perhaps

·   Measurable- calories burned, steps, 

·   Adjustable

·   Realistic- if you hate a gym, don’t pick that for your location to get moving

·   Tracking- minutes/ weeks, pedometers, FitBit

Medications:

There are medications for weight loss.  None come without side effects, and you can’t take them forever.  And unfortunately weight returns after you stop them. 

·   Phentermine is the most common weight loss drug.  It is a stimulant that can increase heart rate, blood pressure, and can cause insomnia, dry mouth, constipation, and nervousness.  It is habit forming and can only be taken for a few months. 

·   Orlistat (Alli, Xenical) is an over-the-counter medicine that stops you from absorbing fat.  Since the fat you eat stays in your bowels, 15-30% have GI side-effects like oily spotting, wet flatus, fecal urgency, and incontinence.  The higher the fat content in your food, the great risk of side effects

There are other medications and combinations available and more coming out in the future. Most do not have good data at this time to support their use in weight loss and the cons still outweigh the pros. 

Supplements:

·   Chromium - 100-200mg daily to reduce carbohydrate craving

·   Green tea - needs to be real tea you make yourself with a tea bag, not a pill. Try to add 2-3 cups a day without sweetener to replace other sources of caffeine and suppress appetite.

·   Water, water, water

Surgery:

Bariatric surgery can be an option. To be considered, your BMI needs to be >40, or >35 with obesity-associated diseases like diabetes, high blood pressure, or high cholesterol.  People considering surgery must:

·   Have to have attempted weight loss treatments without success;

·   Have no known endocrine or metabolic cause for their weight;

·   Be of sound mind, and understand risks;

·   Be committed to regular follow up, sound diet, and exercise program after the surgery

Books We Like:

·   Michael Pollan has several great books, including Food Rules: "Eat food, not too much, mostly plants")

·   Walter Willett, MD (Harvard Med School) & P.J. Skerrett - Eat, Drink & Be Healthy

·   Walter Willett, MD & Mollie Katzen (Moosewood cookbooks) - Eat, Drink & Weigh Less

·   Charles Teague & Anahad O’Connor - Lose It: a companion to the Lose It app and website, and a great book in its own right

·   Alejandro Junger, MD - Clean and Clean Gut:  Junger believes most ailments are linked to an injured and irritated gut. His focus is on fasting, cleansing, and detoxification to improve gut and overall health. 

Final Tips:

People who lose weight and keep it off share the following:

·   Engage in high levels of physical activity at least 3 times a week;

·   Eat a diet that is low in calories and fat;

·   Eat breakfast and never skip meals;

·   Self-monitor weight on a regular basis – buy a scale, chart your weight weekly;

·   Maintain a consistent eating pattern;

·   Catch “slips” before they turn into larger regains.

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