Weight Loss Do’s and Don’ts

Chart of US population with BMI>30

If you have watched the news or read an article recently related to health, you probably know that more than one-third of the U.S. population is considered obese. Obesity is defined as having a BMI equal to or greater than 30 and is based on your weight relative to your height. About another third of the population are considered overweight and are at risk of obesity. Overweight is defined as having a BMI between 25 and 29. These numbers are concerning due to the increased risk of health problems associated with obesity. The causes of this increase in obesity over the past few decades is multifactorial and no one treatment will solve the problem. My concern is that with any problem there are many people willing to offer a solution for the right price. Due to the high number of people living with obesity, the opportunity to sell weight loss products and services for profit is growing and so are the unscrupulous opportunists eager to make money. While there are some good programs and products offered, I want to focus on some important things to consider when trying to lose weight. Here are my weight loss do’s and don’ts.

 

  1. Not all weight loss is healthy.

    1. Don’t skip meals, starve yourself, exercise obsessively or restrict entire food groups.
    2. Do eat regular balanced meals throughout the day, limit your portion sizes, avoid sugary beverages, avoid junk food and be more active.
  2. Anything that promises a 30 lb. weight loss in 30 days is not realistic.

    1. Don’t set your expectations so high that you set yourself up for failure.
    2. Do plan on seeing a 1-2 lb. weight loss per week with the expectation of losing 4-8 lbs. a month. This translates to 48-96 lbs. in a year. Gradual weight loss is better.
  3.  Weight loss does not have to cost a lot of money or severely restrict calories.

    1. Don’t waste your money on expensive diet programs or pre-packaged food. While pre-portioned meals can be helpful, it may not be the most cost effective solution. Calories do matter but restricting calories too much may backfire and lower your metabolism making it harder to keep the weight off.
    2. Do look for more affordable whole foods to incorporate into your diet and plan your meals ahead of time. Most women will need 1400-1600 calories per day and most men will need 1600-2200 calories per day depending on activity level, age, weight and amount of weight loss needed. A registered dietitian can tell you for certain.
  4.  Exercise is an important part of any weight loss program.

    1. Don’t start an intense exercise program if you have not been exercising before. A gradual increase in activity will help avoid injury while building endurance and strength.
    2. Do begin slow and build up over time. Incorporate cardiovascular exercise such as walking, biking or swimming with strength training such as weight lifting to get the best results. Try to get 30 minutes 5-6 days per week.
  5. Weight loss should be just like your medical treatment – individualized for you.

    1. Don’t compare yourself to others. What may work for one person may not work for another. Also your ideal bodyweight may be very different from someone else.
    2. Do focus on your particular goals and what diet and exercise works best for you.
  6. No pill or injection can take the place of a healthy diet and active lifestyle for weight loss.

    1. Don’t think that a pill or injection will solve all your problems without your effort.
    2. Do work on issues that led to the weight gain and use medications if needed as extra assistance to reach your goals. Talk to your doctor if you have made consistent lifestyle changes but still cannot lose weight.

As a dietitian I have heard some crazy ideas about how to lose weight. From very restrictive diets that limit calories to the point of starvation or eliminate entire food groups to avoid certain macronutrients (like carbohydrates) to eating only certain foods in combination with other foods and only at certain times of the day. It can be quite amusing at times. But obesity is serious and there is nothing funny about someone being taken advantage of because they are trying to lose weight. And yes, you can lose weight on just about any of these programs but it is not always a healthy weight loss and may contribute to problems later on. For example, some diets advocate a very low fat diet. While this may save calories, it can also set you up for gall bladder issues. Once you reintroduce foods containing some fat (which you need by the way) you may find yourself having gallbladder issues. This is not a good trade off for a little bit of weight loss.

So my professional advice is to start by restricting the portions of foods that you are currently eating. Eating smaller amounts more frequently can help you avoid being too hungry. Then begin to incorporate healthier fruits and vegetables into your meal plan. Next, start eliminating foods or beverages that you know are unhealthy like sweets and soda. Experiment with different foods in order to get variety in your diet. Choosing fruits and vegetables of different colors makes this easy to do. Be careful when eating out and try cooking without adding excess oil, butter, sugar or salt. Add daily exercise to your routine to burn calories. Make sure you are getting adequate sleep at night. Being sleep deprived can make it harder to handle stress and you may be tempted to eat during the day in order to stay awake. A good 7-8 hours of sleep is ideal.

If these tips do not work for you, see a healthcare professional that can help you identify other possible causes for the unwanted weight such as thyroid issues, hormone imbalances or medication side effects. Diet becomes even more important if any of these are an issue. To find a qualified dietitian in your area that may be able to help, click here.  Feel free to share your comments below.

 

RESEARCH SAYS – Unraveling Mysteries of a Healthy Diet

Fruits and Vegetables

With all the hype surrounding diet and nutrition, it can be easy to become confused in the whirlwind of latest fad diets and contradictory recommendations. So what is a person to eat? Today I want to discuss some known facts and current nutrition research while relying on logic, reason and some common sense. To unravel the mysteries of a healthy diet, here are a few things we know to be true.

  1. Calories in versus calories out determine weight changes. If you consume more calories than you burn, you gain weight. If you burn more calories than you consume, you lose weight. If your calorie intake is equal to your calorie output, you maintain weight. This is basic math and does not get more complicated than that.  Now there are a few caveats here. Some want to argue that the type of calorie matters. You could say that is true or false. While it is easier to get too many calories from foods with more fat and sugar that are higher in calories than it is from eating too much broccoli, it does not mean that the type of food or nutrient is to blame. It just means that we can more easily consume excess calories from foods in this form than we would be able to say from a plate of vegetables. Vegetables are naturally low in calories because they are low in fat and sugar. If we add fat and sugar when cooking vegetables, we have now made them higher in calories and can more easily acquire excess from them. Since most whole foods contain plenty of nutrients including fiber that helps us feel full, we feel more satisfied with less than if we eat empty calories that are void of nutrients. According to an article from the Harvard School of Public Health, the percentage of calories coming from fat, protein or carbohydrate do not matter for weight loss in a laboratory study with controlled diets. It goes on to say that in studies where participants control their food intake, there may be an advantage to a higher protein, lower carbohydrate diet for weight control. This is likely related to the fact that it is much easier to overeat carbohydrate foods than protein foods. For chronic disease prevention, the type and quality of the food sources matter more than the relative quantity in the diet. The bottom line is calories do matter and the source of the calories are important.
  2. The same diet that reduces risk of cardiovascular disease and diabetes also helps control weight. Whether you are trying to lose weight or just want to be healthier, the good news is that you can achieve both by following the same diet. Research and the test of time have shown that a diet high in fruits, vegetables, whole grains, nuts, seeds and legumes with fish and lean meat reduces the risk of many health conditions and can promote a healthy weight. We also know that a diet high in refined carbohydrates, unhealthy fats and sugary beverages leads to weight gain and increased health risks.
  3. Our diet and activity affect metabolism and metabolism affects weight.  When people say “I have a slow metabolism and can’t lose weight”, I say “Let’s fix the metabolism”. There are some things under our control and luckily this is one of them. While it is true that women have a slower metabolic rate than men, we can make a difference here. Muscle burns more calories than fat so exercise is a huge metabolism booster. Any type of strength training or weight bearing exercise can help build muscle to burn more calories. If you gain weight, your metabolic rate actually increases because of an increase in surface area. So if you weigh 200 lbs., you will have a higher metabolic rate than if you weigh 100 lbs. This means that you will burn more calories walking 5 miles weighing 200 lbs. than if you walk 5 miles weighing 100 lbs. Think of it as carrying an additional 100 lbs. while exercising. Other factors to consider that affect metabolism include getting enough sleep, eating enough quality protein, thyroid health, age and medications that affect metabolism.
  4. Fat does not necessarily make you fat. This point goes back to number 1 on our list. Even though fat contains more calories per gram than carbohydrate or protein, it is not necessarily responsible for promoting weight gain. It is the total calorie intake rather than the type of calorie consumed. Some studies actually show participants losing as much or more weight on a higher fat, lower carbohydrate diet. This is thought to be related to the fact that fat promotes satiety so you feel satisfied eating less. Here again the type of fat does matter. Too much saturated fat and trans fat may be more likely to increase weight as opposed to mono- and polyunsaturated fats and there is a definite correlation with chronic disease and the type of fat consumed. It is the total amount of calories not the type of calories that cause weight gain but the type matters for health.
  5. Increased protein intake may help with weight loss. This is related to the fact that protein promotes satiety. A higher protein diet also tends to be lower in carbohydrate but higher in fat so it is hard to isolate whether the protein or the fat makes the difference. Protein is important for maintaining muscle mass which helps with metabolism. But here again the type of protein matters. A higher intake of processed or red meat correlates with higher chronic disease risk than protein from fish, nuts, beans, seeds or poultry.
  6. Whole foods are better than refined foods for health and weight management. Our bodies need certain nutrients in varying quantity to function at its best. Whole foods provide the nutrients needed within a reasonable amount of calories. Refined foods like sugar, white bread, white rice, etc. offer calories but minimal nutrients. This imbalance of calories and nutrients leads to weight gain and increased risk of chronic disease.

There is so much that can be said about diet and nutrition but I think Michael Pollan summed it up best in his book In Defense of Food: An Eater’s Manifesto. Eat food. Not too much. Mostly plants. While some of the book leaves room for debate, I believe the major premise of the statement above is good advice. Another great example can be seen in Dr. Weston Price’s book Nutrition and Physical Degeneration. This book summarizes Dr. Price’s research on different people groups from several geographic areas and the impact of their diet on health. Both are interesting reads and full of thought-provoking nutritional insights. I have included a link to some of my favorite books below. Here is to good food and good health!

 


Cholesterol and Heart Disease

FEBRUARY IS HEART HEALTH MONTH

 

The connection between dietary cholesterol and heart disease has been under scrutiny for some time. While it remains controversial, there are a few things that we do know when it comes to cholesterol’s role in cardiovascular disease. First, we know that deposits along the artery walls called plaque contain cholesterol. Second, we know that once enough plaque accumulates inside the artery, it can cause a narrowing and eventually complete closure of the artery preventing blood flow. This restriction in blood flow is what causes the damage seen in heart attacks and stroke. Without oxygen and nutrients supplied by the blood reaching the heart and brain, the tissues begin to die. To help keep the arteries clean and open, the National Heart, Lung and Blood Institute in cooperation with the American College of Cardiology and the American Heart Association have established target blood cholesterol levels that have been shown to reduce the risk of  cardiovascular disease. These are the guidelines that are currently in practice.

Total Cholesterol

LDL

Triglycerides

Category

Less than 200 mg/dl <100 – 129 mg/dl  <150 mg/dl Optimal
200-239 mg/dl 130-159 mg/dl 150-199 mg/dl Borderline High
Above 240 mg/dl 160-189 mg/dl 200-499 mg/dl High
>190 mg/dl >500 mg/dl Very High

The latest guidelines were set in 2013 and changed how doctors treat people with elevated cholesterol levels. There were several updates based on clinical trial results that changed from the previous guidelines in 2004. The most drastic change was moving away from treating to target. This means that doctors are no longer advised to continue increasing the medication dose or adding more medications in order to get a patient’s number to a particular target. The goal is not whether your cholesterol levels get to a particular number but whether your risk of cardiovascular disease is decreased. This is based on the fact that studies have confirmed lowering your cholesterol levels with drug therapy is not equivalent to lowering your risk of heart disease. In real world experience, we have seen several patients in the Cardiac Rehabilitation program that had great cholesterol numbers but still had a heart attack. This makes it very important to identify other modifiable risk factors for heart disease, such as smoking, sedentary lifestyle, diet, weight and blood pressure. For an online calculator to help you determine your risk, click here. Cholesterol is still a key player but just getting that number to goal does not guarantee your risk is reduced, especially if it is achieved with drug therapy. Lifestyle intervention seems to be more beneficial for reducing risk of heart disease. If lifestyle changes alone are not enough, then drug therapy should be considered once the benefit versus risk are evaluated with your doctor. For those with a very high LDL, the benefit seems to outweigh the risk of drug therapy because the risk is much higher. We have to keep in mind that drug therapy always carries some risk and potential side effects. Another thing doctors must consider is a person’s HDL level. If HDL levels are optimal (>40 for men and >50 for women), then the risk of cardiovascular disease is reduced.

Regardless of cholesterol numbers, there are some healthy lifestyle habits that can help us reduce the risk of heart disease.

  1. If you smoke, quit.
  2. If you are overweight, try to lose weight. Even a 5-10% weight reduction can make a difference.
  3. Get 30 minutes of exercise at least 5 days a week. Even if it is in 5- or 10-minute increments.
  4. Keep your blood pressure under control.
  5. Avoid trans fats! Limit saturated fats in your diet. These include fatty meats, full fat dairy, cheese, egg yolks and butter. Some is okay but don’t overdo it. Healthy fats from fish, nuts, seeds and avocados are better for the heart.
  6. Increase your fiber. Fiber in the diet can decrease our absorption of fat and cholesterol in the gut and help lower cholesterol levels. Fruits, vegetables, nuts, seeds and whole grains are good sources.
  7. Fish or fish oil supplements provide healthy omega 3 fatty acids which primarily target high triglyceride levels but can potentially reduce heart disease risk. Salmon, trout, herring, mackerel, sardines and tuna are excellent sources.
  8. Limit refined carbohydrates and sugars in order to reduce inflammation.

For more information, please visit one of the websites linked above. Heart disease is still the #1 killer in the USA but a lot of these deaths are preventable. Here is to good heart health!

Please feel free to share your comments below and share this post with anyone you love who might benefit from this information.

Blood Pressure and Heart Health

 

Digital blood pressure cuff

Monitoring for Health

You may have noticed your healthcare professional checking your blood pressure at each office visit. But why is knowing your blood pressure so important? To answer that question, we have to understand what blood pressure is and why it matters. Your doctor will give you two numbers after checking blood pressure. The first number is called the systolic blood pressure. This is a measurement of the amount of pressure in your arteries when your heart muscle contracts pushing blood into the arteries. The second number is called the diastolic blood pressure. This is the pressure in your arteries between heart beats or when the heart is not contracting. Numbers are measured in millimeters of mercury (mm Hg) and written as 120/80 for example. Numbers higher than a normal range indicate your heart is working too hard to pump blood to the rest of your body. This can put too much stress on your heart as well as damage the linings of arteries causing damage to blood vessels in the eyes or kidneys for example.

So what is a normal range for blood pressure?       Ideally, you want a systolic blood pressure (first or top number) to be between 90 and 120 mm/Hg. The diastolic blood pressure (second or bottom number) should be between 60 and 80 mm/Hg. So a blood pressure between 120/80 and 90/60 is good. This means your heart is working at optimum efficiency without excessive force against the walls of blood vessels but with enough force to get oxygenated blood to the rest of your body. If blood pressure is too low (below 90/60) then tissues will be deprived of oxygen. Blood pressure that is too high (above 120/80) is called hypertension and blood pressure that is too low (below 90/60) is called hypotension. Your body prefers a happy medium to keep things working well.

The next question is how do we maintain a healthy blood pressure? Lifestyle plays a major role and includes a healthy diet, exercise, maintaining a healthy weight, not smoking, avoiding excessive alcohol intake and stress management. If you have a family history of high blood pressure (hypertension) you will want to be even more diligent about these things. Key dietary factors for controlling blood pressure include getting enough fruits and vegetables and reducing excess sodium. This provides the right balance of minerals (potassium, magnesium, etc.) for blood pressure control. Too much salt in the diet can increase sodium in the blood stream which reduces the kidneys ability to get rid of excess fluid. The fluid retention causes an increase in blood pressure. The more salt you consume, the more fluid you will retain and the higher your blood pressure will be. This is why lowering your salt intake with diets such as the DASH diet can help. Limiting salty snacks, eating out less frequently and using less salt when cooking can all contribute to a healthier diet for your heart. The American Heart Association recommends guidelines based on research showing what is effective for reducing blood pressure and heart disease. They recommend no more than 2,300 milligrams of salt (equal to a teaspoon) per day or 1500 milligrams (3/4 teaspoon) for those who already have high blood pressure. For a review of research regarding the relationship between sodium intake and blood pressure, check out this 5-minute video by Dr. Michael Greger at NutritionFacts.org. These are just a few of the compelling arguments for reducing sodium intake. Limiting caffeine may also help in some people. Incorporating omega 3 fatty acids from fish or flaxseed, getting enough magnesium, potassium and calcium from fruits, vegetables and low fat dairy as well as increasing fiber with whole grains can help. Taking a CoEnzyme Q10 (CoQ10) supplement can also be beneficial especially if you take a statin drug to lower cholesterol. Exercise helps to strengthen the heart muscle making each heartbeat more efficient. Aerobic exercise such as walking, biking or swimming for at least 30 minutes a day 5 days a week is good for the heart. Exercise can also help with stress management. And we all know stress can wreak havoc on our health. Maintaining a healthy weight, especially as we age, is a great way to keep blood pressure controlled. A healthy diet and exercise will help with weight loss. If you have a family history of high blood pressure, be sure to have it tested often and reduce your other risk factors as much as possible.

 

 Blood Pressure Number              What it Means       
<120 / 80    Normal
121-139 / 81-89    Prehypertension
140-159 / 90-99    Hypertension, stage I
>160 / >100    Hypertension, stage II
>180 / >110    Hypertensive Crisis

To be diagnosed with high blood pressure (hypertension) your blood pressure reading must be above 140/90 for several readings. One elevated blood pressure is not enough for a diagnosis. Your doctor may want to test it frequently over several days or weeks or have you monitor at home. If your blood pressure remains elevated, then diet and lifestyle interventions should be recommended first. If this is not sufficient to lower the numbers, then medication will be considered next. If your blood pressure is extremely high (above 160/100), your doctor may want to run some tests to determine if there is a specific cause. High blood pressure should be taken seriously since it is a major risk factor for heart attacks and stroke as well as kidney disease and dementia. Here is my checklist for getting blood pressure under control.

  1. If you are overweight or obese, start making changes to lose weight today. Even a small reduction in bodyweight can make a difference.
  2. If you smoke, stop! Get help as needed. Smoking causes vasoconstriction (narrowing of the blood vessels) which can make blood pressure go up.
  3. Limit your salt! Look at labels and avoid canned soups and packaged foods with more than 400 milligrams of sodium per serving. Other high sodium foods include hotdogs, bacon, luncheon meats and pickled foods.
  4. Eat more fruits and vegetables. These are naturally low in sodium but provide potassium, magnesium and even some calcium. They are also low in calories and can help with weight loss.
  5. Limit alcohol to no more than 2 drinks for men and 1 drink for women per day.
  6. Relax! Find ways to reduce your stress by engaging in hobbies you enjoy, listening to music, taking a walk, getting a massage or talking to a close friend. Deep breathing can also help you feel more relaxed.

Take care of your heart so it can take care of you!

A Healthy Heart is a Happy Heart

Heart with fruits and vegetables

      Heart Health

February is American Heart Month so I thought it would be appropriate to discuss how to keep our hearts healthy. Some tips will not surprise anyone such as don’t smoke, maintain a healthy weight and exercise. But I want to get more specific with what can either prevent or contribute to heart problems. Let’s begin by looking at the top risk factors for heart disease. According to the National Heart, Lung and Blood Institute  (NHLBI) (a division of the National Institutes for Health (NIH)), these include high blood pressure, high cholesterol, diabetes or pre-diabetes, smoking, being overweight or obese, sedentary lifestyle, family history of heart disease, unhealthy diet, having preeclampsia during pregnancy and age (greater than 55 for women). Some risk factors we cannot control such as our age, family history or developing preeclampsia during pregnancy. The good news is we can control the other risk factors in most cases by making some diet and lifestyle changes.  The first thing we need to know is whether we have any risk factors. Do you have a family history of heart disease? Is your blood pressure normal? What are your blood cholesterol levels? Do you have pre-diabetes or diabetes? Do you smoke? Are you considered overweight or obese? Do you get at least 30 minutes of exercise (in addition to your normal daily activity) most days of the week? Do you get 5 servings of fruits and vegetables most days of the week? Do you limit your sodium and saturated and trans fat intake? How about your stress level? Do you have a healthy outlet for managing stress? How you answer these questions determines what areas need focus for making changes. We are going to look at each modifiable risk factor in a series of posts during the month of February. Look for more information on your risk factor(s).

Other articles in this series:

A Healthy Weight for Heart Health

Blood Pressure and Heart Health

Cholesterol and Heart Disease

Diabetes and Heart Health

Diet and Heart Health

Exercise for Heart Health

Stress Management and Heart Health

For more information, you can find a free 127-page book “The Healthy Heart Handbook for Women” from the NHLBI website. There are other resources for men as well but this one is particularly geared to create awareness of heart disease in women. Heart disease is still the #1 killer of both men and women in the United States. Let’s work on making our heart happy and healthy this February.