“Modern Western culture emphasizes thinness, denigrates excess weight and stigmatizes obese individuals, making it likely that obese people internalize these messages and feel badly about their physical presence that brands them,” said Dr. Kelly D. Brownell and Dr. Marlene B. Schwartz of the Rudd Center for Food Policy and Obesity at Yale University in a study report on obesity and body image.

Poor Body Image and Low Self-Esteem Only Add to
The Difficulties of Dealing with Weight Problems

Prejudices against the overweight seem to develop early. One study found that children as young as three years of age believed fat people were “mean, stupid, ugly, and had few friends.” A majority of adults responded similarly, associating obesity with self-indulgence, laziness and lack of discipline. One poll conducted by Reuters found that over 60 percent of respondents believed the current obesity epidemic was caused by personal diet and lifestyle choices alone. Half supported the idea of charging obese patients higher health care premiums.

Views like these are also reflected in the job market, where obese candidates on average fare much poorer than their slender peers, according to a report on the subject by Reuters (5/11/2012). Statistically, obese workers receive lower wages, are more often passed over for promotions, and are less perceived to have leadership potential than their slimmer colleagues.

The effects of stigmatizing obesity have not yet received wide attention in our society. Unlike discrimination based on race, gender, religion or sexual orientation, exhibiting bias against the overweight is not illegal and would in any case be difficult to prove. One of the reasons for this discrepancy may be cultural. Many of us like to think that hard work leads to success and that failure results from weakness. The same applies to our standards of health and beauty. We each are responsible for our own well-being, so the thinking goes, and if we don’t manage, we have only ourselves to blame. So it shouldn’t come as a surprise that obesity, especially when it’s seen as a self-inflicted disorder, is judged so harshly, even in moral terms.

Fat people are increasingly becoming scapegoats for all sorts of cultural ills, said Dr. Linda Bacon, a nutrition researcher and author of “Health at Every Size: The Surprising Truth About Your Weight.” “There is an atmosphere now where it’s O.K. to blame everything on weight. We have this strong believe that it’s their fault, that it’s all about gluttony,” she said.

Even health care professionals are sometimes found to have prejudicial attitudes towards heavier patients, as studies have shown. In one survey, more than half of the interviewed doctors said obese people were “less likely to comply with treatment.” Consequently, they tend to spend less time with them and, as a result of feeling embarrassed and disrespected, the patients themselves avoid seeking the care they need.

In sharp contrast to many popular views on the causes of obesity, the Institute of Medicine (IOM) has recently published a report that identified the increasingly “obesogenic” environment we live in as the root of the crisis, rather than individual behavior.

Dr. Rebecca Puhl, a psychologist at Yale’s Rudd Center, agrees with the IOM’s conclusions, but she warns that “as long as we have this belief that obese people are lazy and lacking in discipline, it will be hard to get support for policies that change the environment, which are likely to have a much larger impact than trying to change individuals.”

People suffering from emotional distress in connection with weight problems are much less likely to succeed in their efforts to improve their health. Dissatisfaction with one’s size or body type can produce great amounts of stress. The results can be eating disorders like binge eating or bulimia, social isolation, depression and other psychological dysfunctions. Comprehensive counseling and support from family members, friends and people with similar experiences can be lifesaving. For our society in general, a shift in attitude would help as well.

Related articles:

1. BMI Found Insufficient for Measuring Obesity
2. Minorities Are Hit the Hardest by the Obesity Crisis
3. Strategies to Overcome Portion Distortion

Did you know there are some things you can do right now to help you lose weight without depriving yourself? Check out this list of “skinny secrets”!

You snooze, you lose
As a Registered Dietitian and sleep aficionado, I have been fascinated by recent research on the relationship between sleep and weight. (I love studies that make me feel good about my laziness). Scientists have long suspected that skimping on sleep can add extra inches to your waistline. Proof is adding up in the research that has been conducted in the last decade.

One study published in 2005 followed the sleep patterns and weights of 8,000 adults over several years. Sleeping fewer than seven hours a night corresponded with a greater risk of weight gain and obesity, and the risk increased for every hour of lost sleep. In 2009, a study conducted by the University of Chicago concluded that participants consumed more calories from snacks and carbohydrates after five and a half hours of sleep compared to eight and a half hours. Just last year, a study published in the American Journal of Clinical Nutrition found that after a night of abbreviated sleep, adults consumed over 500 extra calories (roughly 22 percent more) than they did after eight hours of sleep. While the exact mechanism is not yet fully understood, researchers believe that the amount of time you sleep (and possibly the quality of your sleep) may influence hormonal activity tied to your appetite.

Don’t just think skinny, drink skinny
Use a tall, skinny glass instead of a short, wide tumbler to cut liquid calories for weight loss without dieting. You’ll drink 25 to 30 percent less juice, soda, wine, or any other beverage.
How can this work? Dr. Brian Wansink of Cornell University has found that visual cues can trick us into consuming more – or less. His research reveals that most people pour more into short, wide glasses than in taller, skinnier ones – even experienced bartenders.

Set your table for slim
Small is beautiful. Wansink’s research also showed that going from a 12-inch plate to a 10-inch plate can reduce how much you eat by about 22 percent. That’s right, just using a smaller plate can fool your brain into thinking you are satisfied on fewer calories.

The same is true with smaller bowls and spoons. Smaller servings spoons were found to result in a 14 percent decrease in food intake, while smaller bowls led to a whopping 50 percent decrease in eating.

Eat more soup
Start your meal with soup. Dr. Barbara Rolls, professor of Nutritional Sciences at Penn State University has been a pioneer in studying the role of “high water volume” foods on fullness and weight loss. One of her key findings were that broth-based soups can contribute to a feeling of fullness. Broth-based soups like miso or chicken noodle are most effective, while heavy, cream-based soups such as New England clam chowder defeat the purpose. And keep in mind that soup isn’t only a cold-weather food. In the summer, try chilled gazpacho or cucumber soup. Broth-based soups are the perfect appetizer and can keep you from overindulging during main courses and desserts.

Eat with your mind
Consider this: Researchers found that distracted eaters ate up to 100 percent more and that eating while watching TV increased subsequent snack intake by 20 to 100 percent. And the distracted eaters not only ate more calories, they still reported being less satisfied compared to those who didn’t do something else while eating.

In our fast-paced, multi-tasking world, one of the consequences of eating while working, texting or driving can result in eating up to twice as many calories compared to eating, tasting and appreciating your meals and snacks without distraction.

Munch in the morning
You’ve heard it before: Breakfast really is the most important meal of the day. But too many of us are missing out. Over 150 million Americans do not eat breakfast. If you want to lose weight, make sure you make time for a morning meal.

There are several key reasons why you should start everyday with a nutritious morning meal. Breakfast boosts your metabolism. By starting your day with a balance of healthy carbohydrates (including fiber) and protein, you will boost calorie burning by speeding up your metabolism. So you really can eat to lose weight.

Breakfast eaters tend to be leaner. Those who eat breakfast are more likely to maintain a healthy weight than those who do not. In fact, research shows that some 78 percent of successful dieters almost always eat breakfast compared to just 4 percent who rarely eat it. Why? Not only does breakfast boost metabolism, what begins with skipping breakfast often builds up to an evening finale of excess portions and high calorie food. A solid breakfast can keep you from overeating later in the day.

Veg out
Fruits and veggies are probably among the best lose-weight weapons in your arsenal. High in fiber and water, they’ll fill you up without blowing your calorie budget. Aim for nine or more servings of fruits and vegetables every day. You can incorporate them into your diet in many ways. Bulk up recipes or simply include more servings in regular meals or snacks.

Katherine Brooking, MS, RD is a Registered Dietitian and expert contributor to numerous television programs and writer. She has appeared on The TODAY Show, Live with Regis & Kelly, The Early Show on CBS, Good Morning America Health and many others. She covers health and wellness topics in SELF Magazine, The Washington Post, The New York Times and New York Daily News. For more information go to www.AppForHealth.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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Chocolate, is it a bad food, an addictive drug, an instigator of dietary disasters? Or is it a health food, dieter’s weight loss aid, and effective recovery food when you’re tired or hungry?

I vote for the latter! Personally and professionally, I like to think of chocolate (in moderation, of course) as one of life’s pleasures. Here is some research that might be of interest to people who love chocolate.

A Treat With More Health Benefits
Than You Might Have Thought

Chocolate cake for breakfast enhances weight loss. Really? Yes, according to researcher Prof. Daniela Jacubowicz (1). The subjects were 193 obese, non-diabetic adults who ate either a 300-calorie low carbohydrate breakfast or a 600-calorie breakfast that included protein plus chocolate cake (or another sweet dessert).

Both groups were instructed to eat the same amount of total calories: 1,400 for the women and 1,600 for the men. In the first 16 weeks, both groups lost an average of 33 pounds per person. But in the second half of the study, the no-cake group had poor compliance and regained an average of 22 pounds per person while the cake-eaters continued to lose another 15 pounds each. By week 32, the cake eaters had lost about 40 pounds more than their peers.

Prof. Jacubowicz noticed that those who had cake for breakfast had fewer cravings for carbohydrates and sweets later in the day. By frontloading their calories, they were less hungry and less likely to stray from their food plans. They had curbed their cravings for sweets and treats, in comparison to the group that ate the smaller breakfast.

So what does this research mean for you?
• Eat a satisfying breakfast that leaves you content. Do not stop eating breakfast just because you think you should.

• If you want a treat, such as chocolate cake, enjoy it earlier in the day, as opposed to indulging at 9 pm when you are tired, too hungry, and lack the mental energy needed to stop yourself from overeating. Think of having dessert after breakfast instead of after dinner.

• Even on a weight reduction diet, you should eat what you truly want to eat, without deprivation of your favorite foods. Otherwise, you’ll end up doing “last chance” eating. (You know, “I just blew my diet by eating cake, so I might as well keep eating it because this is my last chance before my diet starts again.”).

Note: Even people with diabetes can substitute chocolate cake for grains at a meal without creating blood glucose problems. Just eat the cake instead of – not in addition to – the grains! (2)

It’s not a secret: A candy bar contains primarily nutrient-poor calories from sugar and fat. For example, a Hershey’s Bar (43 g) contains 210 calories, of which 46 percent are from sugar and 55 percent are from fat. Hence, you want to enjoy milk chocolate in moderation, not in binges.

However, less-processed dark chocolate can be considered a healthier choice. Chocolate is made from cocoa, a plant that is a rich source of health-protective phytochemicals (just like you’d get from fruits, vegetables, and whole grains). Two tablespoons natural cocoa power (the kind used in baking) offers the antioxidant power of 3/4 cup blueberries or 1.5 glasses red wine. Unfortunately, dark chocolate has a slightly bitter taste and most people prefer the sweeter milk chocolate, a poorer source of phytochemicals. (We need to raise our children on dark chocolate, so they will they learn to prefer it.)

Dark chocolate also contains flavonoids, health-protective compounds found in many plant foods including tea, apples, and onions. Epidemiological surveys of large groups of people indicate those who regularly enjoy chocolate consume more of these health-protective flavonoids than non-chocolate eaters. This reduces their risk of heart disease. For example in the Netherlands, elderly men who routinely ate chocolate-containing products reduced their risk of heart disease by 50 percent and their risk of dying from other causes by 47 percent (3). Maybe a daily (preferably dark) chocolate fix can be a good idea?

If you’ve just had a killer workout and want to rapidly refuel and repair your muscles, boost your blood sugar, and replace sweat loss as well as reward yourself with a tasty treat, reach for some low fat chocolate milk. Research indicates refueling with chocolate (or any flavored) milk enhances recovery of both fluids and muscles better than the standard carb-only, sugar-based sports drink (4).

Anyone responsible for stocking the recovery food table for tired, thirsty athletes who want to rapidly refuel after a hard workout will tell you that chocolate milk is an all-time favorite. Weight-conscious females, in particular, can enjoy this treat “guilt-free” and boost their intake of nutrients commonly missing in their diet, such as high quality protein, riboflavin, calcium, and vitamin D. What a positive change from their embattled relationship with chocolate! This is good.

But shouldn’t we be staying away from sugary foods? The World Health Organization (WHO) recommends a limit of 10 percent of calories from refined sugar per day. That’s about 200 to 300 sugar-calories. Getting sugar from chocolate milk is nutritionally preferable than from sports drinks. Milk’s high quality protein, calcium, vitamin D, riboflavin and a host of other important nutrients is far better than sugar water with a dash of salt.

For those of you who happen to read the Boston Globe (3/13/12), you might have caught my answer to a healthwriter’s criticism of USA Swimming for choosing chocolate milk as a sponsor. My response: “Kudos to USA Swimming for choosing to be sponsored by the maker of a whole food as opposed to an engineered sports food. To have role-model athletes touting low fat chocolate milk is preferable to the alternative of them touting sports drinks. I only wish more “real food” companies would do the research needed to counter the influential engineered sports food industry.”

By no means is chocolate the key to a healthy diet, nor is eating lots of dark chocolate preferable to snacking on apples and bananas. Eat chocolate in moderation so it does not crowd out other nutrient-dense foods. But chocolate can be balanced into an overall wholesome diet and add pleasure to the day – even if you are dieting to lose weight. For chocolate lovers, deprivation of chocolate may create more problems than it solves.

Nancy Clark, MS, RD, CSSD (Board Certified Specialist in Sports Dietetics) counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her Sports Nutrition Guidebook and food guides for new runners, marathoners, and soccer players offer additional information. They are available at www.nancyclarkrd.com and www.sportsnutritionworkshop.com.

References
1. Jakubowicz D, O Froy, J Wainstein, M Boaz. Meal timing and composition influence ghrelin levels, appetite scores and weight loss maintenance in overweight and obese adults. Steroids 77(4): 323-331, 2012.

2. Peters, AL, MB Davidson, K Eisneberg. Effect of isocaloric substitution of chocolate cake for potato in type I diabetic patients. Diabetes Care 13(8): 888-92, 1990.

3. Buijsse B, Feskens EJ, Kok FJ, Kromhout D. Cocoa intake, blood pressure, and cardiovascular mortality: The Zutphen Elderly Study. Arch Intern Med. 27; 166(4): 411-7, 2006.

4. Lunn WR, Pasiakos SM, Colletto MR, Karfonta KE, Carbone JW, Anderson JM, Rodriguez NR. Chocolate milk and endurance exercise recovery: Protein balance, glycogen and performance. Med Sci Sports Exerc. 44(4): 682-91,2012.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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Now a new program is making headlines that elevates the meaning of ‘radical weight loss’ to a whole new level. The K-E diet, abbreviation for Ketogenic Enteral Nutrition, promises astounding short-term success without hunger pangs or the need for exercise.

A New Crash Diet Gets a Lot of Attention
But the Health Risks Can Be Considerable

And it’s radical alright, even by the looks of it. Instead of following a specific meal plan, dieters have a feeding tube inserted through their nose into their stomach to facilitate a constant drip of a protein and fat solution mixed with water that can lower their daily calorie intake to about 800. Although this equals a near-starvation scenario, those who have tried the procedure say they never felt hungry.

“It’s a hunger-free, effective way of dieting,” said Dr. Oliver Di Pietro of Bay Harbor Islands, Florida, who offers the program in his clinic. “Within a few hours, your hunger and appetite go away completely, so patients are actually not hungry at all for the whole 10 days [the program lasts]. That’s what’s so amazing about this diet.”

Although the K-E diet is not entirely new and has been in use in Europe for some time, it has suddenly attracted wide attention over here ever since Jessica Schnaider, a soon-to-be bride, has been wearing the feeding device in public for over a week so she could slim down enough to fit into her wedding gown.

“I don’t have all the time on the planet just to focus an hour and a half a day on exercise, so I came to the doctor, I saw the diet and I said, ‘You know what? Why not? Let me try it. So I decided to go ahead and give it a shot,” she said in an interview with ABC News.

Dr. Di Pietro asserts that his approach is perfectly safe. He says body fat is burned off through a process called ketosis that leaves muscle tissue intact. Although exercise is not required during the short diet period to ensure weight loss, Dr. Di Pietro agrees that exercising to maintain muscles may still be a good idea.

When the K-E diet first made the news, many nutrition experts responded with skepticism and a few were downright outraged. “Any extreme low-calorie diet is associated with side effects [such as] kidney stones, dehydration, headaches,” said Dr. Louis Aronne, director of the Comprehensive Weight Control Program at New York Presbyterian/Weill Cornell Medical Center. “Nutrition should probably be included in that. If you lose muscle mass and water, what’s the point of that.”

That is a problem with most crash diets. The quick success in weight loss rarely lasts. As soon as people go back to their normal eating habits, they regain their lost pounds and sometimes add even more. This can result in the notorious ‘yo-yo’ effect when body weight fluctuates considerably within relatively short periods of time.

Another potential danger is the development of eating disorders in connection with crash dieting, warns Dr. David L. Katz, director of the Prevention Research Center at Yale University and founder of the Integrative Medicine Center at Griffin Hospital in Derby, Connecticut. He has little patience with concepts like the K-E diet and compares them to disorders like bulimia. “This ‘diet’ is little short of lunacy,” he wrote in a recent article published in the Huffington Post. “If self-induced vomiting after meals constitutes an eating disorder, what exactly is infusing a liquid formula through a tube into the duodenum without medical indication? It has nothing at all to do with health and basically endorses the notion that weight loss by any means is acceptable.”

Dr. Di Pietro argues that his method applies mostly to people who are in need of a quick fix and not to those who have large amounts of weight to lose or deal with weight-related illnesses, such as diabetes or heart problems. “I get a lot of brides, nervous eaters,” he said. But that may not be enough justification for resorting to such radical measures, according to Dr. Jodi Krumholz, director of Nutrition at the Renfew Center in Philadelphia, who specializes in the treatment of eating disorders. “Even though they might do this one time for the wedding, I think there can be addictive qualities to these diets, and I think that someone might continue to do something like this. And it could put them in a really dangerous low weight place,” she said.

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A friend of mine who recently started taking an antidepressant medication said the other day, “Well, I may gain 50 pounds with this drug, but at least I’m feeling better.” Her sentiment is one expressed by many new and longtime users of medications for depression. And for good reason: As many as 25 percent of people who take certain antidepressants report weight gain.

No one knows for sure why antidepressants do this. Some may trigger food cravings, particularly for carbohydrates. The drugs may also affect metabolism. It is possible that when the antidepressants kick in, you become less depressed and a previously suppressed appetite becomes robust.

Medications Can Trigger Food Cravings
And Other Unwanted Side Effects

According to the most recent statistics from the Centers for Disease Control and Prevention (CDC), more than one in 10 Americans over the age of 12 now takes antidepressants. The CDC reported that women are two-and-a-half times more likely to take antidepressants than men.

With nearly 70 percent of Americans either overweight or obese, the prospect of weight gain resulting from antidepressants is, well, a little depressing. Depression can be a serious disorder, and in some cases, modern antidepressants are literally lifesaving. For millions, they can significantly improve day-to-day quality of life.

So what should you do if you are taking antidepressants and experiencing weight gain? First, speak to your doctor. If your weight gain is the result of your antidepressant medication, the solution may be as simple as switching drugs. If you are unsure whether your medication is the cause, keep a food journal to record your meals and beverages (including quantities).

DO NOT suddenly stop taking your medication as this can cause serious side effects. Different drugs have different effects, depending on the person. Be patient and work with your doctor to find the most helpful treatment with the least unwanted side effects. Some antidepressants, like Effexor and Wellbutrin may be less likely to cause weight gain than other drugs.

Also consult with your physician and/or a registered dietitian to create an eating and exercise plan that won’t interfere with your depression treatment. Often a change in meals and snacks, combined with daily aerobic and strength training can help you shed pounds. Exercise also comes with a potential added bonus: A growing body of scientific evidence suggests that increasing your daily exercise may affect not only weight loss but also help your depression. In one large study, published in the journal Preventive Medicine, involving more than 3,400 men and women from Finland, researchers found that those who exercised at least two to three times a week experienced less anger, depression and stress than those who exercised less frequently or not at all.

Finally, work with your doctor to assess if you should gradually reduce or even eliminate your antidepressant medication. This may not always be an option, however, it is worth exploring if weight gain becomes significant and unmanageable. A study published in the Journal of the American Medical Association (JAMA) in 2010 concluded that prescription antidepressants may provide little benefit for patients with mild or moderate depression, although they do help patients with very severe depression. If your depression is mild, exercise, dietary changes, meditation, or cognitive behavior therapy may be effective, drug-free alternatives.

Katherine Brooking, MS, RD is a Registered Dietitian, an expert contributor to numerous television programs and a writer. Her appearances include The TODAY Show, Live with Regis & Kelly, The Early Show on CBS, Good Morning America Health and many others. She covers health and wellness topics in SELF Magazine, The Washington Post, The New York Times and New York Daily News. For more information, go to www.AppForHealth.com.

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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Weight Fluctuations Can Damage Your Metabolism

This experience is as common as it is counterintuitive. If you eat more calories than your body burns off, you will gain weight. The same should be true the other way around. Use up more than your intake and you will lose weight.

One pound of body fat represents 3,500 calories. You can increase or reduce that amount – it would seem – by equal measures. But that is not necessarily so. A great number of additional factors must be taken into consideration to understand the difference between weight gain and weight loss.

For example, your actual weight determines how many calories you burn. The heavier you are, the more calories your body requires to function properly. If you are overweight or obese, you need more calories to maintain your weight and, paradoxically, you can also lose some faster than if you were normal-weight – but only to a certain extent.

Dr. David Ludwig, director of the “Optimal Weight for Life” program at Children’s Hospital Boston and co-author of a commentary on the subject of weight gain versus weight loss in the Journal of the American Medical Association (JAMA), explained the difference like this:

“Our bodies don’t gain or lose weight indefinitely. Eventually, a cascade of biological changes kicks in to help the body maintain a new weight. A person who eats an extra cookie a day will gain some weight, but over time, an increasing proportion of the cookie’s calories also goes to taking care of the extra body weight. Similar factors come into play when you skip the extra cookie. You may lose a little weight at first, but soon the body adjusts to the new weight and requires fewer calories. Regrettably, however, the body is more resistant to weight loss than weight gain. Hormones and brain chemicals that regulate your unconscious drive to eat and how your body responds to exercise can make it more difficult to lose weight. You may skip the cookie but unknowingly compensate by eating a bagel later on or an extra serving of pasta at dinner.”

Unconscious or “mindless” eating, as Dr. Brian Wansink called it in his landmark book, “Mindless Eating – Why We Eat More Than We Think,” can contribute substantially to unwanted weight gain or the inability to lose weight. Indulging in some tasty but less-than-healthy snacks or downing a few sodas or alcoholic beverages on the side can add on unaccounted calories real quick. But burning those off can take a lot longer and require serious efforts.

Another issue is whether your weight gain was rapid due to some exceptional occasion or event (e.g. a party or a vacation) or whether you put on more pounds over time. The former can usually be undone by returning to your healthier eating and lifestyle habits. The latter is a different story. In that case, some self-evaluation may in order. Did your eating pattern change for any particular reason such as stress at work, a move, financial issues or domestic problems? Did you stop exercising? Age may also be a factor. As you get older, your metabolism slows down and you require less food than you used to – but your habits have not kept up with your biological changes.

One of the greatest frustrations people with weight problems can go through is the so-called weight cycling or yo-yo dieting – losing weight successfully, only to gain it all back. Unfortunately, this phenomenon is quite common. Over 80 percent of dieters regain some or all of their former weight back within two years and two-thirds of once successful dieters end up heavier than they were before their initial weight loss, according to a study by the University of California at Los Angeles (UCLA).

Yo-Yo dieting is not only emotionally frustrating, it can also have serious consequences for a person’s physical well-being. “The more diets you’ve been on, the harder it becomes to lose weight,” said Dr. Kelly Brownwell, director of the Rudd Center for Food Policy and Obesity at Yale University.

Even on a sensible diet, your body is reluctant to let go of some of its mass. When you are dieting, it may perceive it as impending starvation and a threat to its survival. In cases of rapid weight loss (e.g. crash diets), a metabolic overcompensation can kick in, resulting in a slower metabolism and greater difficulty to lose additional weight.

Weight cycling can actually change your physiology, according to Dr. Brownwell. One of the reasons for this is that through dieting a hunger hormone called ghrelin increases, and a fullness hormone called leptin decreases, so you feel hungrier and less satiated every time around. Also, frequent yo-yo dieting lets you lose muscle mass and replaces it with fat as you regain weight. Because muscle burns many more calories than fat does, your metabolism slows down even further.

“Losing and regaining weight regularly takes a huge toll on your body,” said Dr. Keith Ayoob, professor at Einstein College of Medicine at Yeshiva University in New York, not just aesthetically by loss of skin elasticity but, more importantly, by the damage being done to the inner organs, the arteries and the skeletal system, and by a host of potentially life-threatening illnesses resulting from unhealthy weight gain like diabetes, heart disease, high blood pressure and cancer.

Of course, there are cases where the body is resistant to weight loss because of an underactive thyroid or other disorders. But those are relatively rare by comparison to diet- and lifestyle-induced weight fluctuations. In the absence of such medical conditions, the best way to prevent weight gain and promote weight loss (if necessary) is, as always, healthy eating, regular exercise, managing stress and getting enough sleep – in other words, opting for an all-around healthy lifestyle.

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But that may be wishful thinking, according to Mark Hyman, MD, chairman of the Institute for Functional Medicine and medical director of the UltraWellness Center in Lenox, Massachusetts, and author of several bestselling health books, including his latest, titled “The Blood Sugar Solution.” The way he sees it, we are in the middle of an explosive epidemic of obesity and type 2 diabetes that will touch almost everyone in one way or another. He does not hesitate to call it “the modern plague.”

“The Blood Sugar Solution”
by Mark Hyman, MD
Rings the Alarm Bells

Obesity, insulin resistance, metabolic syndrome, pre-diabetes, type 2 diabetes, heart disease, dementia and cancer are ultimately all rooted in one and the same problem: Our dismal diet- and lifestyle choices. Diagnosing and treating these diseases separately as if they were not interconnected misses the whole picture. Instead, Dr. Hyman proposes using a more comprehensive term to describe the continuum of which all these health problems are part of: “Diabesity.”

Diabesity can range from slight weight problems and mild insulin resistance to morbid obesity and severe diabetes. Because the disease is not well understood as a continuum, millions of those affected by it remain undiagnosed and untreated. As a consequence, more people all over the world die now from chronic illnesses than from infectious diseases. The real tragedy is that the causes are almost always environmental and lifestyle-related, which would make them perfectly preventable or curable through public education and enough political will to implement the necessary changes.

“This is a lifestyle and environmental disease and won’t be cured by medications,” Dr. Hyman writes. “Billions and billions have been wasted trying to find the ‘drug cure,’ while the solution lies right under our nose. Shouldn’t the main question we ask be why is this happening? Instead of what new drug can we find to treat it?”

Since most of our modern-day ailments are primarily caused by poor diet choices, chronic stress and sedentary lifestyles, as well as toxins and allergens in the environment, we must address these problems from the ground up (literally). Instead of looking for quick fixes through medication and surgical procedures, we can make many important corrections by ourselves and without delay by using the right ingredients that make us healthy again, including whole, fresh food, vitamins and minerals, water, fresh air, exercise, stress reduction, etc. “When we take out the bad stuff and put in the good stuff, the body knows what to do and creates health and disease goes away,” writes Dr. Hyman. Care for the environment is part of that, too. Here, he strongly agrees with Sir Albert Howard, who is by many considered the founder of the organic agriculture movement, when he wrote in his landmark book, “The Soil and Health,” that we must “treat the whole problem of health in soil, plant, animal and man as one great subject.”

Finding our way back to wholesome nutrition is one of the greatest challenges we face today. “In America, we eat more than we ever have, yet we are nutritionally depleted,” writes Dr. Hyman. The epidemic of diabesity and other chronic illnesses is paralleled by an epidemic of nutritional deficiencies. Most of us don’t eat enough the kind of food that protects us from diseases and too much of the kind that makes us sick.

“Food literally speaks to our genes,” he writes in a chapter titled “Nutrigenomics.” “The information your body receives from the foods you eat turns your genes on and off.” Whole-foods and plant-based diets have been shown in clinical studies to be able to turn off cancer-causing genes or turn on cancer-protective genes. No medication can do this. “What you put on your fork is the most powerful medicine you can take to correct the root causes of chronic disease and diabesity,” he writes.

“The Blood Sugar Solution” is a highly informative but, thankfully, also a very accessible book for both professionals and the laypersons. Some readers may find Dr. Hyman’s positions to be somewhat radical, if not utopian, especially where he seeks to offer hands-on solutions. Admittedly, he writes with passion and a sense of urgency – and rightly so. The obesity crisis keeps growing unabatedly worldwide and the time for “small steps” may have passed. Something has to change on a fundamental level. Unfortunately, that makes it so much less likely that we will see significant successes in the near future, if ever.

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Brown fat is hot. It is the focus of two recent research papers, one in mice and one in men, and the marquee item in a recent New York Times Article. Brown fat is hot because it may help keep us warm, burn calories and help keep us thin.

But how hot is it? Proverbs tell us that where there’s smoke, there’s fire. But sometimes where there’s smoke, there’s just smoke – and a whole lot of hot air. That was my impression when brown fat first started heating up in 2009. In the April 9th issue of the New England Journal of Medicine that year, three articles and an editorial highlighted the potential and apparently overlooked importance of brown fat in human weight regulation.

New Studies on Brown Fat Explore
Opportunities for Weight Management

The New York Times jumped on the brown fat bandwagon, suggesting that these “new” findings might offer a “cool way to lose weight” – namely by using some yet-to-be-discovered wonder drug to reset the human thermostat.

The heat has been turned up rather than down on the topic, however, with the advent of the two new brown fat studies. One, in mice, published in the prestigious journal Nature, purports to establish the existence of a new hormone, irisin, which is integral – in exercising mice, at least – to the process of converting garden-variety white fat into its hot counterpart, brown fat. Irisin exists in humans as well as in rodents.

If irisin does in people just what it does in mice, and if we can develop irisin to give people, it might cause them to burn more calories without needing to exercise. Of course, amphetamines do that already, and they’re not really a terrific idea. But I don’t want to get ahead of myself.

The second new study demonstrated in six healthy men that cold can induce brown fat to burn white fat. Body temperature is maintained with cold exposure by the combustion of the body’s stored fuel (i.e. white fat) by the body’s newly discovered stove (i.e. brown fat). If the body gets even colder, shivering ensues and the muscle activity of shivering helps restore a normal temperature. Only when all of these defenses are overcome does hypothermia occur.

The new study was also noteworthy for the magnitude of the observed effect. By making the participants cold up to but not past the point of shivering, metabolic rate was reportedly increased by some 80 percent, resulting in the expenditure of an extra 250 calories or so over 3 hours. That’s not an unimpressive figure, but a brisk walk for one hour would do the same.

That’s why brown fat, or at least brown fat combined with cold, is hot. One opportunity to which this research points is weight management by toughing out the cold. But being cold all the time is, in a word, uncomfortable. If people were willing to be uncomfortable to control weight, a whole lot more of us would exercise.

The second opportunity, related in particular to the mouse study, is to increase the generation of calorie-burning brown fat by exercising. But this is really just another way of saying if you exercise more, you are apt to weigh less and almost certain to be healthier. Those arguments haven’t carried the day with most members of our population thus far, and it’s not obvious that the added bonus of and you’ll have a bit more brown fat, too will clinch the deal.

Which brings us to the last great opportunity: A new wonder drug. Irisin, or something like it, in a capsule or syringe.

We have numerous, intricate and overlapping layers of metabolic defense against starvation – the threat that has stalked the heels of homo sapiens from time immemorial. An effort to use a drug, any drug, to rework the fundamentals of human metabolism, so that we don’t turn a surplus of calories into an energy reserve in burgeoning adipose tissue, seems to me an enterprise fraught with peril. I don’t believe we will ever devise such a drug, and if ever we do, I shudder to think what its unintended consequences may be.

Like everyone else, I hope the new studies of brown fat provide insights we may eventually exploit to improve the human condition. But while a bit less inclined to give the whole topic the cold shoulder than I was in 2009, I am cool on the concept of weight control through pharmacology. I contend, as I always have, that we will win or lose the war of weight control with our feet and our forks, not pharmacotherapy. So stay tuned to the smoke signals about brown fat. But I urge you to keep other irons in the fire.

David L. Katz, MD, MPH, FACPM, FACP is the founding director of Yale University’s Prevention Research Center. He is a board certified specialist in both Internal Medicine and Preventive Medicine/Public Health. He is the director and founder of the Integrative Medicine Center at Griffin Hospital in Derby, CT. For more information visit http://www.davidkatzmd.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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Most Resolutions Are Short-Lived
But Don’t Throw in the Towel Too Soon

“Some people’s New Year’s resolutions are so broad that they’re often unattainable,” says Leslie Fink, a Registered Dietitian and contributing writer for Weight Watchers. “When expectations are set too high, it doesn’t take much to throw a person off.” Instead of aiming for a perfect score, she advises, people should be content with 80 percent of their initial objectives. That by itself would qualify as a great success.

How we manage our aspirations in pursuit of our goals is critical either way. In fact, there are physiological reasons why we feel gratified or disappointed when we succeed or fall short of our expectations. A release of a neurotransmitter, called dopamine, is triggered in our brain when our intentions are fulfilled, causing a pleasant sensation of satisfaction and well-being, according to Dr. David Rock, Director of the NeuroLeadership Institute and author of “Your Brain at Work.”

Unfortunately, this mechanism works also in the other direction, and even more so: “When our expectations are not met, […] our negative feelings are much stronger than the good feelings we get when expectations are exceeded,” says Dr. Rock. “When we don’t hit our expectations, our brain doesn’t just get slightly unhappy, it sends out a message of danger and threat.”

In other words, as humans we generally tend to be optimistic (and oftentimes overoptimistic) about our prospects but are more afflicted when they end up in failure. The trick is not to get stuck in the negative emotions, even if they initially dominate.

Being able to build on the successes you already had is crucial for staying motivated. Take your cues from what worked and what didn’t and find out what made the difference. Then, if you fail or are about to fail, put a plan into action you may call “resolution revival,” suggests Dawn Jackson Blatner, a Registered Dietitian at Northwestern Memorial Wellness Institute. “Evaluate where you’ve been and where you want to go,” she says, “and make sure your initial goal was realistic.”

If you expected too much of yourself, “chop up your resolution into little pieces,” as Blatner puts it. Small steps are much more manageable and they eventually add up to greater achievements. If you are continuously able to meet your (somewhat scaled back) expectations, you will gain more confidence over time and can set the bar higher as you go.

Being realistic about your abilities and limitations also includes to learn from your past mistakes. Don’t make the same resolutions year after year, says Blatner. Rather, ask yourself what you can do differently from hereon in. Also, keep your eye on the larger picture: You are not trying to perform a quick fix (at least, you shouldn’t) but to make lasting lifestyle changes.

Last but not least, do not expect that losing weight, getting back in shape and looking more attractive is going to solve every other issue you may be dealing with in your life. Being thinner does not necessarily turn you into the person you idealize in your fantasies. Don’t listen to all the “testimonials” from people on TV claiming their entire lives have been turned around after they lost weight.

“People expect a lot from weight loss, things that weight loss alone can’t deliver,” warns Dr. Lee Kern, Clinical Director of Structure House, a residential weight management facility in Durham, North Carolina. “And then they learn the hard way that success and happiness aren’t linked to a number on a scale,” he says.

Identifying your real goals and pursuing them in realistic ways will make it much more likely for you to stay on track. If your motives are misguided, the messages you give your body will be equally confusing.

“The first thing I always ask people is why is this the right time for you to lose weight,” says Dr. Madelyn Fernstrom, Professor of Psychiatry and Epidemiology at the University of Pittsburgh School of Medicine and author of “The Real You Diet.” If they say they’re happy with their lives but have hypertension – great. If they’re losing weight just to be happier, then we’ve got to talk. Happiness isn’t a size 2.”

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Those of you who are familiar with my work know that I love to discover and illuminate the unseen connections in the world of health, nutrition, and consciousness. Indeed, if we truly want to advance the field of eating and nutrition, or any field for that matter, we need to be courageous enough and original enough to see into the hidden web of life. For me, connections tend to reveal themselves as I continue to cultivate openness and deep listening.

On the Path to Healthy Living
The Journey Will Always Inform the Destination

Sometimes the hidden architecture of the universe is indeed hidden from our vision. At other times, it’s right in front of our eyes, but we simply hadn’t notice. The great linguist and philosopher, Alfred North Whitehead, said: “It requires a very unusual mind to undertake the analysis of the obvious.” With that in mind, I’d love to share with you these thoughts around the connection between women, food, pleasure, sex, and weight.

A client once came to see me to lose 30 pounds. Alice was 49 years old, a health professional, 5’10”, smart, funny, attractive, outgoing, successful, and frustrated that 22 years of intense dieting and exercise still had gotten her nowhere. She desperately wanted to lose weight but knew she needed a different approach. Alice had also tried medical fasting, a long list of supplements, and received all the relevant medical tests that revealed what she suspected all along – that nothing was wrong with her metabolism and her health was fine. Alice felt confused and fed-up with the world of dieting.

When I asked her why she was so motivated to lose weight, she replied that she wanted to find the love of her life – it was time to meet a special man after having divorced in her early 30s and spending the last six years without any dating or relationship. A few more details about Alice: She hated her body, constantly insulted her own weight and figure, enjoyed food but was forever fighting her appetite, and seemed to have a love/hate relationship with men. She was still angry with her ex-husband and found herself resenting any man who showed any attraction toward her. Her diet was pretty healthy and moderate in terms of calories.

So let me cut right to the heart of the matter and tell you how I helped Alice lose the weight without changing anything she ate.

First, I noticed that because she had “disowned” her body and decided it was worthy of her contempt, she had cast out any sense of pleasure and fun. She hadn’t been touched or massaged in six years. She went to the gym but hated exercise machines. She ate her meals quickly and didn’t really feel “nourished” by her food. She dressed in clothing that was outdated and unflattering. And she complained about how she couldn’t feel comfortable in her own skin.

I find that many of us believe that once we lose weight, then and only then will we love our body, be happy, be the real “me”, be outgoing and confident, and finally have the good life. But here’s the headline news: It’s a complete lie. Indeed, Alice had lost the weight several times, but gained it back rather quickly – a very typical story.

The strategy that I use with weight loss clients like Alice is very simple: Let’s achieve all the results you expect at the end as a result of weight loss – in the beginning. Meaning, it’s time to love your body right now. It’s time to receive pleasure now. It’s time to be the real you now. Then and only then can lasting weight loss be possible. How can we treat the body with punishing exercise, a flaccid diet, negative self talk, and constant unlove – and expect to be happy at the end of it all?

So, I coached Alice in baby steps: Start getting some touch. Pay for a regular massage. Slow down with food. Eat in with some sensuousness and appreciation. Buy some fabulous new clothes. Give up exercise machines and take the dance class you’ve always been interested in. Pamper yourself more. Show your body some love. Needless to say, this was all groundbreaking for Alice. And she embraced it with anticipation, and a nervous excitement.

Next, we did a bit of a deeper dive into her relationship with sexuality. It turns out that her boss had raped her during a summer internship as a graduate student. Her excess weight came on shortly after that experience. Alice had never made the connection between her weight and her sexual assault. It stunned her. I suggested to her that for many women, excess weight is often a brilliant protection against sexual harm and dangerous men.

The lights really came on for her. Here she was, with one part of her trying to lose weight so she can find a man, while another part of her was committed to holding onto the very weight that protected her from men. Can you see the conundrum here? And can you now understand why, after years of intense effort, the weight could not come off until she uncovered the reasons why it needed to be there in the first place?

After a number of months exploring these different voices within her, making some peace, and integrating her past with more insight and compassion, Alice felt ready to date. She understood that she had cast out pleasure from her life, and cast out her sexuality. Yet she had been using diet and exercise to try to have the kind of body that would somehow make it all better. Previously, she could not lose the weight because she needed that weight to protect her.

The body has a wisdom that trumps all the ways we try to take shortcuts in life. We cannot override the wisdom of the universe that speaks through the body. We simply need to listen to it.

After six months of working together, Alice was truly enjoying food. She wasn’t in dieting consciousness, she wasn’t doing punishing and boring exercise, she had “reclaimed” her sensuality through touch and beauty care and dance, she was going on dates with different men, and she was falling in love with her body. But here’s the real eye opener: She lost 25 pounds. The weight came off gradually and without any dieting whatsoever. In so many ways, Alice had simply re-birthed herself as a woman.

Of course, if we continue to look at weight as if it’s exclusively a bunch of ugly invasive body fat that we need to hate and attack, then we will continue to battle with it, and wonder why we keep losing. It’s time to let go of the fight altogether, and dive deeper into our humanity and into our metabolism that is influenced by more than mere calories and exercise.

This is just one example, one story of the profound connections between our relationship with food, weight, pleasure, and sex. There are plenty more connections and magical ways that the body can heal and transform and shape-shift once we begin to see weight as more than just “calories in and calories out.”

The human body is profoundly complex, and deeply impacted by the soul inhabiting it.

This, by the way, is also one example of the work that we teach at the Institute for the Psychology of Eating. We look for the every-day and profound ways that our inner world impacts our metabolic world. We use weight-loss as a doorway to help people get to the deeper places within themselves that matter most – the places where true and lasting shape-shifting is born.

Marc David, MA is the founder and director of the Institute for the Psychology of Eating. He is a leading visionary, teacher and consultant in nutritional psychology and author of best-selling books, including “Nourishing Wisdom,” “The Slow Down Diet” and “Mind Body Nutrition.” Learn more about his work at psychologyofeating.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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