Facebook Diet!

Happy February! How are those New Year's Resolutions holding up for you? I hope at least a couple healthy choices are sticking with you...If not, I've got a social media suggestion that might just keep you on the straight and narrow. Meet the "Facebook Diet" concept!

Full credit for this idea comes from my high school friend, Anne White. In fairness, in her case, I should call it a FB Exercise Plan, but the concept is easily extended to other healthy choices such as pumping up your fruits and veggies, quitting smoking, or yes, exercise. Back to Anne. In December, she boldly proclaimed on Facebook that she was committing to 90 days of a very challenging exercising program called P90X. Each day, she posted a short blurb about what she did or what muscles were screaming, as the case may be. I am proud to boast that last I FB stalked, Anne was on Day #37, and going strong!

There are so many positives about this form of accountability: 

• Simply recording your action makes you accountable to yourself, and has been repeatedly shown to increase success of maintaining a habit. Recording it PUBLICLY adds the bonus of accountability to others. In the case of social media, MANY others!
• FB or other social network posting takes a tiny amount of time, and no travel.
• POSITIVE REINFORCEMENT- friends cheering you on is wonderful!
• 21 days to make a habit- so "they" say...so even if you only post for a few weeks, you may have done enough to create that new habit
• Inspiring others! Anne's pledge has motivated many of us to dust off our old P90X DVDs and "Bring It" once again. For non-P90X'ers, Anne has motivated them to pick SOMETHING to push their own bodies out of our comfort zones.

Anne has impressed me so much with this public declaration of prioritizing her health. When she got sick with the flu, she simply posted on FB that she was down a couple days, but then jumped right back in once she was physically able. 

BOTTOM LINE: If you use social media for fun and entertainment, why not use it for health? Set a goal, make it public, and let all those FB friends cheer YOU on to better health!

It's BACK- the Cursed Halloween Candy

Yes, we've just got our kids starting to settle into their school routine, and yet what has already appeared in the grocery stores? That's right- Halloween Candy. I swear this is the start of the fall fattening project...

Don't get me wrong, I love Halloween! I adore seeing all the kids in costumes and frankly, I pull out a witch or Mrs. Incredible costume for myself each year. But here is the catch- candy to the max on one night per year is no big deal (brush & floss those teeth afterwards, of course.) Unfortunately, what happens in many households and work sites is that those "sample size" candies start showing up in a convenient drawer near you, handy for daily snacks and pick-me-ups. Before you know it, you've got a candy habit that is truly tough to break, not to mention that the extra 500 calories per day that you are innocently consuming is adding on a full extra POUND per week!!

If you think I am exaggerating about this, check the calorie count and serving size on your favorite candy. Hershey's miniatures, for example, are only 42 calories per mini, but most of us don't stop at one- even the "serving size" is 5 minis at 210 calories.




BOTTOM LINE: If you don't want to literally increase YOUR "bottom line", save the Halloween candy for HALLOWEEN and don't buy it till October 30th. Trust me, the stores will still have it in stock.

A New Weight Loss Drug!

Have you heard that the FDA approved not one, but TWO new weight loss drugs this summer? Hooray! Our problems are solved, right? Are there still overweight doctors out there? Well...yes, there are, so that should give you a clue that these new drugs are not miracle workers.

Today I will focus on the first drug approved. Locaserin, brand name Belviq, came out in June 2012. This drug will decrease your hunger and increase your feelings of satiety (feeling full after a meal). Locaserin works within the serotonin system (like the antidepressants such as Prozac) but targets a specific receptor that is key in the appetite game, rather than mood. Fenfluramine, an older drug with a similar mode of action, was removed from the market in 1997 due to concerns of its detrimental affect on heart valves. The selling point of locaserin is that it targets a different, very specific receptor that is not linked to these deleterious valve changes.

In the studies necessary to get approved by the FDA, patients on this drug lost an average of 12 pounds in one year. Let me remind you that good steady weight loss is a pound or two per month (not the 30 pounds in 30 days we all would like), so this is reasonable weight loss. However, from my standpoint, I'd like to see a drug produce better results before risking the side effects. In this case,  side effects of lorcaserin include headache, dizziness & nausea. So at this point, I am not impressed enough to prescribe this drug.

BOTTOM LINE: Lorcaserin (Belviq) may provide obese patients help with decreasing their appetite & increasing satiety, but does not provide dramatic weight loss results.

Pop Tart and Candy Diets

Ready to lose weight? Step up to the newest diet craze- the Peanut M&M diet! Can you imagine a diet that will let you eat this delicious candy and still lose weight? Okay, hold on right here. I could go on and actually give you details of how my new Peanut M&M diet will work- but be prepared to hear something like eat ONLY the green ones- then clip on your pedometer and don't eat the yellow ones till you've walked 2500 steps. So what's my point?

Last week, I was at a wonderful talk by registered dietitian, Daniela Knight, and one of the participants asked what she thought about the "Pop Tart Diet". (BTW, for fun, I googled pop tart diet and sure enough, came up with not only a diet but a youtube video explaining the supposed health benefits of pop tarts.) I loved her response- "Oooh, doesn't that sound enticing? Wow! A diet where you eat pop tarts! Way more fun than eating more fruits and vegetables, right?" But the audience was hooked, and all wanted to know details of the "diet". So here's the thing- ANY weight loss program CAN include pop tarts (or donuts, or peanut M&Ms), but if that is the mainstay of the calories in the diet, you are not going to feel so great. Your body (obviously) needs a balance of nutrients and vitamins that ideally comes from multiple colors of produce plus a protein source. Weight loss occurs when you consume fewer calories than you burn off. Period. So yes, you COULD eat six strawberry pop tarts per day, with as much water and diet sodas as you can hold, and you would be on a 1200 calorie per day diet. For most people, that would result in weight loss- BUT- you would be seriously lacking in protein, fiber, calcium, B Vitamins, Vitamin C...get the picture? No energy. None!

Am I saying NEVER eat a pop tart? No! Daniela (my favorite dietitian) would tell you immediately that NO food is "bad". Treats like pop tarts and M&Ms we need to limit, not ban. What IS a healthy way to lose weight? Fruits & veggies galore, with enough protein (eggs, meat, chicken, fish or nuts) at each meal to equal a daily total of roughly one gram per kg of your body weight.

Now, if I wanted to get RICH, I'd go back to my color-coded peanut M&M diet...but don't forget walking the mile in between color changes...

BOTTOM LINE: Yummy treats like pop tarts or peanut M&M's can be INCLUDED in any healthy diet- but should be the occasional bonus, not the mainstay!

2012 Health Action Plan (aka. New Year's Resolutions)

Welcome to the first Friday in 2012! How are those New Year's Resolutions coming along? Already blown them? If so, no worries, because you are not alone. I'm hearing more people say they haven't even MADE their resolutions yet, so really, you could be ahead of the game if you even know WHAT you'd like to change. Though I am sitting here with my laptop in glow of our Christmas tree lights, many people have packed up their holiday decorations or plan to "clean up" this weekend. As we all make the mental shift from holiday time back to ordinary routines, I'd like to encourage you to make CONCRETE PLANS to improve your health- whether you call them New Year's resolutions or not. Here's a starter list:

1.If you have ANY health concerns that you have not fully addressed with your family doctor, call TODAY and schedule an appointment. And PLEASE let the office know what you are truly coming in for- even if you simply say "I have four or five separate minor concerns" if you don't want to list specifically what they are. If you are trying to squeeze in questions about your weight, insomnia, or indigestion during an office visit you've booked for your sore throat (or worse, during your spouse's or child's visit), you are obviously not going to get the full attention and evaluation those issues deserve. I find that patients don't want to "bother" their doctors with "minor stuff like that"- but we'd much rather you schedule a longer appointment to address multiple concerns than to either ignore them or to toss them in as a "by the way, while I'm here..."

2. Step on the scale. This advice is directed at the silent majority of Americans who fall into the "overweight" category, but don't realize it. If you are 100 or even 50 pounds overweight, I'm betting you are aware of it (and same goes for underweight.) However, I have found that many of us don't realize just how many pounds we have added over the last year...or two...or decade. If you fall into this category, please step on the scale, own the number, and move forward with an action plan to improve your health in 2012.

3. Clear out the candy! Cheerful red and green M&Ms, candy kisses, or candy canes decorate many offices and homes during December. Before you replace them with Valentines or Easter candies, consider setting out flowers, candles, or scent infusers instead. Or, simply give yourself permission to put the bowls away. Empty bowls will get filled up...and emptied again & again.

BOTTOM LINE: Make HEALTH a PRIORITY in 2012, and create specific, concrete action items on your health to-do list!

New Year's Resolutions- a WEIGHTy Issue

Happy New Year! Welcome to 2012, the year that holds the potential to be your HEALTHIEST yet! Virtually every list of top 10 New Year's Resolutions leads off with the battle of the bulge- whether it is "lose weight", "get fit", "eat healthy", "join weight watchers", "join a gym" or some other variation. With the vast majority of Americans falling into the "OVERWEIGHT" or "OBESE" categories, these resolutions certainly make sense. Unfortunately, many of us fight the SAME 10, 20, or even 30-plus pounds over and over again. We get motivated, make healthy changes, lose weight...and then gain it back. Ugh. What might we do differently this year?
Here is some food for thought...

1. Figure out the WHY of your eating behaviors, and learn to eat MINDFULLY. Dr. Michelle May's book "Eat What You Love, Love What You Eat" is a FABULOUS start- buy it today. Her focus is how to break the "eat, repent, repeat cycle". AMEN.

2. Speaking of buying- let's put our money where our mouth is- literally! I have heard over and over again that it's too expensive to meet with a dietician, join a gym, or eat fresh fruits & vegetables, or take up a new sport, yet these same people are spending far more discretionary money on their daily Starbucks, hair highlights or a round of golf. Seriously, we need to prioritize our health and be willing to pay for it!

3. Commit to ONE small permanent change each month. Experts say it takes 21 days to cement a new habit, so why not make 2012 the year to develop 12 new healthy habits? Start with something simple, like making sure you eat breakfast every day OR (assuming this was not part of your routine already.) In this case, it can be a granola bar or a cup of yogurt. Remember to keep it simple. If you try to make a change from no breakfast to cooking a veggie omelette and drinking freshly squeezed grapefruit juice- well, I'm not optimistic it will stick!

Whatever you choose, find a way to make yourself accountable. Make a deal with a friend, tell your co-workers, announce it to your family (if you have teens, they will HAPPILY hold you accountable), or simply record it on your smart phone, computer or an old fashioned piece of paper.

BOTTOM LINE: Make 2012 the year you make your New Year's Resolutions last beyond Janaury, and choose GOOD HEALTH!

WAIT! Weight...

Okay, this is a quickie blog entry, but here's the deal: I can count on one hand the number of patients that I have seen this month that have NOT gained weight. Yes, the average American gains around 10 pounds between Thanksgiving and New Year's Day, but this is not something we should be proud of! It is also a "tradition" to put weight LOSS at the top of everyone's New Year's Resolution list, right?

So, do yourself a favor, and simply pull out the scale today and step on it. And look at the number. This is NOT to chastise you or to make you feel bad, but to give you a quick reality check. If you are part of the majority who has been happily indulging in little extras at work, school, and parties this season, just be AWARE of that- and try not to add on between now and the end of the year. Kick up your exercise a notch, and remember these few party tips:

1. Eat something healthy before you go- grab a Honey Crisp apple (they are in season and delicious!) or a salad, or whatever healthy choice you have handy. Just do not walk in STARVING.

2. Start with a glass of water when you walk in to the party. Hosts love to hand out wine or champagne as you enter, which is lovely, but ask for a glass of water "to start".

3. At a buffet, fill your first plate with healthy choices, THEN go back and have your dessert sampler.

BOTTOM LINE: Let's step on the scale TODAY so we are NOT increasing our..."bottom line".

What is BMI?

Yesterday, I mentioned that discussing your BMI with your doctor might be a less emotionally charged way to discuss your weight. Terms like "overweight" and "obese" tend to make us all shut down and stop listening, but it is really important to understand whether or not your weight is becoming a medical issue. The BMI is your "Body Mass Index", and it is a reflection of your relative body fat. Note that I said "reflection"- the BMI is NOT a precise measure of your body fat percentage.

BMI is simply calculated by using a person's weight and height. Specifically, BMI equals your weight in pounds multiplied by 4.88, divided by the square of your height in feet. There are charts to look at and on line calculators as well. Click on this link to the U.S Dept. of Health & Human Services' BMI calculator to see what YOUR BMI is today.

Now that you've got your number, what does it mean? Well, if you are less than 20, you are underweight. If you are between 20-25, you are considered healthy, or "normal" weight. Please pay attention if you are in the 25-29 segment, because you are overweight! If you are >30, you fall into the medical definition of obesity.

Why did I bold face that 25-29 segment? Because in my clinical experience, no one with a BMI of 30 or more is surprised that they weigh too much. However, I would estimate that over HALF of my patients who fall in the "overweight" category are shocked that they have a medical issue with their weight. After college, people often put on a couple pounds per year, very slowly creeping that scale. During that time, they may only go up a size or two in clothing, especially if they are buying more expensive clothes (which tend to run larger and larger.) Before they realize it, they weigh 20 or 30 pounds more than is healthy, yet they don't "feel fat". I don't care very much about cosmetic issues with weight, but I care deeply about increased risk of diabetes, heart disease, low back and joint pain, all of which come into play when your weight goes up.

BMI's are not flawless. If you are an "ARNOLD" with tons of huge muscles, your BMI will be falsely elevated. If you are elderly and frail, chances are good that your BMI underestimates your body fat. In general, however, the BMI is a great tool to assess your weight.

BOTTOM LINE: Take a moment and calculate your BMI, and take an honest look at your weight: 1/3 of Americans are overweight, 1/3 are obese, and only 1/3 are normal or underweight, so the odds are stacked against you.

My Halloween TRICK for Treats

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...

Before you toss that bag of yummy Halloween candy in your grocery cart this week, recognize that Halloween is still four weeks away. Will that bag still be around at the end of the month? Come on, now, you know if you are buying it now, you are going to be eating it sooner than later. So, let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little chocolate candy bars- how many calories does just one have?"

Okay, you asked, so here are a few of my favorites: Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

PS. It's a new month, so CHANGE THOSE AIR FILTERS!

The Perfect Diet Pill

Ready to sign up? I think we're all looking for that pill that let's us skip exercise and eat whatever we want, but still allow us to lose weight effortlessly- and oh yes, with no side effects. Sigh. I hate to disappoint you, but no such pill exists. I often think patients believe we doctors are hoarding this mysterious pill somewhere, keeping it for our own use! But seriously, if there were such a pill, there would be no overweight or obese doctors, right? And look around...doctors struggle with their weight as much as the next person.

What IS out there, and why don't we use it more? The main drug still on the market for weight loss is phentermine. The common brand names are Adipex, Fastin, Obenix, and Oby-Trim. Phentermine is a very effective appetite suppressant. It is a stimulant (similar to amphetamine) and can be addictive. It doesn't magically speed up your metabolism, it simply suppresses your appetite so you consume fewer calories. In the past, it was combined with another diet medications (fenfluramine and dexfenfluramine) but this combination turned out to potentially cause pulmonary hypertension- a very serious and possibly fatal lung disease. By itself, however, phentermine is usually well-tolerated, though it has it's own list of side effects, and it cannot be taken along with many antidepressants. Phentermine is thought to raise blood pressure, increase heart rates, and increase your risk for heart disease. A study published last month in Obesity, however, suggests that these cardiac effects may not be significant, or in fact, may not be there at all. While this was not our highest quality study, its numbers (300 patients) and methods are enough for us to take note.

So, if you don't have heart risk factors (beyond obesity) and you are not taking an antidepressant, should you rush to your doctor for a phentermine prescription? Probably not. If you need to jump start a weight loss program and you are ready to really improve your diet quality and quantity along with pursuing a solid exercise program - maybe. It's worth a discussion. However, you need to know from day one that most people REGAIN the weight when they go off the drug. Again, not magic, just they quit suppressing their appetite so they are more hungry, and they eat more.

I rarely prescribe phentermine, probably less than five patients per year. My personal standards are that the patient needs to be seeing a registered dietician and demonstrate that they are exercising daily for a least a month. I see the patient back in one month, and will not prescribe phentermine for more than two months. This is not a "cure all" drug, but in selected patients, it can be a wonderful jump start towards better health.

BOTTOM LINE: If you feel overriding hunger is truly keeping you from losing weight, open the discussion with your doctor about considering a prescription appetite suppressant.

Can't Lose Weight? Count LIQUID Calories!

Many times when people are frustrated with weight loss, they look and look again at their food records and insist that they are eating only healthy food in small portions, yet the scale wont budge. There are certainly multiple reasons for this, not the least of which is the scientifically proven human tendency to record LESS than we consume and MORE than we exercise. It's not purposeful cheating, but small things such as forgetting the handful of M&M's off a co-worker's desk, or chips at a Mexican restaurant (we didn't ORDER chips, right?) or assuming we must have walked "at least a mile" during the day (without counting steps on a pedometer.)

My focus today, however, is on the portion of calories that we all tend forget- the LIQUID calories! Yes, Virginia, the liquid calories count, too...and often way more than you'd expect. Let's review some common ones:

Soda: 1 can of Coke is 140 calories
Starbucks:Tall Cafe Latte with Nonfat milk: 126 calories (Grande: 168 )
Caramel Frappuccino Blended Coffee with whipped cream: Brace yourself- 430 calories!! (Note a McD's Quarter pounder is 410)
Wine: 4 oz- a HALF CUP- glass of Chardonnay~90 kcal. MEASURE your glass once- most of us drink at least 6-8oz- check the picture above!
Frozen Margarita: 180 kcal for 4 oz...but most Margarita glasses hold 12 oz, which is over 500 kcal!
GATORADE: 12 oz is 310 kcal.

Recognize that 3600 calories equal one POUND, which means your simple morning coffee may be adding a pound or more per month. Or your workout drink, ironically, can easily do the same.

BOTTOM LINE: Focus on WATER the most, and low or no calorie drink options if you are trying to lose weight!

MORE Ways to Lose Weight in 2011

As promised, in keeping with the new USDA guidelines, I am returning to talk about my MORE philosophy that has helped many patients lose weight. When people decide they want to lose weight, what is the first thing that pops into their mind? DIET, right? So what's next- which foods am I going to cut out of my diet? Followed closely by feelings of deprivation, and then frustration and disappointment when they give in to a craving for that off-limits food.
What if, instead of focusing on LESS, you focus on MORE? I encourage my patients to simply INCREASE their fruit and vegetable servings. The goal is 5-10 servings per day, total, of either veggies or fruit. A serving is what comfortably fits in your cupped hand. Therefore, a salad like the one pictured here is roughly four servings- 2 handfuls of lettuce, one of shredded carrots and one of tomato. Easy, right?

What happens when you focus on MORE vegetables & fruit servings is no secret. You FILL UP on "nutrient dense" foods that are GOOD for you, and eat less of, well, everything else! It tends to be the complex carbs (think breads, crackers, muffins, cookies, chips) that pile on the calories, NOT the fruits, vegetables and protein.
Does this mean you are not "allowed" to eat those complex carbs? Absolutely not! What it means is that you will be focusing on MORE quality in your diet by pushing up those F&V servings, and that typically will automatically decrease your total calorie intake, which POOF- "magically" helps you lose weight.
BOTTOM LINE: It's not rocket science, my friends- simply consume less calories than you burn, and yes, you will lose weight. But do it RIGHT, and make sure you are not skipping any meals, and that you ARE eating foods packed full of vitamins and fiber...our friends, the fruits and veggies.

Amazing Weight Loss & the Acai Berry

Happy 2011! I hope your New Year's Resolutions include steps towards GOOD HEALTH this year! I am enjoying a snowy vacation in gorgeous Crested Butte, Colorado, this week. As I checked the weather report to decide on layers of clothing this morning, my attention was caught by a news headline by a Crested Butte health reporter.

The report was part of a series about effective weight loss strategies. I was immediately sucked in by the reporter's frank style and her admission that she was skeptical about different weight loss claims. She and the News 5 team decided to do their own trial, and guess what? She LOST 25 POUNDS in a MONTH, and looks slim and sexy with NO CHANGE in her diet! WOW!

Okay, wake up and smell the coffee! Of course, this is a SCAM and and AD to buy the berries. Unfortunately, it is SO CONVINCING that despite knowing the numbers and facts couldn't add up, I initially thought it was real, and that the reporter was simply exaggerating. The site looks amazingly valid, and she appears to be a legitimate health reporter. If you start to research the reporter, however, you quickly discover that no such reporter exists-ANYWHERE. This ACAI berry distributor simply created multiple websites under the names News5Health.com (and News6, and News7, etc.)

What is the truth?
1. You need a deficit of 3600 calories to lose a pound. Period. At burning (or not consuming) 500 calories per day, that is a pound of weight loss per week, which is terrific weight loss.
2. We do NOT have "gunk" lining our guts and creating "toxins". If we did, everyone who has a colonoscopy would be "cured" of obesity!
3. It's CALORIES IN vs. CALORIES OUT that creates weight loss or gain!

BOTTOM LINE: BEWARE OF WEIGHT LOSS SCAMS POSING AS NEWS REPORTS, especially the ACAI berry. Eat more fruits and vegetables and start moving more to lose weight in 2011!

MORE Losing Holiday Weight

Tip number two for losing that holiday weight is another common sense solution- GET SOME REST! A study published in the Annals of Internal Medicine this year compared weight loss between a group that followed a low calorie diet and had only an average of 5.5 hours of sleep per night versus a group that followed the same diet and averaged 8.5 hours of nightly sleep.
It may surprise you that not only did the people with more sleep had more weight loss, but they also had greater reduction in body fat and in HUNGER.

Scientists are not sure of exactly how more sleep resets your hunger thermostat or changes your metabolism, but we certainly know that less sleep stresses your body, which is not conducive to better health. If you struggle with INSOMNIA as the reason for your lack of sleep, make sure you are having good sleep hygiene (keeping a regular bed time, not watching tv or doing computer right before bed, etc.) and limiting or avoiding caffeine and alcohol. Check out my blog on covering the clock, and make an appointment with your doctor if you cannot restore good sleep on your own.

BOTTOM LINE: Make sure you are getting at least 8 hours of sleep to maximize your success with losing those extra holiday pounds!

Calcium: Adequate serum calcium is needed for fecal fat excretion. Observational data has shown that those who supplement their diet with calcium have lower levels of body fat. This systematic review found supplementation of about 1,200 mg of calcium per day leads to an increase in fecal fat excretion. Obes Rev 2009; 10(4): 475-86



Sleep: A very small pilot study compared a low calorie diet and either 5.5 hours of sleep vs 8.5 hours over 14 days. Those who slept more had greater loss of weight and body fat, and, among other things, less hunger. The authors postulate it was due to the neuroendocrine changes decreased sleep induces. Ann Intern Med 2010; 153: 435-441

Chronic PPIs: When used chronically, PPIs are associated with pneumonia, C. diff infection and other problems. This case control study found obesity developed in patients with GERD who were treated chronically with PPIs vs other treatments World J Gastro 2009; 15(38): 4794-4798.

Losing that Holiday Weight

Borrowing from my editor-in-chief's blog (Dr. Frank Domino) at the 5-Minute Consult, I'd like to share some tips this week to help you lose that extra weight you picked up over the holidays. Remember, the average American unfortunately gains close to 10 pounds between Thanksgiving and New Year's, so if your pants are fitting a bit tootight, you are not alone!

First of all, a simple trick models have known for years: DRINK WATER!! A trial of obese adults (published in the journal Obesity this year) showed that people who drank 16 oz of water before each meal along with following a low calorie diet lost >4 pounds MORE than the group that simply followed the same low calorie diet.

Often, we think we are hungry when we are really thirsty, so focusing on this simple tip of drinking a couple glasses of water with each meal will help you recognize what your body is really craving.

BOTTOM LINE: Add TWO 8 oz glasses of water to breakfast, lunch and dinner to help lose some of that holiday waistline!

MORE Trick or Treat!

Ah yes, I am reminding you about MORE again...but really, the time to think about "New Year's Resolutions" and optimizing health and losing weight is NOW, BEFORE you weigh, well, MORE at the end of the holiday feasting season! (pardon the pun)
Today, though, I'm writing in response to yesterday's blog, where I suggest that we-gasp- SAVE THE HALLOWEEN CANDY for HALLOWEEN! I am ALL ABOUT Halloween, in fact, it may be my favorite holiday. My birthday is right after Halloween, so I grew up having costume parties and I have nothing but wonderful associations surrounding this festival. Our house is decorated with ghosts, pumpkins and skeletons from October 1st. I want to be clear that I am NOT saying "don't enjoy Halloween"- I am merely saying let's choose a HEALTHIER way to extend the celebration beyond one day!
So, what can you do if you are a Halloween candy fan? Number one: enjoy Halloween candy ON HALLOWEEN. This year, Halloween falls on a Sunday, so splurge all weekend if you'd like. Just do NOT buy the candy now, and have it sitting on your desk at work or out as "decoration" in your home. How about using some delicious pumpkin spice scented candles to liven up your surroundings instead?
If it's fall FOOD you are craving, whip up some healthy, delicious pumpkin muffins from a Cooking Light recipe, for example.
Enjoy the crisp apples of the season- maybe ONE with caramel wrapping and placed on a stick- but savor the season's fruit every day! We adore kitchen gadgets in general, and literally have three different apple slicers (pictured above). A knife will do the trick, but an inexpensive peeler/slicer makes apples so fun that every kid who visits our house asks to have an APPLE!
BOTTOM LINE: Celebrate HALLOWEEN with healthy TREATS, so you don't have to work to find new TRICKS to lose weight come New Year's.

Trick or Treat?

Can you believe that Halloween is right around the corner? We are officially in "treat yourself" season, as we hit the trifecta of food oriented holidays: Halloween, Thanksgiving and Christmas/Hanukkah. We tend to celebrate with nonstop EATING, and then what do we do every January? That's right, make New Year's resolutions where LOSING WEIGHT tops the list!
This year, let's THINK AHEAD...
The great news is that the weather is generally BEAUTIFUL in the fall (at least here in Texas!) What better time to head OUTSIDE and go for a walk? If you're here in Austin, make time to head down town and stroll, walk or jog around Lady Bird Lake. Wherever you are, respond to that sweet tail wagging of man's (and woman's) best friend, and grab your dog's leash and start WALKING.
Now, here's the "hard" part- which really is not so hard. Let's SAVE THE HALLOWEEN CANDY for...yes, HALLOWEEN! Start in the grocery store. Do NOT BUY the candy till the DAY BEFORE Halloween. It's way easier not to eat it when it is still sitting on the shelf in the grocery store, rather than sitting on your desk at work or your kitchen counter top. And forget the excuses here: "if I don't buy it now, they wont have my favorite kind", "I wont remember, then we wont have candy to give out", or "but I LOVE those little Reeses cups- how many calories does just one have?"
For a great list, check out Daniela Knight, R.D.'s list on her website, http://www.austinnutritioneducation.com/Halloween-Treats.html, but the ones that matter to ME are Snack Size Butterfinger: 170 kcal, Fun Size Kit Kat- 50 kcal, and ONE plain M&M-4 kcal. Now, if you stop at ONE, it's really no big deal. but if you eat a handful of M&Ms each DAY for the next few weeks, or grab a couple fun size chocolate treats, BOOM-you will gain a pound right there. (Remember one pound is 3600 kcal- do the math.)

BOTTOM LINE: Don't wait for NEW YEARS to make a resolution for better health- start NOW by limiting Halloween CANDY to HALLOWEEN DAY!

Avandia Latest News

Last week, the FDA issued more restrictions regarding the diabetes medication Avandia (rosiglitazone). You can read the full notice at FDA.gov, but I will try and hit the highlights for you.

Avandia is a "TZD" which is a class of medications that helps to increase the body's sensitivity to insulin in diabetics. We have seen that it is very effective at lowering blood sugars. Unfortunately, it was discovered that this class should NOT be used in diabetics who also have congestive heart failure. Now, additional studies have shown that there is also an increased risk of heart attack and stroke in patients who took Avandia. At this time, the other drug in the same TZD class, Actos (pioglitazone) is not proven to have the same risks, though many experts are concerned this will be a class effect. Europe has completely withdrawn Avandia from the market, but in the United States, patients doing well on Avandia may discuss the risks with their physicians before making a decision whether or not to continue this drug.

What should YOU do if you take Avandia? There is no need to panic, but schedule an appointment with your doctor to discuss what is best for you. My advice is to take this news as a wakeup call that it is time to STOP LOOKING TO PILLS for an answer for your diabetes, and get serious about the behavior modifications in your diet and exercise that are necessary to reverse your disease! Yes, there are patients with adult onset diabetes who are thin and fit (I have three such patients in my practice) but the vast majority are significantly overweight. The GREAT news is that I have seen time and time again that when patients really embrace healthy eating and daily exercise ("MORE") the high blood sugars, high blood pressures, and high lipids (cholesterol) not only improve, but often disappear!

In Western medicine, we are conditioned to find the quick fix for disease states by prescribing the "right" pill. We have invented wonderful medications that improve the quality and quantity of life. However, the longer people take them, the more long term side effects we identify. What is safe and the "best" practice today is often the next great lawsuit tomorrow. I am NOT anti-medication, but I am most definitely PRO-behavior modification when that choice exists to treat the same problem.

BOTTOM LINE: If you take AVANDIA, please schedule an appointment with your physician and ask for concrete suggestions for a healthier lifestyle!
PS. For a jump start towards "MORE" health, check out my January 2010 blogs: More, More Exercise Buddies, More Fun, When is a pound really gone, etc.

Weighty Issues

The American Academy of Family Physicians is ramping up our patient awareness of individual responsibility and health choices. As family doctors, we certainly are well-positioned to take the lead on community education, as well as prioritizing preventative care with our patients. Has your doctor addressed your weight issues? Do you wish (kind of) that she would?

You may wonder why more doctors do NOT address their patients being overweight. Well, let me share a few (misguided) reasons. Primarily, doctors want to help their patients, but do not want to be perceived as rude or judgmental. Additionally, many doctors are overweight themselves, so it's a bit easier to turn a blind eye towards this particular issue. Physicians fear if they bring up this subject, they may be in for an extended visit that will put them running behind the rest of the day. Additionally, insurance companies do not want to reimburse us for nutrition counseling, and with our overhead expenses, we have to mindful of the bottom financial line. Finally, many physicians feel at a loss for what they can offer their patients.

I hope any doctors not actively addressing overweight & obesity issues will read the latest issue of AAFP NEWS NOW and see how I and many other FPs are tackling these obstacles. Feel free to forward this link to your doctor and open up the lines of communication for your health!
BOTTOM LINE: Ask your doctor about ALL your health concerns, including those 10, 20, 50 or more pounds you want to lose!

I can't lose weight, no matter what I do!

At least two or three times per week, my patients tell me that they can't lose weight, no matter what they try. Often, they feel their metabolism or hormones are to blame. They would like me to test their thyroid levels and other hormones. 

Well, for every one patient who legitimately is severely low thyroid or has their hormones "out of whack", there are a hundred who come back with completely normal lab values.

 So, how do I, as their physician, try and help these patients when it would be harmful to prescribe thyroid medicines or appetite suppressants? Many physicians fall back on the old standby of saying "there is no metabolic explanation for your problems." As true as that is- and I certainly do tell patients this- that is NOT all there is to say.

Ultimately, we all know that losing weight means burning off more calories than we consume. What I try to make clear to people is that they need to take ownership of what they are putting in their mouth as well as how many calories they are burning off. It is human nature (proven in study after study) that we will OVERestimate our exercise and UNDERestimate our calorie consumption. The only way to truly assess this is to log what you eat- and I mean MEASURE it and log it as the day goes along; do NOT rely on your memory, or you'll forget the handful of chips or M&Ms that you grabbed from your friend's house/desk, PLUS log in the amount of exercise- count minutes and/or miles- and MEASURE it. Patients tell me all the time that they walk 2-3 miles in a half hour, but never break a sweat. Hmm... I don't think so. Try it on a treadmill.

There are a dozen easy, free calorie counters on the web that will help you catalog your ins and outs daily- pick one!

OR... try this: simply count your servings of fruits and vegetables each day. You need 5-10/day. A serving is roughly what you can hold in your hand. So yes, a big person (big hand) gets a bigger serving than a kid. A huge banana, for example, is likely two servings.  An apple- usually one; a handful of berries or grapes- one. A huge lettuce/tomato/carrot/cucumber salad might be four or five servings. 

BOTTOM LINE: fill up on fruits and vegetables, ten servings per day, and the protein, fat, and carbs that round out your plate (should be only one quarter of a round plate) will still likely add up to fewer calories than you need, and the weight WILL come off.

P.S. The only people who maintain weight loss in meta-analysis studies exercise daily. Yes, that would be every day, seven days per week. It's not magic, it's habit. And yes, walking counts.