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Pound Foolish
In a world of bewildering diet advice, losing weight can be surprisingly simple
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Business New Haven
12/22/2003
By: Karen Singer
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As Americans grow - let's be realistic here - fatter and fatter, those intrepid individuals prepared to buck the trend may find that the solution lies no farther than their feet and the palm of their hand.
The message, say health experts, is: "Eat less, and exercise more."
Though doctors and nutritionists may argue the pros and cons of various weight loss regimes, they generally agree dieting is more likely to provide a short-term fix than long-range results, which require more extensive lifestyle changes.
The key to weight management, they suggest, lies less with what to eat than how to eat.
"Going on a diet will never be the answer," says David Katz, director of the Yale-Griffin Prevention Research Center. "What people need is a strategy for healthy eating. Until they master that they'll be on a rollercoaster ride of weight loss and weight gain."
"Anybody who wants to lose weight had better cut calories and move," adds Carol Ann Rinzer, who writes a nutrition column for the New York Daily News and is author of Nutrition for Dummies (Wiley, 2003).
Between 65 percent and 80 percent of American adults are overweight, according to Katz, who believes many have gotten sidetracked with an obsession over carbohydrates, fats and foods containing them.
"The public thinks there's confusion, but there really isn't any," he says.
"We know a healthy diet contains lean protein, lots of plant foods, nuts and seeds, and less saturated fats and trans fats."
Katz outlines his views in The Way to Eat: A Six-Step Path to Lifelong Weight Control (Sourcebooks 2002), which includes recommendations on how to make better choices when shopping, preparing meals and dining out.
But he acknowledges his advice may be difficult to follow "in a world where there's a McDonald's on every corner and a vending machine in every building."
Why Lose Weight?
Medical experts point out that obesity, poor nutrition and lack of exercise are triggers for Type II diabetes, which prevents the body from processing insulin properly. It's the most common form of diabetes in the U.S. - and the most preventable. Recent studies suggest that weight loss, a healthful diet and even a modest amount of exercise can lower the odds of developing Type II diabetes.
Some 17 million Americans already have diabetes, a disease that can lead to blindness, kidney failure, loss of limbs and a shortened life span. Experts estimate nearly as many are at risk, and say the number of children with high blood pressure, high triglycerides and other risk factors for Type II diabetes is increasing at an alarming rate.
Concerned about the "unacceptable crisis" of obesity among children, Katz urges parents to "focus on life skills," enabling the entire family to eat better.
Neil Grey, medical director of diabetes life care at Hartford Hospital, is on a similar crusade. He's trying to encourage officials at several Hartford-area schools to jettison vending machines and embrace more healthful lunch menus.
Weight loss may be difficult for many Americans because obesity "really is a disease," Grey says. He describes obesity as a physical abnormality related to the hypothalamus, a region in the brain controlling many bodily functions, and chemicals regulating the sensation of satiety or fullness.
"That's the difficult part for people to understand," Grey adds. "Losing weight is not like smoking cessation or stopping alcohol. You can't do that with food. Everyone has to eat."
Diets proscribing various types of food or food groups, however, have little likelihood of success.
"Fad diets generally don't work in the long run, but may be helpful in the initiation of weight loss," Grey says.
They also can provide a sense of accomplishment and motivate the dieter to make behavior changes more conducive to weight control and management.
"A quick weight loss is really important to people who have found it hard to lose weight," says nutrition writer Rinzer. "But humans are omniverous, and no healthy person will live for an entire life on a diet that excludes lots of foods. That's why you often have failure and yo-yoing of pounds."
Fad diets also may even be hazardous to your health. The au courant Atkins Diet, for example, advocates consuming lots of protein (often saturated fat-laden) and few carbohydrates, and changes body metabolism from burning carbohydrates to burning fat. Some experts warn extended stays on such high-protein, low-carb diets can cause kidney problems, high cholesterol and micro-nutrient deficiency.
Healthful eating, critics assert, should be grounded in moderation, not deprivation.
"Make sure you're getting foods from all food groups," says Susann Kraska, a registered dietician at the Nutrition Clinic at Yale-New Haven Hospital. "Don't eliminate food groups, and don't give up foods you like. Just don't have them so often. A lot of people are eating healthy foods, but too much of them."
Out of Proportion
Not surprisingly, portion control is a major problem for many Americans.
"Lots of people have lost weight many times. The trick is how to keep it off," says Joan Kirby, author of Dieting for Dummies (Wiley 2003).
"The simplest recommendation is to reduce the amount of food you eat. But few of us have a clear idea of what makes a portion size - and most of us have lost track of what it feels to be hungry."
You needn't buy a scale or calculator to keep track, however.
A simple solution to portion control, Kirby says, is to use your hand as a measuring guide. An average woman's hand holds about a cup of most foods; a man's holds a quarter- to a half-cup more.
In our supersized world, it may come as a bit of a shock to learn a typical portion is a half-cup serving.
Rinzer recommends playing with your food to get a clearer sense of size.
"Go into the kitchen. Make a pot of rice. Roll some into your hands the size of a golf ball," she says. "These things are indelible once you see them."
And though it has its flaws, Kirby says, the USDA food pyramid can "still be a template" for determining daily quantities of servings from each food group. Pyramid guidelines include six to 11 servings of bread and grain, two to four servings of fruit, three to five servings of vegetables, two to three servings of protein, two to three servings of dairy, and occasional servings of fats and sweets.
Currently being revamped, the pyramid will likely contain more servings of fruits and vegetables in its new incarnation.
Mindful Eating
Kirby believes more Americans could lose weight merely by paying attention to eating and deriving pleasure from the experience.
"Try to stop doing other things while you're eating," she advises. "Food is not a medicine. It's not a punishment. It's supposed to be enjoyed.
"Think about all of the flavors that the human palate can detect - sweet, salty, sour, bitter - and all the textures - creamy, crispy, crunchy, hot, cold.
"You need all that sensory experience to feel satisfied."
But that doesn't mean you have to pig out, either.
The Thanksgiving feast, she suggests, isn't a bad model, so long as one doesn't overdo it.
Katz advocates fewer choices per meal, saying one is more likely to get fuller faster when flavor varieties are limited.
But he and Kirby agree with other experts who say buffets are best avoided.
By making smarter choices, business lunches or dinners need not lead to packing on excess pounds. In a chapter on restaurant eating, Rinzer suggests more healthful alternatives, including skipping the butter on bread and vegetables and requesting broiled, baked or grilled entrées.
"There's a way to see if the bread is already buttered, and that is to surreptitiously wipe it with your napkin," Rinzer says. "If it leaves a damp spot, it's got butter or oil on it."
Move It!
Nearly all experts cite exercise as a central component of any weight-loss program.
For those disinclined to don designer togs and sweat at a local gym, putting one foot in front of the other may suffice.
"Get in the habit of parking the farthest distance from your destination," Kirby says. "Better yet, buy a pedometer - not just for you, but for everyone in the family."
A pedometer will give its user instant feedback, and may provide an incentive to move more.
Kirby recommends walking at least 10,000 steps a day, "which just about works out" to 30 minutes, a minimum goal rarely reached by many Americans.
Making It Work
Experts advise seeing a physician before changing food choices.
"People need help with bridging the gap between knowledge and action," says Marita Holl, a registered dietician and nutritionist in Hamden. "Going to a Web site or getting factual information is not as effective as working with [a specialist] to develop strategies that facilitate behavior changes they want to make.
"It has got to do with a balance of what you taken in versus your activity level."
Before devising such strategies, Holl helps clients examine their food-consumption habits. For some people eating may be linked to stress, she says, while snacks or takeout food may be sources of overindulgence.
Once one understands the patterns, she or he can begin to change them in a way that suits the individual's lifestyle. "We try to work out a plan that's health-promoting, one you feel you can stick with, and one which incorporates foods you enjoy," Holl says.
"You have to do what works for you, without endangering your health," adds Kraska, the dietician at Yale-New Haven's Nutrition Clinic.
Physician Grey agrees, and cites the case of a 65-year-old client who was considering gastric bypass surgery to shed weight. Her insurance company refused to cover the cost of the operation, so she elected to pay for it herself. Grey advised her to consult a nutritionist before making a final decision. The nutritionist suggested spending the money instead to hire a personal chef to make her small portions of delicious food.
And that's what she decided to do.
It appears to be money well spent. "So far, she has lost 50 pounds," Grey notes.
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