Tag Archive for: weight

What Not to Do When You Want to Lose Weight

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How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.

Weight Loss Is Always Possible

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After last week’s Memos, you may think that you have to do something radical to address your body weight or some other health situation, but that’s not the case. You can lose weight under the most extreme conditions, even if you’re completely sedentary. Let me tell you about my mother-in-law, Ruth Jones.

My mother-in-law struggled with her weight for decades. I don’t know what her peak weight was, but I would estimate around 240 pounds. She maintained around 200 pounds for most of the time I knew her. She had severe arthritis in her knees and because she wouldn’t have been able to do the rehab, the decision was made to replace them both at once. She did great at lifestyle and occupational therapy, but she never quite got the complete mobility she thought she would get because the physical therapy was more of a challenge than she could handle. She was able to get around the house but used a wheelchair or scooter in public.

A few years later, she had a very bad reaction to a new statin that damaged a great deal of muscle mass, and she remained in long-term care until she died several years later. But here’s the thing. Even though wheelchair bound, she was able to lose 30 or so pounds; that’s discounting the last few months before she died when she lost interest in eating.

How? How was she able to do it?

How about you—are you ready to make a change in your weight? Blood pressure? Prediabetes? Then you really don’t want to miss Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Three Ways to Really Reduce Your Cancer Risk

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In the last Memo before Spring Break, I said I’d cover ways to reduce your risk of getting cancer that really work. Every cancer website has lists, ranging from 10 to 15 recommendations. I’m going to give you my top three ways to reduce the risk of cancer of the items you can control. You can’t control your age or your genetic risk factors, but there are many elements of your health you can control if you work at them.

I’m not including smoking cigarettes or other tobacco products. That’s a no-brainer and shouldn’t even be mentioned, because no one should smoke. (I’m not saying that from my perch on Mount Olympus; I smoked when I was young and foolish, and quitting was one of the best decisions I ever made.)

Dr. Chet’s Top Three Ways to Prevent Cancer

  1. Eat more vegetables and fruits every day and the wider the variety, the better. They don’t have to be organically farmed; you just have to eat eight to ten servings per day. That seems like a lot, and I’m not perfect at it, but you get a new chance every day. Here’s a tip: weigh your produce instead of measuring it. Find out what constitutes a serving in grams or ounces. You may find out that a large banana is actually two servings. Do supplements matter? Yes, but the important point is to eat the fruits and veggies first, then add a multivitamin as backup.
  2. Exercise for 30 to 45 minutes per day. The fitter you are, the lower your risk of cancer. It doesn’t all have to be aerobic; yoga and strength training count as well.
  3. Reduce your weight until you achieve as close to a normal BMI (under 25) as you can; you’ll find all the info you need in the Body Mass Index article on the Health Info page at drchet.com, including how to adjust your target for your body type. We talked about caloric restriction in February, and that’s a way to slowly reduce your weight. My theory is that the older you are, the more movement matters, so if you are doing well at Numbers 1 and 2, you’re well on your way to accomplishing Number 3.

Those may sound very familiar: Eat less. Eat better. Move more. The reason these are my top three is that they reduce inflammation in different ways.

On Thursday, I’m going to cover a study on the relationship between a test for inflammation and cancer.

What are you prepared to do today?

        Dr. Chet

Aging with a Vengeance and Your Proteome

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This year’s Super Bowl Webinar focused on aging with a vengeance—becoming the best version of yourself, no matter your age. The study we just reviewed on the proteome suggests that the people were healthier who were biochemically younger than their actual age. Here are the actions I believe can help at the three critical phases of aging that were identified in proteome study. As I find out more, I’ll be more specific.

31 to 37

If you have weight to lose, now is the time to lose it. Take it from me and my decades of experience with weight loss programs: it becomes more difficult the older you get. Find a way to eat that will maintain a reduced body weight and stick with it.

Reduce your protein intake. That may seem a little odd, but this is a time to focus on vegetables, fruit, whole grains, and quality oils.

Focus on your cardiovascular system by doing aerobic exercise on a regular basis. Use interval training to make the most of your time, and when you’re fit enough, you can add high-intensity interval training (HIIT) to your routine.

57 to 63

The kind of 80- to 85-year-old you’re going to be is dependent on what you do now. If you haven’t achieved a normal body weight, that’s a high priority just as it was in the prior age group. I know how difficult this is because it’s eluded me throughout my life; I lost a lot of weight and kept it off for years, but I’d still like to weigh less.

Increase protein intake to 1–1.5 grams per kilogram body weight per day.

Supplement your diet with essential amino acids. While the amounts are still not absolutely clear from the research, 10–20 grams per day is a good goal.

If you’re not already doing so, add weight training to your exercise routine. Start with using your own body weight, then add exercise tubes or light weights, and then use machines or free weights. Now is the time to retain or even increase your muscle mass.

75 and Older

If you haven’t achieved a normal body weight, there’s still time. My wonderful mother-in-law lost a significant amount of weight at this age, and she was an overweight diabetic in a wheelchair.

Increase protein intake to 1.5–2 grams per kilogram body weight per day. It’s difficult because appetite decreases and protein makes us feel full. It will help reduce the muscle loss that’s happening.

Supplement your diet with essential amino acids; the amounts are still between 10–20 grams per day.

Add weight training to your exercise routine. It will help you to retain or even increase your muscle mass. Stay within any orthopedic or other limitations, and get some help if you need to, but do it. Your primary caregiver will probably be glad to refer you to a physical therapist who can get you started safely.

The Bottom Line

For all that’s been written about healthy aging, we still don’t know very much. Healthy aging begins the day we are born, but we realize that only when it dawns on us that we’re aging. No matter your age, no matter your current state of health, it can be better. You can learn more in the replay of this year’s Super Bowl Webinar, but it will be available for only a little while longer.

The simple things I’ve talked about in this Memo are a beginning. When I know more, so will you. Inevitably, it comes back to a single question:

What are you prepared to do today?

        Dr. Chet

Reference: Nature Medicine. 2019. https://doi.org/10.1038/s41591-019-0673-2

Obesity Game Changer?

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Obesity is a serious issue in the U.S. and around the world; type 2 diabetes, hypertension, CVD, and other diseases associated with obesity have significant health costs. That’s why a real game changer would be important to help people lose weight and maintain their weight loss. The latest candidate is semaglutide, an anti-diabetic medication used for the treatment of type 2 diabetes by increasing insulin secretion. In my opinion, the results of this study do not achieve game-changing status. Let’s take a look at the details.

There Was Limited Weight Loss

The mean weight loss was 14.9% which translated to 34 pounds in 68 weeks. That’s really not impressive; most people can lose a half pound a week by paying more attention to their diet and increasing their activity level. The rate of weight loss in the placebo group stabilized at about 20 weeks, and that’s where it stayed for the rest of the study. In the experimental group, the rate of weight loss declined twice; first at about 20 weeks and then again at 52 weeks. By 60 weeks, the experimental subjects did not appear to be losing any more weight.

The Lifestyle-Change Program Was Ineffective

With 35 years of experience in weight loss programs, my hunch is that by 20 weeks, both the placebo and the experimental group had reverted to their prior eating patterns. We don’t know for sure because no nutritional data were presented, but that would explain the lack of continued weight loss in the placebo group and slowing weight loss in the experimental group. The drug may be game-changing, but without permanent lifestyle changes, it’s just another weight loss drug.

The medication was effective in continuing weight loss in the experimental groups, but we don’t know how. Insulin is the most powerful hormone in the body, but we don’t know exactly how semaglutide helped these subjects lose weight. Did it influence appetite? Did it impact insulin levels alone?

At What Price?

The lowest price I could find with insurance coverage was $800 per month. This would be cost-prohibitive for most people. Another way of looking at: it cost $376 per pound of weight lost. I’m not sure that’s worth the price because we still don’t know if the drug will help maintain the loss for a significant period.

And besides the monetary cost, what physical cost did the drug have? Every drug has side effects. That’s why in most cases I recommend trying lifestyle changes before adding a medication; if unhealthy habits helped create the problem, changing those habits is the best place to start. Even if a healthier diet and increased activity don’t solve the problem, those changes may mean you can take a lower dose of the med, thus reducing side effects. Except in urgent cases, most doctors will give you some time to try lifestyle changes before adding a medication.

The Bottom Line

I consider the study a failure because the subjects in both groups never learned how to change their food intake and exercise behaviors. Yes, those people taking the pharmaceutical did better related to weight loss, and because of that, some metabolic factors improved. But the rate of weight loss slowed down as the study progressed and eventually appeared to stop. Maybe this drug will give some people an edge with initial weight loss and thus improve their odds of long-term success, but if they don’t permanently change their behaviors, they won’t permanently lose weight.

We have to quit thinking of a healthier diet as a temporary change. The challenge is not losing weight; the challenge is in maintaining the lost weight. If you go back to your old eating habits, you’ll go back to your old weight; if you won’t commit to changing your diet and activity, taking a pill isn’t going to help you for very long.

While interesting, this study doesn’t change the game. The game was, is, and always will be eat better, eat less, and move more. For life.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2021. DOI: 10.1056/NEJMoa2032183

“Game-Changing” Treatment for Obesity!

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If ever a health headline gets your attention, it’s one that proclaims there’s a better way to lose weight. “A game changer” said one of the principle authors of the study in a news release about the study. The results of any study that suggests “game-changing results” just has to be reviewed, and that’s what I’ll do in this week’s Memos.

The study was a trial of 1,961 subjects conducted at 129 sites around the world. The subjects were randomly assigned to the experimental group and placebo group in a 2:1 ratio. The experimental group received once-weekly injections of semaglutide, currently approved as a diabetes treatment, while the controls were injected with a placebo. Both groups received individual counseling sessions every four weeks to help them adhere to a reduced-calorie diet and increased physical activity. The study was 68 weeks long.

After 68 weeks, the mean change in body weight from baseline to week 68 was 14.9% or 34 pounds in the semaglutide group as compared with 2.4% in the placebo or about six pounds. Anthropometric measures, BMI, and cardiovascular and metabolic measures were better in the semaglutide group compared to the controls.

The results of the trial have already caused the manufacturer to apply for a rapid approval review as a weight loss drug. The question is this: is it really a game changer in the treatment for obesity? I’ll talk about that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2021. DOI: 10.1056/NEJMoa2032183

Practice Makes Perfect

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Have you ever looked at new health habits as a series of tasks you need to perfect? There are many different habits that are part of a healthy lifestyle such as eating more vegetables, exercising five days a week, taking your supplements regularly, and dozens more. Losing weight is not just eating fewer calories; it’s a process that involves many different tasks in order for you to be able to do that.

  • What are you going to eat?
  • Who is going to buy the food?
  • Who is going to prepare the food?
  • How are you going to measure the food?
  • When are you going to eat it?

Think about all the decisions that have to be made in order for you to simply eat breakfast—not just any breakfast, but one that fits with your overall meal plan and caloric goal for that particular day.

Let’s say you want to start with a protein smoothie in the morning. Do you have the right kind of blender or juicer to be able to do that? Have you purchased all the fruit, vegetables, and protein powder that you’re going to need? How much time will you need to add to your morning routine in order to do it?

There are probably dozens more nitty-gritty things you need to perfect. The point of this memo is to have you recognize the types of changes that you’re going to have to think about, and remind you that you probably won’t get it right the first time that you try. You’re going to have to practice these new tasks. Hence the title of this memo: Practice Makes Perfect.

Fitness: An Example

If you take any tasks related to the overall goal of getting fit, there are elements of it that you’re going to have to complete. It’s not just the exercise itself. That’s something you can do. Where this idea comes into play is in preparing to exercise.

Are you going to exercise in the morning? Set your alarm at least 15 minutes before you want to begin. For some of you it may have to be an hour earlier because you have certain rituals you perform in the morning before you start your day.

When your alarm rings, get up and get out of bed. You can go back to bed if you want to, but you have to get out of the bed. Do that for one week, weekdays, or weekend. Get good at it. Get used to it. You’re practicing to get up on time in order to be able to exercise. You may find out right then that getting up early is not going to work—maybe mornings just aren’t your time and you’re going to have to figure out some other time to exercise.

Then the following week, the night before you start, lay out your exercise gear. When the alarm goes off, get up get out of bed and put on your workout gear. Do that for a week. Laying out your clothes the night before. Getting up on time. And getting dressed on time. Again, you can go back to bed if you want. When you’ve got that mastered, again weekday or weekend, then you can start your workout routine.

Seems a little silly, I know. But you have to practice being successful at the things that precede exercise before you can be successful at exercising itself. You’re going to run into obstacles, and you don’t yet know what they are. It may be that your wife will want to get up at the same time. It may be that your kids, if you have them, will hear you and want to get up as well. You have to be able to deal with all of those issues and anticipate that they may happen at varying times before your workout. Think of it as getting prepared for a game-time situation. Once you’ve experienced it, you’ll know how to react better than you would if you leave it to chance.

We could do this approach for every task related to any health or fitness goal. The degree to which you have to cut up that elephant to consume the parts depends on you. Some tasks may be easy to manage while others will not. But unless you perfect the component tasks, it will be too easy to quit when an obstacle appears.

The Bottom Line

In this summer of coronavirus, improving everyone’s health has never been more important; if the virus tracks you down six months from now, you can be better prepared to fight it off. This week I’ve written about ways to help you prepare to change your health from where it is to where you want it to be.

  • Setting realistic goals allows you to break up any big goal into manageable parts.
  • Changing directions is critical, or you’ll end up where you don’t want to be.
  • Finally, you have to practice to get the tasks that contribute to your goal just right. You can do it with enough practice. One bite at a time.

What are you prepared to do today?

        Dr. Chet

Holiday Eating: The Best Solution So Far

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In our quest to find the best holiday eating strategy, we may have been looking at the wrong metric. Prior researchers have been looking at the subjects reporting of how well they stuck to their eating habits and exercise program. The final study looked at a hard metric: body weight. Here’s what they did.

Researchers recruited subjects who were overweight and obese but had been losing weight, plus a group of normal-weight subjects. They further divided the two groups into control groups and experimental groups. The control groups simply weighed in before the holiday season began at Thanksgiving, after the season ended on January 1st, and again a month later. The experimental groups also weighed in during those times but in addition, they were told to weigh in every day using a scale with Wi-Fi access. Their results were displayed graphically to chart progress.

What happened? The control groups, whether overweight, obese, or normal weight, gained an average of close to six pounds during the holiday season. The normal weight subjects who weighed themselves daily maintained their weight. Those who were overweight and obese continued to lose weight, losing on average 2.5 pounds. At the one month follow-up, the control group lost only half the weight they gained over the holidays. Researchers speculate that annual holiday weight gain contributes to weight gain over years.

The Bottom Line

What’s the best strategy for holiday eating? There are two things that are critical: maintain your exercise program and weigh yourself regularly, preferably every day. True, your daily weight will fluctuate but you won’t let it get away from you—that’s when you get into trouble. As for your eating habits, not every day is a holiday party with mass quantities of food to consume. Chill out a little during the parties and pitch-ins, but for the most part, stick to your regular eating habits; that applies whether you’re overweight or not. I think that’s the best strategy for the holiday season.

What are you prepared to do today?

        Dr. Chet

Reference: Obesity. 2019;27(6):908-916. doi: 10.1002/oby.22454

Is a Relaxed Holiday Eating Plan Better?

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The Portuguese Weight Control Registry is similar to the National Weight Control Registry. While the amount lost is different, 11 pounds, the members still have to have kept the weight off at least a year. Researchers asked what techniques participants used for weight maintenance, comparing weekdays versus weekends and holidays versus non-holidays. The criteria were different. Those researchers were looking at weight regain of 3% or less that was maintained for an additional year. What did they find?

Subjects who relaxed their eating plan on weekends maintained their weight loss better than those who strictly adhered to their diet and exercise regimen. The comparison with holiday and non-holiday habits didn’t show any differences in weight regain. There were a significant number of subjects who dropped out, and that probably impacted the results.

Neither of these studies on the Registries was perfect but it does give us some insight. Depending on your mental make-up, it may be better to stick to your regimen during the holidays or maybe you can relax a little. While not reported, it would depend on your mental willpower at the time. That might change year to year. Well, where does that leave you? One more study to review that might provide the solution.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1186/s12937-019-0430-x

Should You Have a Strict Holiday Eating Strategy?

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Tis the season for gaining weight. It began on Thanksgiving, but we’re in it big time now. If you’ve lost weight and want to make sure you don’t see it again, what do you do? Let’s review some of the research on strategies that people who’ve lost weight and maintained it have used.

The first is a report from the National Weight Control Registry. In order to be a subject in that study, you have to lose 30 pounds and maintain it for at least a year. Researchers took a group of recent additions to the study and asked them specific question on their strategies during the upcoming holiday season at that time, and then tracked how they did. They also recruited a group of normal weight people and did the same thing.

Most of the experimental group said they were going to follow their typical routine as related to diet and exercise plan. In other words, they were going to try to strictly follow their weight loss routine. The normal weight individuals didn’t really have any special plans. Most successful losers did follow their plan although it was more difficult during the holiday season. About the same percentage of successful losers and normal weight subjects gained weight, maintained their weight, or lost weight during the holiday season. The difference was that the successful losers found it more challenging to do so based on their response to survey questions.

Is that the best strategy? Stay the course? Another study on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: J Consult Clin Psychol. 2008. 76(3): 442–448.