More Sound Advice from Johns Hopkins Health Alert

Advice for Long-Term Weight-Loss

If you're a postmenopausal woman, you probably don't need a medical study to tell you that gaining weight is easy -- and that losing it can be a battle. But you may find it helpful to know that a study published in the Journal of the Academy of Nutrition and Dietetics found that overweight or obese postmenopausal women had increased success in shedding pounds over the course of a year with these three strategies ...

1. Keeping a food journal. Study participants who wrote down what they ate every day lost about six pounds more than women who didn't self-monitor with a journal.

2. Not skipping meals. Women who ate at regular intervals lost about eight more pounds than women who skipped meals. Meal skippers tended to consume more overall calories later. Also, not following regular eating patterns may cause metabolism to slow.

3. Eating more home-prepared meals. Women who limited restaurant meals saw a more significant drop in weight compared with those who dined out more often, mainly because diners have little control over portions, cooking methods and ingredients. 

The bottom-line advice.

· Set your sights on the small changes you can make, which will likely make a big difference years from now.

· Try adding vegetables such as broccoli, green beans, leafy greens, zucchini, cauliflower, cabbage, carrots and tomatoes to your diet. All are low in calories yet high in fiber, vitamins and minerals.

· And eat fruits of different colors for a variety of nutrients: orange (citrus fruits, mango), green (kiwi, cantaloupe), red (berries) and yellow (bananas). Even though you may not see any weight change at six months as a result of adding more fruits and vegetables to your diet, you'll likely see a healthier payoff down the road -- and one that you'll be better able to sustain.

And don’t forget to exercise. Dietician Carmen Roberts, M.S., R.D., who serves on the Editorial Board of the Health After 50 newsletter, adds her advice: "We shouldn't discount exercise as a weight-loss strategy, either. Simply put, healthy weight loss is best achieved by consistently decreasing calories and increasing activity."

And this from me: Coaching helps keep you on track when your family and friends resist your changes. Change is made more difficult by the outside forces that depend on us staying the same and not rocking the boat. But if that boat is leaking - meaning your habits are slowly killing you - I can help you make those changes so small, but consistently effective, that your family and friends may not notice.

Advice to Help You Build Your Plate

This just in from the October 12, 2012 Johns Hopkins Health Alert!

 

 

The U.S. Department of Agriculture (USDA) has replaced the MyPyramid food guidance system with MyPlate as the official model for healthy dietary choices. The recommendations for what should be on your plate haven't changed, but a shift in emphasis and a new icon make the guidelines easier to visualize, follow and remember.

Based on the USDA's Dietary Guidelines for Americans, the agency offers the following recommendations to "build your plate":

• Half of your plate should be fruits and vegetables.
• The other half should be equal parts grains and proteins. At least half of your grains should be whole grains. Breads, cereals, rice and pasta are all available as 100 percent whole grain.
• Protein should come from a variety of sources. For instance, choose seafood twice a week, replace meat with beans some days and go for small portions of lean meat and poultry.
• Switch to skim or 1 percent milk and other low-fat dairy products, such as cheese and yogurt.
• Reduce your sodium intake by checking food labels and choosing foods with the lowest sodium. Aim for less than 1,500 mg of sodium daily.
• Avoid foods and beverages containing added sugar. Drink water and choose fruit for dessert.
• Limit foods high in saturated fats or solid fats, such as cakes, pizza and hot dogs -- reserving them for an occasional treat.

Take away. The USDA stresses that a key component of good nutrition is to enjoy your food. But avoid oversized portions. Use a smaller plate and a smaller glass to make your serving sizes appear larger. And pay attention to the calorie count. When dining out, be sure to check the posted calorie amounts. Stop eating when you're satisfied but before you're really full.

You can find out your personal daily calorie limit as well as discover meal planners, recipes and other resources at www.choosemyplate.gov

Counseling Before Bariatric Surgery

Weighing Gastric Band Surgery for the Less Obese from Johns Hopkins Medicine

Until recently, bariatric surgery -- also known as weight-loss surgery -- has been an option only for the severely obese, especially those who also have obesity-related conditions such as type 2 diabetes or sleep apnea (both of which increase the risk for heart disease complications). But now that has changed.

One of the most common bariatric surgeries is adjustable gastric banding, which places a modifiable band around the stomach to curb food intake.  In January 2011, the U.S. Food and Drug Administration (FDA) approved gastric banding for those who are less than severely obese.  

How gastric banding works. During gastric banding, an adjustable silicon band is placed around the top part of your stomach. It forms a thumb-sized pouch that can hold only a small amount of food.

"The band's purpose is to prevent overeating," says Michael Schweitzer, M.D., a surgeon at the Johns Hopkins Center for Bariatric Surgery at Johns Hopkins Bayview Medical Center. 

How? The band is adjusted at a doctor's office to control the rate at which food passes from the pouch to the lower part of the stomach. Slowing the passage of food to the lower part of the stomach makes you feel fuller longer, so you consume fewer calories.

Gastric banding is attractive for many reasons. It's a minimally invasive outpatient procedure -- the surgery itself takes less than an hour. It is also more easily reversed than other bariatric surgeries and has low complication rates.

For example, another common bariatric surgery, gastric bypass, requires that part of your stomach be stapled shut and the digestive tract rerouted. It also includes a two-day hospital stay.

Cons and caveats of gastric banding. There are good reasons not to rush into gastric banding, including:

• Recovery from gastric banding includes a month-long diet of pureed foods and about six trips to the doctor's office for band adjustments in the first year.

• After gastric banding you must also permanently go on a strict low-fat diet to achieve and maintain a normal weight. Eating too much or too fast can cause you to regurgitate swallowed food from the upper pouch after meals.

Finally, if you're a candidate for gastric banding surgery, you'll have to prove that you are ready for both the procedure and challenging lifestyle changes. You must undergo psychological counseling and show that you have tried diet and exercise for at least six months.

Gee, I really don't want to negate bariatric surgery, but my research shows that less than 15% of those who opt for this dangerous surgery ever achieve a healthy weight. It's not because the surgery is bad or doesn't do what it intends to do; it's that most - and I do mean most - patients learn to cheat. And they do so because they have NOT dealt with the underlying emotional issues with food and eating. Counseling does - but counseling works on the past. Coaching does - and it works on the present habits and behaviors and helps the client learn new behaviors. We can't change the past, but we can change the future, and we do it by changing how we think and what we do TODAY.

Obese Adults Should Get Couseling (or Coaching)

By Melissa Healy, Los Angeles Times
June 25, 2012, 8:23 p.m.

In a move that could significantly expand insurance coverage of weight-loss treatments, a federal health advisory panel on Monday recommended that all obese adults receive intensive counseling in an effort to rein in a growing health crisis in America.

The U.S. Preventive Services Task Force urged doctors to identify patients with a body mass index of 30 or more — currently 1 in 3 Americans — and either provide counseling themselves or refer the patient to a program designed to promote weight loss and improve health prospects.

Under the current healthcare law, Medicare and most private insurers would be required to cover the entire cost of weight-loss services that meet or exceed the task force's standards.

That could all change Thursday, when the U.S. Supreme Court is expected to rule on the constitutionality of President Obama's healthcare law, which requires adoption of certain recommendations from the task force, such as this one on obesity.

Few private health insurers now reimburse physicians for weight-loss counseling or pay for programs that patients seek out on their own. A growing number, in fact, charge obese patients more for coverage — a policy that some public health officials have denounced as punitive and ineffective.

The task force concluded after a review of the medical literature that the most successful programs in improving patients' health were "intensive, multi-component behavioral interventions." They involve 12 to 26 counseling sessions a year with a physician or community-based program, the panel said.

Successful programs set weight-loss goals, improve knowledge about nutrition, teach patients how to track their eating and set limits, identify barriers to change (such as a scarcity of healthful food choices near home) and strategize on ways to maintain lifestyle changes, the panel found.

In some cases, programs include exercise sessions as well.

The recommendation, published online in the Annals of Internal Medicine, does not apply to the roughly one-third of Americans who are considered overweight, those with a BMI from 25 to 29.9.

It follows a November decision by Medicare to reimburse physicians for providing "intensive weight counseling" to the roughly 14 million obese Americans insured by the government program.

The new guidelines were met with cautious support by many physicians on the front lines of the nation's struggle against excess fat.

Dr. Jack Der-Sarkissian, a family medicine specialist at Kaiser Permanente's Los Angeles Medical Center, called the guidelines a "long-overdue" prod to physicians to help their patients control weight gain, which raises the risk for diabetes, heart disease and other health threats.

He cited a recent study that found that more than half of all obese patients had never been told by their physician that they needed to lose weight. "That's just not fair to the patient," said Der-Sarkissian, who leads Kaiser's adult weight management efforts in Southern California.

"You have to diagnose the patient and have the discussion, even if the patient doesn't really want to hear it," he said.

But Jeffrey Levi, executive director of the nonpartisan think tank Trust for America's Health, said the recommendations would put physicians in a difficult position: Few have the time or resources to provide obese patients with intensive counseling, he said.

And since programs meeting the standards set by the task force remain scarce, most doctors won't know where to send their obese patients.

"The question is whether the services will develop fast enough to meet the potential demand," Levi said.

Susan Pisano, a spokeswoman for the trade group America's Health Insurance Plans, said it was unclear how the report would affect the industry and patients. But, she said, "there's a lot being done" already by health insurers to help their enrollees lose weight.

Obesity and obesity-related diseases are already responsible for an estimated $147 billion in annual healthcare spending. Widespread adoption of the panel's recommendation would increase that spending, at least initially.

The panel acknowledged that one problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.

There appear to be short-term ones. Two studies cited by the panel found that patients who received intensive counseling were 30% to 50% less likely to have Type 2 diabetes two to three years later than those who received lighter counseling, drug therapy or both.

But the counseling subjects' cholesterol numbers barely budged, and changes in blood pressure and waist circumference were, on average, small.

A pilot program considered a model by the task force is now being launched in 21 cities by the federal Centers for Disease Control and Prevention.

It is based on a clinical trial, the Diabetes Prevention Program, that encouraged modest improvements in food choices and at least 150 minutes of weekly exercise for participants, who were at high risk for developing diabetes.

The subjects, who typically met weekly for six months and monthly for the second half of the year, lost between 5% and 7% of their body weight and reduced their diabetes risk by 58%.

Thanks, Melissa, for pointing out some delicate information. If you've tried diets, diet pills, even bariatric surgery, and are still not at a healthy weight, you need some support. Call me.  830-837-5940. But before you do, please review my website.

Obese? The Devil Made Me Do It!!

In the beginning, God created the Heavens and the Earth and populated the Earth with broccoli, cauliflower and spinach, green and yellow and red vegetables of all kinds, so Man and Woman would live long and healthy lives.

Then using God's great gifts, Satan created Ben and Jerry's Ice Cream and Krispy Creme Donuts. And Satan said, "You want chocolate with that?"

And Man said, "Yes!" and Woman said, "And as long as you're at it, add some sprinkles." And they gained 10 pounds And Satan smiled.

And God created the healthful yogurt that Woman might keep the figure that Man found so fair. And Satan brought forth white flour from the wheat, sugar from the cane and he combined them. And Woman went from size 6 to size 14.

So God said, "Try my fresh green salad." And Satan presented Thousand-Island Dressing, buttery croutons and garlic toast on the side. And Man and Woman unfastened their belts following the repast.

God then said, "I have sent you heart- healthy vegetables and olive oil in which to cook them." And Satan brought forth deep fried fish and chicken-fried steak so big it needed its own platter And Man gained more weight and his cholesterol went through the roof.

God then created a light, fluffy white cake, named it "Angel Food Cake," and said, "It is good." Satan then created chocolate cake and named it "Devil's Food."

God then brought forth running shoes so that His children might lose those extra pounds. And Satan gave cable TV with a remote control so Man would not have to toil changing the channels. And Man and Woman laughed and cried before the flickering blue light and gained pounds.

Then God brought forth the potato, naturally low in fat and brimming with nutrition. And Satan peeled off the healthful skin and sliced the starchy center in to chips and deep-fried them. And Man gained pounds.

God then gave lean beef so that Man might consume fewer calories and still satisfy his appetite. And Satan created McDonald's and its 99-cent double cheeseburger, and then said, "You want fries with that?" And Man replied, "Yes! And super size them!" And Satan said, "It is good." And Man went into cardiac arrest.

God sighed and created quadruple bypass surgery.

Then Satan created HMOs.

Author Unknown

 I found this parody a number of years ago and thought it worth sharing. Enjoy!

What happened to December?

I know you won't believe this, but it's the most creative excuse - made up story - for not blogging since November! Santa got stuck in my chimney and I have been working with him to get a few extra pounds off. Well, he's doing fine, and I'm baaack. More later. I promise!

This is SCARY!

It's not terrorism that will bring this country down, it's our weight. This chart is from the Gallup Poll folks.

The latest on the streets is that possible legislation is being introduced to protect the obese from being discriminated against in job hirings. This is not right. Our businesses are so overburdened with health care costs, they are unable to compete with overseas companies.

Is anyone as nervous about our country's future as I am?

That bottom number is over 153 BILLION dollars; that's with a B, folks. Billions!