Integrative approach to weight control

Dealing with Weight Control Concerns

Principles and Resources

Introduction:

The problem: 60% of Americans are now overweight or obese. Children are especially hit hard by this epidemic, and are acquiring ‘adult’ obesity-related diseases such as Type 2 diabetes mellitus at an early age unheard of even 30 years ago. Obesity is now by some calculations the number one preventable cause of disease and death in this country.  Many of those suffering from obesity spend their lives going on or off various diets in a desperate attempt to finally keep off the pounds. Such attempts are ultimately futile, since ‘diets’ (defined as any unusual way of eating that is non-sustainable and will eventually be abandoned) have been shown scientifically to  not work. If ‘diets’ don’t work, what does?  Why is losing weight so difficult?  

Weight control on one level is simple – just take in fewer calories than you expend and the laws of thermodynamics guarantee you will lose weight.  However, simple does not necessarily mean easy. Many aspects of our society predispose to excess weight gain. These include:

• Ubiquitous advertising and easy accessibility to high calorie but low nutrient-dense foods. 
• Distortion in portion sizes is a major problem, with excess serving sizes that have often doubled in the last 20 years. 
• More Americans are eating out – restaurant food is generally designed for entertainment, not health. Portions (and calories) are often excessive.
•  Low fiber foods and completing a meal faster than 20 minutes prevent proper feedback from the stomach and brain of when to stop eating. 
• Fast absorbed (high glycemic index) carbohydrates which induce overeating.  
• A sedentary lifestyle also impairs the body’s ability to balance calories. 
• Excess stress and lack of life balance predispose all of us to ‘emotional eating’ of ‘comfort foods’ that pack in the calories. 
• Cultural attitudes towards food, especially early childhood experiences can deeply embed behavior that is resistant to future change. 
• A family tendency towards obesity (genetic and congenital factors) is often expressed in an environment of excess. 
• Only uncommonly does an undiagnosed medical problem such as hypothyroidism turn out to be the cause of the weight gain. Certain medications however can predispose to weight gain – ask your doctor.

 The totality of all these factors makes it very difficult for most people to lose and then maintain proper weight. Excess weight is a symptom of unhealthy eating/ lack of fitness. Focus on changing the underlying cause, not on the weight itself. When fitness is restored and sustainable health eating patterns are established, the weight will come down naturally.

The solution is simple (but not necessarily easy): adopt a whole foods style of eating high nutrient/calorie ratio (i.e. mainly plant) food and exercise at least one hour daily or almost daily, and do this for the rest of your life.

 Details on this healthy lifestyle are listed below. Only scientifically validated concepts are included in the specific food recommendations listed in this section:

□    Eat mainly whole foods that are rich in low calorie, nutrient dense foods such as vegetables and whole fruit. A whole food is any food as it is found in nature with no or minimal processing, or traditional foods like bread whose ingredients are minimally processed. Examples: 

Whole food	Partly Processed food (eat sparingly)	Heavily processed food(avoid)
Apple, other whole fruit	Apple juice	Apple Pop tarts, etc.
100% stone-ground or sprouted grain whole wheat (or other grain) bread	Whole grain bread  (that is finely milled & feels ‘squishy’ when compress it)	White bread, bagels, pastries, many commercial breakfast cereals
Brown rice	White rice	Rice pastries
Whole vegetables like broccoli, spinach, yams, etc.	Veggie smoothies	Veggie chips or sticks, Nutraceutical or food bars
Lentil (Dal), whole soybean & other bean dishes	Foods made with processed soybean, e.g. ‘textured vegetable protein’	Bean chips and similar snack foods

□    At least three quarters of your plate should be plant food, (≤ 1/4 animal products), and should include at least 3-6 servings of vegetables (1 serving = 1 cup raw or ½ cup cooked) and 3-4 whole fruit per day:

□  Eat as many raw vegetables (such as in a salad) as you can every day. Eat these first in all meals. Use only a small amount of low fat dressing.

□  Eat liberal amounts of cooked vegetables, including at least 1 serving of cooked greens daily, e.g. kale, collards, spinach, broccoli.

□  Eat at least 2 whole fruit (not fruit juice or drink) per day

□  Practice cooking vegetarian main dishes, so you reduce reliance on animal products. See below ‘Vegetarian cooking for everyone’ and similar cookbooks.

□  Always spend at least 20 minutes eating all meals. This allows time for the stomach to feel full.

□    Include moderate amounts of low glycemic index, high fiber carbohydrate sources such as beans, squash and whole grain cereals (as opposed to finely milled flour products, potatoes and white rice). (See separate handouts). Keep average glycemic index < 60.  Avoid all white flour products whenever you can.

□    Avoid excess and unhealthy Trans and saturated fats: Limit frying. Trim visible fat from meats and choose only the leanest varieties (e.g. those that end with ‘-loin’). Avoid ‘industrially produced’ meats, such as ‘corn-fed steers’. Cows are designed to graze, not stand in a crowded feedlot and eat corn, which makes them (and you!) fat and sick. If you do decide to eat animal products, choose white meat of poultry without the skin. Fresh fish is a healthy choice. Use cheese only as a condiment, not as a central part of a meal. Use butter and margarine sparingly. Limit heavy sauces and gravies. Limit even low fat beef and poultry to one or two servings a week total. Fish can be eaten up to 4 servings per week.

□    When eating out, choose the ‘Heart healthy’ or ‘low fat’ offerings. Avoid cheap fast food restaurants and ‘all you can eat’ buffets. Even salad bars can lead to overdoing the calories if you pile up your plate with non-vegetable offerings and dressings. If the portion is excessive, have the excess packaged for a second home meal or give some to a companion before you start eating.  (See separate handout on tips for eating out healthily)

• Re-train yourself to eat proper serving sizes of all foods (besides vegetables & whole fruit, which should be eaten in abundance).  This is necessary because of the ubiquitous ‘portion distortion’ that has normalized excess portion sizes in our society.
  • Obtain a portion-control diet plate set by going to www.thedietplate.com or calling 1 800 665-7652. Use it.
  • Take the ‘Portion distortion’ quizzes: http://hp2010.nhlbihin.net/portion/
• Calorie awareness – learn to make low calorie but high nutrient choices
  • The best references to learn this are the following books: ‘Picture Perfect Weight Loss’ and accompanying cookbook (see below). Teaches scientifically sound Food Awareness program using mainly pictures.
• Adequate fiber/ bulk. This happens almost automatically if you eat whole foods.  ‘Volumetrics’ is an excellent reference to support this concept (see below).
• Pacing of Weight loss: 0.5 to 2 lbs/week. One needs to have a daily calorie deficit of 500 kcal to lose 1 lb. in a week. Trying to lose >2 lbs. /week is a recipe for failure and increases chance of inadequate nutrient intake. An exception is very low calorie diets done under professional guidance in a structured program.
• Avoid ‘dieting’. There are new diets every week, with periodic fads such as Grapefruit diet, Vinegar diet, etc. Healthy nutrition is all about balance, variety & moderation. Especially avoid any diet that labels any one nutrient class (such as carbohydrates) as either ‘bad’ or ‘exclusively good’. No unsustainable diet works, and they should all be ignored.
• Decide on a reasonable quota of sweets and treats servings to eat per week (such as 3 to 5) and stick with it. (A serving is 1 slice of pie or cake, or 2 medium cookies). Make a little ritual out of eating these, doing nothing else at the time so you can savor your treat slowly and mindfully without any guilt.
• Consider taking a multivitamin/multimineral daily supplement to ensure adequate nutrients while losing weight (scientific benefit not proven).
• Exercise for at least 60 minutes daily or almost daily. Regular exercise has been demonstrated to be crucial for maintaining weight control. (see exercise handouts)
  • This should include at least moderate level aerobics (at least at the level of brisk walking – not just strolling).
  • Should include strength training for at least 20 minutes at least 2 – 3 alternate days/week.
• While education on proper eating & exercise is important, this is often the easiest aspect of lifestyle change. To accomplish all the above, you need also to proactively organize your life to allow adequate time to shop for, prepare and enjoy healthy food as well as to exercise.  (See separate handout on food shopping tips). This usually means that you will have to give up something else, which in turn means you need to adjust your value system of what is important to you. 
• Consider taking a Plant based whole foods cooking course. This may be one of the most valuable endeavors you will ever do in your life for both yourself and your family!
• Develop the mental habit of planning how you are going to eat well and exercise at the beginning of every week, with a quick review at the beginning of every day.
•  Such a change in values and lifestyle often demands an entire repertoire of ‘meta-skills’, which may include the following:
  • Assertiveness – the ability to say ‘no’ in a healthy way to people and situations that are not in line with your new healthy lifestyle.
  • Self-awareness – the ability to monitor how balanced your life is every day and, just like a musical instrument, to ‘re-tune’ your life on a regular basis as the need arises. Staying centered helps one stay on goal.
  • Positive attitude – the ability to tackle the inevitable challenges, obstacles and set-backs involved in any lifestyle change with constructive action (or if this is not possible, then graceful acceptance).
  • Self-acceptance – the ability to unconditionally accept all sides of yourself while at the same time not indulging or getting lost in unhealthy emotional states that lead to counter-productive behaviors. This includes forgiving any lapses, instead spending your emotional energy getting back on track. 
  • Healthy skepticism – the ability to critically assess the barrage of questionable health claims aimed at consumers, to detect ‘saboteur foods’ that pretend to be healthy but aren’t and to cut thru market hype.
  • Self-discipline: the ability to resist ‘comfort food’ and sedentary temptations of the moment and keep a long view of what you really want.
• Given all the skills required and the societal predisposition to weight gain on multiple levels, we should not be surprised that weight loss, while simple, is also difficult. So if you fall off your healthy lifestyle, don’t get down on yourself. Give yourself a break and just get back on track as soon as you realize the need to do so. Do something positive for yourself everyday, even if it is not perfect.  Reward yourself in a healthy manner for your efforts. Enlist the moral support and coaching of trusted friends. Systems like Weight Watchers may help.
• Dedicate at least ½ hr. but better 1 hr. per day of guarded time each day to lifestyle change. 

• The secret is that there is no secret. There are a large number of skills you will have to learn to accomplish your goals of improved fitness and healthy eating. When you accomplish these, the weight will normalize by itself.  Accomplishing your goals requires discipline, hard work and sacrifice – don’t let anyone tell you otherwise! Yet it can be immensely satisfying and fun.  Break it down into manageable short-term goals. Small but consistent steps are more important than brief intense efforts to change. Have a professional monitor your progress. Utilize the skills of qualified specialists such as Personal trainers, Wellness coaches and Nutritionists.  Don’t try to go it alone, for the same reasons you would not try to become a pianist or a doctor on your own. A support network of friends with a healthy lifestyle and professionals is often crucial to success.

• Recommended Readings: 
  • Eat to Live by Joel Fuhrman, MD. Little, Brown & Co. 2003. Focuses on Nutrient/Calorie ratio as a key to successful weight loss.
  • The Volumetrics Weight-Control Plan by Barbara J. Rolls, Robert A. Barnett. Harper Torch Publishers 2000. Very good book to understand how to use low calorie dense foods to lose weight and control hunger. 
  • Picture-Perfect Weight loss (& cookbook) by Dr. Howard Shapiro. Warner Books publisher. 2000. Teaches calorie awareness thru pictures!
  • The Omnivore’s dilemma and In Defense of Food by Michael Pollan Penguin Books. These books explain where our food comes from and the strengths, weaknesses and toxicities of American food culture. 
  • Glycemic index cooking made easy by Jennie Brand-Miller, Kaye Foster-Powell & Joann McMillan-Price. Rodale Inc. 2007. Helps one put the Glycemic index concept in action, with lots of delicious recipes.
  • Vegetarian Cooking for Everyone by Deborah Madison. Publisher: Broadway Books, 1997.  An excellent guide to cooking vegetables in interesting and tasty ways that can be used by vegetarians and non-vegetarians alike.
  • Fast Food, Good Food by Andrew Weil, MD, 2015. Publisher: Little, Brown and Company. Addresses the issue of preparing quick and easy healthy meals when life is too busy. 
  • The China Study Cookbook: Over 120 Whole Food, Plant-based recipes by LeAnne Campbell, 2013. Recipes are based on the landmark research of T. Colin Campbell as presented in The China Study (also recommended reading). While not all will commit to a pure plant based, completely animal product free diet, and there is still honest differences of opinion in the nutritional literature on this approach, the rationale for eating more plants in unassailable. 
  • Mindless Eating by Brian Wansink, PhD. Bantam Books, 2006. Explains how we all eat for reasons other than to satisfy hunger and what to do about it.

• Long term goals: 
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• Short term goals:
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© Alan Remde MD     3/ 2008      Revised 4/2011