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Q&A on Weight Loss

Question: Self control and portion control are my two biggest downfalls. What works and what doesn't?

Answer: Self-control is a complicated issue. People increase their self-control by different means. Some benefit from the support of a group, others like to have a personal trainer, and others find various methods for enhancing their motivation. The most important thing is to find a way of keeping yourself motivated and practicing that on an ongoing basis.

Portion control is a terribly important topic. Portion sizes in America are out of control. The typical restaurant has a portion size equal to 2.5 meals. There are web sites available for information on healthy eating and portion sizes. Finally, being physically active will help with motivation and regulating portion sizes.

Question: Are the issues involved in weight loss for obese pre-adolescents different from those for adults? Where can parents find useful, usable, compassionate help in dealing with an obese child?

Answer: Obesity in children is a very important issue and one that's received far less attention than it deserves. If one goes to two web sites, there will probably be helpful information on weight control in children. First is www.nutrition.gov and the other is the site for the Centers for Disease Control. There is also a program called Shapedown that has been tested.

Question: What is BMI?

Answer: BMI stands for Body Mass Index. To really confuse you, you calculate BMI by dividing your weight in kilograms divided by your height, squared, in meters. This may all sound perplexing, but in fact BMI is a useful concept. It is a better number than pounds on the scale to help determine how close a person is to their ideal weight.

Question: Should we follow the food pyramid and consume a large quantity of carbohydrates, or go toward the Atkins approach, and minimize carbohydrates?

Answer: Always see your doctor first before starting a diet. There are good carbs and bad carbs, the same as there are good calories and bad calories. Eat right, exercise and follow the advice of your doctor.

Question: What is your opinion of the view expressed recently in the magazine section of The New York Times that carbohydrates (as opposed to fat) are the real villains in the "obesity epidemic?"

Answer: There is huge controversy about carbohydrate and fat spurred to a great extent by an article published several weeks ago in The New York Times. The main complaint with Atkins is he never did solid, scientific tests of his diet to prove that it was safe before promoting it and selling millions of books. Scientists are now studying the Atkins Diet but no long-term results are yet available. At some point we will probably learn the optimal balance of carbohydrates, fat, and protein a person needs to lose weight. I suspect that this balance will change from person to person. While we await this science, the best advice we can give is to follow the food guide pyramid. I have long believed that one can accomplish much of a healthy diet by doing a few simple things:

Eat more fruits and vegetables
Eat less junk food
Consume fewer soft drinks
Eat more reasonably sized portions

Question: Is there such a thing as "negative calories" (hard-boiled eggs, etc.), that require more calories to digest than are actually in the food itself?

Answer: No. This is another diet myth among many which has been proposed over the years. It's true that foods like lettuce have few calories, but don't believe that eating certain foods leads to tangible weight loss because of this concept of negative calories.

Question: What about keeping a detailed food journal? How important is journaling to motivation and success?

Answer: Journaling is tremendously helpful for many people. The act of journaling itself helps some control their eating because they know everything must be written down. But more important, a journal helps you keep track of situations that may provoke eating.

Question: Where do you feel artificial sweeteners such as sucralose, aspartame, acesulfame, or stevia (not artificial) fit into a healthy weight-loss diet?

Answer: Some are concerned that artificial sweeteners may have negative health effects. There is not substantial evidence of this. Whether these help people control weight is another question. People have been using these sweeteners for many years before scientists finally tested whether they are helpful. The research that exists suggests artificial sweeteners do help to control calories. They are certainly not the solution to a weight problem, but may help. If someone is overweight, switching from sugar-sweetened drinks to calorie-free drinks could make an important difference in overall calorie intake.

Question: How do you find out what your ideal weight is?

Answer: You can calculate your BMI (body mass index). I caution against getting too caught up in the concept of ideal weight. Some people have naturally heavier weight, and they may be eating a healthy diet and getting regular physical activity, but still weigh too much according to the BMI tables. Thinking of a healthy weight, or a comfortable weight, may be a better practice.

Question: What do you think of Dr. Barry Sears' work and diet (The Zone)?

Answer: The Zone diet, like almost all other diets written in diet books, has received too little scientific testing to know whether it is safe and whether it really works. Sears, like Atkins, believed it was acceptable to sell a diet plan to countless people before it was tested. In my mind this is not the ethical way to proceed.

Question: Do you think the glycemic index is useful for appetite control and weight loss?

Answer: The glycemic index refers to foods that make insulin levels spike after eating and then fall abruptly shortly thereafter. The theory is that foods with a high glycemic index drive up insulin levels and then make people feel hungry after a short time. An excellent article on the glycemic index was published recently by Dr. David Ludwig in The Journal of the American Medical Association. From the data I see, I suspect we will be hearing much more about the glycemic index. Long-term studies have not been done to see whether a diet based on this concept is more helpful than alternatives, but I am optimistic. Overall, a diet based on the glycemic index leads one away from junk food, snack food, and soft drinks, and toward foods we already know to be healthy, such as fruits and vegetables. Therefore, I believe there is considerable promise to the concept of the glycemic index.

Question: I try to eat a healthy variety of foods and I exercise every day but I've been stuck at a stand still for about two months. I can't seem to lose anything and I still have 20 pounds to go to be at the top of my height/weight chart. Why?

Answer: Plateaus present people with a vexing situation. Sometimes patience pays off, and hanging in there with a healthy eating and exercise plan will restart the weight loss for reasons we don't understand. Some people may hit a plateau because their body is resisting further weight loss. People then must make a conscious decision whether to accomplish more weight loss by either cutting calories more or increasing exercise. Only you know whether you can and should do these things. Sometimes a person who has made substantial progress with their weight never loses to the ideal, but is still a lot better off than if they had remained at the original weight. The best approach is to experiment with eating and physical activity to find a plan you can live with and that's healthy.

Question: Diabetes makes it very difficult to lose weight. What does and doesn't work?

Answer: You can go to the web site of the American Diabetes Association for some helpful information. Being diabetic does not mean that weight loss is impossible. In fact, many diabetics lose weight and show tremendous improvement in their diabetes. Obesity is the number one cause of diabetes. The beauty about changing lifestyle is you are making three changes, all of which improve health and help with conditions such as diabetes. Changes in diet and physical activity, and the weight loss these produce, all can be tremendously beneficial. It's important to realize that changing diet and increasing exercise are helpful for health, no matter what happens to weight.

Question: With obesity so common now, has there been some change in the additives to food that is a contributor to this?

Answer: The increase in obesity has occurred because we live in a terrible environment and because physical activity is being engineered out of our daily life. It is a simple matter of people eating more and exercising less. Calories are what matters, not additives.


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