It is not surprising that many people are looking for a new and different approach to losing weight. People tend to look for a new approach whenever the one that they were using before did not work. Even if the approach got them to lose weight, it did not last. Several surveys have shown that just about every person who has tried to lose weight—and that is a lot of people—has tried a variety of different approaches.

In one survey of adults, a general diet and exercise approach was the most frequently used method for both men and women, followed by vitamins, meal replacements, over-the-counter products, participation in a weight-loss program, and diet supplements. In another survey focusing on younger people, skipping meals was a method used by almost half of all women (interestingly, men did not seem to employ this method).With so many approaches to try, the idea of a new and different one not only makes sense, it is appealing.

The science of weight management as we know it is only about fifty years old, a baby in the world of science. In the early 1960s, therapeutic starvation was the treatment of choice.This particularly diabolical trend was followed by low-calorie diets that restricted particular foods, then moved on to protein-sparing modified fasts that took the idea of food completely out of the weight-loss equation. If you are more than a few decades old, you probably remember these approaches and can attest to the fact that they rarely resulted in sustained weight loss.

Fortunately, the science of weight management has advanced over the years. Dr. Albert Stunkard, the researcher who said back in the 1950s that 95% of diets fail, frequently talks about the advances that have been made in weight management treatments since he put forth his discouraging statistic over fifty years ago. In an article he published in the 1990s on the topic in the prestigious American Journal of Medicine, Dr. Stunkard attributes the advances to the recognition that a variety of factors must be included in a comprehensive weight-loss program. He also credits improved weight-loss success rates to the realization that weight management cannot be viewed as a one-time, weight-loss event that disappears with the achievement of a weight goal. It is not the same as completing a course of antibiotics to get rid of a bacterial infection. Rather, sustained weight loss involves making ongoing lifestyle changes.

The Whole Truth

The central theme of this book is that weight loss that lasts requires a comprehensive method including making wise food choices, getting more active, making positive lifestyle changes, and creating a supportive atmosphere.

This article focuses on making wise food choices. Most weight loss methods address only this component of weight loss, and it is an important one. But you might be wondering how to choose from the hundreds of food plans out there.

Three Steps to Finding the Right Approach for You
Start with the hundreds of diets that are available, then ask yourself:
1. Does it create a calorie deficit?
2. Is it healthy?
3. Does it fit my life?
If you answer yes to all these questions, it’s the one for you!

Weight Loss Means Cutting Calories, and There Are Many Ways to Do It

The fundamental scientific truth of weight loss is that it can occur if a caloric deficit is created.This is the first question when considering any weight-loss method.To lose a pound of fat “costs” about 3,500 calories and those calories have to be “paid” by eating fewer calories than the body needs to stay the way it is, by burning more calories than the body needs to stay the way it is, or a combination of the two. But the number of approaches that a person can take to create the caloric deficit is infinite.

Then, the question is whether the food plan is healthy. Is it nutritionally complete? Does it encourage healthy eating habits? It is possible to eat just enough bacon or chocolate-chip cookies during the whole day to create the calorie deficit you need to lose weight. But your goal is to get your essential nutrition from healthy meals from all the food groups.

Because you are a unique individual with your own personality, lifestyle, preferences, and eating style, the path you follow to achieve sustained weight loss must be your own. The notion of a single approach that works for everyone could hold true only if we were all the same. The laws of thermodynamics for weight loss are universal (1 pound of fat = 3,500 calories), but the laws of human nature (no two human beings are identical) hold true as well.

To lose weight and keep it off, it is critical to find the approach that is right for you. Does the eating plan fit your preferences and your lifestyle? Does is it encourage healthy eating habits you can keep up? Counting and writing down calories is an effective approach to self monitoring food intake for many people, but that does not mean that it is right for everyone. For some people, finding another mechanism that will ensure they eat fewer calories than they burn is preferable. The guideline is to monitor food intake—the approach of how this is done varies.

The focus of credible weight management research today is to define and refine the factors that are critical in a comprehensive weight-loss program, then provide a set of guidelines that reflect the findings. For example, the preponderance of evidence shows that about sixty to ninety minutes of moderate physical activity per day is
associated with sustained weight loss. Science does not say that the exercise has to be walking or swimming or that it has to be done in a single session or spread throughout the day.Your approach is how you create the caloric deficit needed to lose weight.

The remainder of this chapter explores some of the most important things for you to consider in sorting through the myriad available weight-loss approaches.

Wonder Diets Are One-Hit Wonders

It is safe to predict that at least one new wonder diet or product will be promoted this year. It is also safe to predict that next year and the year after that will bring new wonder diets and products. The trend has been well established. A recent online search of books under the title or topic of weight loss revealed 2,214 matches! As the problem of excess weight has increased in the United States and around the developed world, the proliferation of diet books has followed suit.

Every year, new diet books promise a revolutionary approach to weight-loss success. Call these one-diet wonders, much like the one hit wonder bands in popular music that release one hit song and rarely are heard from again. Like the one-hit wonder bands, these diets come onto the weight-loss scene with a splash. Devotees gush over the new diets. But like hit songs and bands, new diets and their creators vanish quickly once the reality of short-term weight loss overtakes the promise of thinness forever.

Most bestsellers do not last, whether they are songs or books. According to a conference report from the National Arts Journalism Program at Columbia University, most diet bestsellers do not stand the test of time. They are on the shelf today and out of print only a few years later.Trendy ideas in weight loss change very quickly and do not make for true longevity.

Testimonials Are One Person’s Story

Almost any approach to weight loss will work for at least one person. Every approach can offer testimonials about how it led to weight loss. While motivating and fun, testimonials need to be read with caution. If the testimonial is one example of the real-world success of many people who have followed the diet, then it can be a valuable resource. But testimonials are just one piece of the evaluation process. They are usually most helpful for learning about the practical aspects of a weight-loss method—which foods are encouraged or discouraged, tips for following the recommended approach to eating, and how making the recommended changes affected the person’s life.They are only useful if they go beyond headlines like “I lost 50 pounds in one month.”

Sort the Truth from the Fiction

Most new diet approaches are simply nonsense, although some are legitimate. Unfortunately, at times it can even be difficult for health professionals to tell the difference because scientific explanations that sound so believable. What are some of the tricks for spotting short term fixes? Typically, they are promoted with grand words like “revolutionary”
or “miracle.” Beneath their title, they often include a tag line with an appealing promise, such as “based on a scientific breakthrough” or “the only program you will ever need.” The front or back cover of the book will include other appealing promises: “lose weight forever,” “never be hungry,” “drop pounds quickly and painlessly.” When it comes to weight-loss promises, if it sounds too good to be true, it often is too good to be true.

Public health organizations have become more active in helping people make informed choices about weight loss. Overweight is a big problem, and the potential for harm or good has greatly increased. Organizations like the American Heart Association (AHA) and the American Dietetic Association, as well as government agencies like the National Institutes of Health and the Federal Trade Commission, provide information and resources to help people sort through the many options available to them.

AHA has declared war on fad diets. As part of its comprehensive education campaign, AHA provides information to help identify ineffective or questionable weight-loss diets and claims. AHA discourages following programs that do not advise people with diabetes, high blood pressure, or other long-term health problems to seek advice from their physician or other health care provider. It also disapproves of programs and diets that do not call for increased physical activity and specifically cautions against certain types of fad diets.

The American Heart Association Does Not Endorse:
Specific combinations of foods or food combining
Diets that eliminate dairy
Liquid-only diets
Programs that require the purchase of packaged meals
High-protein diets
Juice fasting
“Cleansing” diets
Bizarre quantities of only one food (hot dogs, cabbage soup)
Magic or miracle foods that burn fat
Rigid menus with limited foods
Rapid weight loss of more than 2 pounds a week
Source: Adapted from www.americanheart.org.

Find Credible Resources

Armed with strategies for sorting out truth from fiction, it is time to turn to credible resources for information on weight control. According to the government’s National Institutes of Health Weight-Control Information Network (WIN), “Experts agree that the best way to reach a healthy weight is to follow a sensible eating plan and engage in regular physical activity.Weight-loss programs should encourage healthy behaviors that help you lose weight and that you can maintain over time.” Because activity is covered more fully in another article, this article will focus on what to look for in the food plan of a comprehensive weight-loss program.

A credible source for weight-loss information is the Partnership for Healthy Weight Management. Coordinated by the government’s Federal Trade Commission, the mission of this partnership is to promote sound guidance on strategies for achieving and maintaining a healthy weight. A core principle of the partnership is that no single weight-loss approach will work for everyone. The partnership offers general guidance that is in agreement with the principles in this book: nutritional balance, nutrient intake consistent with recommendations for health promotion and disease prevention, and a rate of weight loss that promotes loss of body fat rather than lean muscle. Its brochure available at www.ftc.gov/bcp/conline/pubs/health/wgtloss.pdf  includes a personal checklist for helping select a weight-loss method in line with the partnership’s mission.

Questions to Ask When Choosing a Food Plan
Does it encourage sensible, balanced eating?
Does it include foods from all food groups?
Does it meet all my nutrient needs?
Does it provide information on healthy eating?

Consider Other Factors

In addition to the general factors promoted by the Partnership for Healthy Weight Management, these other factors should be considered when evaluating a weight-loss food plan

Is the plan clear and up front about the role of calories in weight loss? Experts agree that the overwhelming driver of weight loss is the creation of a caloric deficit—fewer calories in than out. No good scientific proof of any kind supports changes in metabolism or other magic approaches to melt away body fat.

Does the plan support an eating pattern that fits your individual lifestyle and preferences? Eating plans are easier to follow when they fit the dieter’s lifestyle and include foods that the dieter enjoys eating. Recently, the AHA revised its dietary guidelines to emphasize the importance of flexibility in food selection.

The number of daily meals and snacks should be based on personal preference. There is no right or wrong approach when it comes to a plan with three meals and a snack versus six or so mini-meals per day. People who have a low level of dietary restraint and respond to food cues by being tempted to eat or overeat may prefer fewer meals and snacks in order to minimize exposure to food. Using an extreme method like skipping meals is not recommended, and eating in an overly strict way to comply with a specific method is not, either.

Does the plan give eating satisfaction? Eating provides pleasure, so you want to enjoy the food that you are eating both while you are losing weight and while you are keeping the weight off. Eating satisfaction is a complex issue, and there is no one meal plan or eating style that is satisfying for everyone.

Factors Affecting Eating Satisfaction

Eating satisfaction is linked to a variety of factors. What works for one person when it comes to eating satisfaction may not work for another. Finding what works is key because being satisfied affects the ability to lose weight and keep it off. While there is no single formula for eating satisfaction, there are threads that can guide you toward finding the
pattern that works best.

Body processes involved in the regulation of appetite are very complex and involve a number of hormones and biological systems. Other factors that affect eating satisfaction include taste, palatability, and energy density. Likewise, the composition of food affects eating satisfaction. In general, high-protein foods are more satisfying than foods with carbohydrates, and carbohydrate foods are more satisfying than high-fat foods. Alcohol stimulates eating.

The term carbohydrate encompasses thousands of foods from sugar to wheat germ. The effect of carbohydrates on eating satisfaction varies. Research suggests that whole grains provide greater eating satisfaction than refined grains. Dietary fiber, a component of carbohydrate foods, has been shown to reduce hunger and increase satiety. Increasing fiber intake as a weight-loss strategy appears to be related to the amount of excess weight—the more weight to lose, the more effective the strategy.

Energy density plays a role too. Some recent research has shown that from a very young age, people are trained to eat a volume of food, not a certain amount of calories. For example, most people will fill the same bowl every time they eat soup; they will not fill the bowl less full if it is a high-calorie bisque or have a second bowl if it is a low-calorie
broth. An effective approach to reduce caloric intake is to choose foods with a low energy density because the amount of food that can be eaten for a set number of calories is greater for a low-energy-density food than it is for a high-energy-density food. In other words, you get more food for the calories, and more food is associated with higher eating satisfaction.

For example, a cup of boiled corn is 130 calories. A cup of airpopped popcorn is 30 calories. Both are kernels of corn, but with popcorn the kernel has been pumped up with air and that makes popcorn a low-energy-density food that is low in calories.

Foods with a low energy density increase eating satisfaction with fewer calories because these foods usually are higher in water or air, lower in fat, and/or higher in fiber. Fruits and vegetables, for example, are rich in water and fiber. As such, they are low-energy-density foods that are useful for weight management. A review of studies looking at weight loss over at least six months concluded that a dietary pattern lower in fat and higher in fiber provided the best results.

For the same calories, a portion of a low-energy-density food is larger than a higher-density food portion. High-energy-density foods, many of which are concentrated sources of refined carbohydrates, sugars, and/or fat and taste good, are more likely to be overeaten.They are harder to stop eating in a single setting and over time.

Several studies have looked at whether altering the amount of food provided or altering the calories in the amount of food makes people eat differently. The findings are consistent. The daily amount of food eaten influences appetite; the number of calories eaten does not affect appetite.

Self-Monitor to Stay on Track

Finding an eating pattern and foods that provide eating satisfaction are critical to lasting weight loss because eating in a way that works for you enables you to stay the course. But there is one more component that is essential: self-monitoring. Without a system in place that helps you monitor what you are doing and eating, it is easy to stray off the path of weight loss and return to old habits without even realizing it. Several studies have found that self-monitoring makes a significant difference when it comes to successful weight loss. One study showed that 25% of weight-loss success is attributable to consistent self-monitoring. The people who are the most consistent in self monitoring have the greatest success.

There is no right or wrong way to self-monitor. Self-monitoring takes different forms and measures different things. It works when you find a method that you are comfortable with and are willing to do over time.

Most people benefit from monitoring two separate but related things when it comes to weight loss: food intake and body weight. Tracking food intake can be as simple as counting and writing down some measurement of food eaten, for example, calories or POINTS values of foods. Tracking may be expanded to include recording the food item and the portion that is eaten in addition to its calorie or POINTS information. To add even more detail, the tracking can include information about what time of day a food is eaten and/or feelings experienced while eating. Information can be written down on a piece of note paper, on an index card, or in a journal, whichever is most convenient.

When used consistently, tracking food intake in writing produces superior weight-loss results. However, not all dieters are consistent in their short-term tracking and over time.

Assessing internal cues for and feelings of hunger and satiety is an alternative method of monitoring eating habits and patterns and eating satisfaction. In practical terms, this means eating the amount of food needed for eating satisfaction, then stopping. Internal cues are closely linked with the person’s level of dietary restraint and disinhibition. One theory says that overweight people do not recognize their body’s cues for hunger or satiety because they never learned how to do this. Learning to recognize and self-monitor these cues may be a helpful technique in weight management.

Monitoring food intake helps keep track of the weight-loss process; monitoring weight loss keeps track of weight-loss progress.Weight loss can be monitored in several different ways: body weight, body measurements, or the clothing test.

Body weight is the easiest measure of progress. An added benefit of using weighing as a self-monitoring strategy is that it allows pacing of weight loss to equal a 1- to 2-pound loss weekly. Body weight measurement is more effective as a weekly weigh-in than as a daily weighin. Because body weight fluctuates a great deal from day to day for many reasons, including menstrual status and recent sodium and carbohydrate intake, it is easy to put too much stock into a change, be it up or down, with a daily weigh-in. A weekly weigh-in is a better indicator of true weight-loss progress and trends.

Body measurements are an alternative to weighing, especially for people who feel stressed from watching the scale numbers go down and up. Keep measurements simple by sticking to key body parts like the bust, waist, and hips. Because measurements change more slowly than weight does, body measurements should be taken only once a month or so.

The clothing test is the simplest method of self-monitoring. One way to do the clothing test is to monitor the fit of a favorite pair of pants or a favorite nonstretch shirt. Try the clothing on immediately after washing before it stretches out with wear. The belt-notch test is particularly useful for men.

Monitoring your weight-loss progress can be a solo event or it can be done with someone’s help. Some people find that being accountable to others is useful. Accountability can include weighing in weekly with a spouse or partner, participating in a structured weight-loss program that includes monitoring activities as part of its program (such as being weighed each week by trained staff), or having a monthly appointment with a physician or health professional to assess your progress. Regardless of the monitoring method chosen, the goal of keeping track is to learn how it’s working.

At the end of the day, paced weight loss is the yardstick for success and goal attainment. And, as shown in the Institute of Medicine (IOM) report and the National Weight Control Registry (NWCR) database, regular monitoring is key to keeping the weight off. The IOM report lists self-monitoring as a positive predictor of weight loss as well as maintenance of weight loss. Participants in the NWCR database say that they frequently monitor their food intake and their body weight.

The Bottom Line

When it comes to weight loss, one diet or approach does not fit all. While there are many ways you can create a calorie deficit, you should also choose a food plan based on whether it is healthy and a good fit with your preferences and lifestyle.We all are different, with different personal habits and preferences. That is why what works for one person may not work or be the right approach for someone else. The science of weight management continues to evolve as researchers learn which program elements help people sustain their weight loss.

Beware of being lured into trying the latest and greatest diets. They usually sound terrific and make big promises. Keep in mind that testimonials, as convincing as they sound, do not apply to everyone and may not tell the full story. Enjoy success stories as a way to get inspired and find out what following the weight-loss program might be like for you. Remember that many diet programs have not been proven with large numbers of people and have not passed the test of time for lasting weight loss.

It is important to look carefully at weight-loss programs for proof that they are healthy and that they work. Compare their features to those discussed by the American Heart Association and use the Partnership for Healthy Weight Management for guidance on selecting an appropriate program. Important features for effective weight loss include adaptability to individual lifestyle and preferences and a diet that is satisfying to eat.

Self-monitoring is essential. Monitoring eating habits and weight loss helps track the process and progress of weight loss. There is no right or wrong way to self-monitor, as long as it is sustainable and useful. Self-monitoring enables you to make adjustments in eating habits for a desirable pace of weight loss.

Are you as strong, flexible, and physically fit as you would like to be? If you are, good for you. However, if you want to make some improvements, here’s one piece of advice: Try to improve a little bit at a time.

The only way to walk a mile is to take 1 step at a time. The only way to improve your fitness level is to take it 1 step at a time.

• Pick 1 aspect of fitness (aerobic, strength, flexibility) you want to improve first.
• Pick an activity that you enjoy. Your more likely to keep doing something you like.
• Set a 1-month goal that you think you can reach. For example, plan to walk for 10 minutes at lunch 3 days a week, or stretch for 5 minutes each morning.
• Start today. Keep a record of what you do.
• When you reach your first goal, reward yourself! Then set a new one.

Consistency brings success. Each success may be a small one, but small successes can quickly add up to physical fitness that will make a big difference in your life.

How hard should I exercise?

Nice and easy does it. Exercise does not have to be intense to be of value. In fact, if you exercise too hard, you get less benefit than if you go at a moderate pace.

Above all, listen to your body. If the exercise feels too hard, slow down. You will reduce your risk of injury and enjoy the exercise much more.

Try the “talk-sing test” to determine your ideal exercise pace:

• If you can’t talk and exercise at the same time, you are going too fast.
• If you can talk while you exercise, you are doing fine.
• If you can sing while you exercise, it would be safe to exercise a little faster.

Your exercise is most effective when you can talk, but not sing, while doing it.

How Often should I Exercise?

Most studies show that exercising for at least 30 minutes a week is what it takes to improve fitness. However, sometimes it’s easier to make exercise a habit if you do it every day.

With aerobic exercise, harder is not better, but longer is. Although you can get good fitness benefits from as little as 10 minutes of aerobic exercise per day, extending your exercise time will increase your rewards. This is true for up to 1 hour of exercise per day. Beyond that, there may be diminishing health returns and increasing risk of injuries.

Warm Up and Cool Down

For the first 5 minutes of your exercise routine, start out slowly and easily so your muscles have a chance to warm up.

End your exercise with a little cool-down period. If you’ve been running or walking quickly, gradually slow your pace, then do a few light stretches to improve flexibility.

Drink some extra water before and after exercising.

Overcome Barriers to Exercise

There are 6 barriers to exercise are all easy to overcome

1. No time?
   Try shorter periods of activity spread out throughout the day, such as three 10-minute walks.
2. Too tired?
   It’s often lack of exercise that makes you tired. Exercise gives you energy, try it.
3. Embarrassed?
   Many people are, especially at first. Be proud that you’re taking care of your body.
4. No partner?
   Yes, it’s more fun to exercise with a friend. If your regular exercise partner quits, find another one. You could also join a fitness club, take a class, or exercise to a video.
5. Bad weather?
   Too hot, too cold, too wet, too windy-it never seems right for exercise. Lots of people exercise come rain or shine. Try a variety of indoor and outdoor activities.
6. Too costly?
   You had to let the fitness club expire. You can’t afford a mountain bike. You panic at the price of running shoes. It all costs money, but can you afford not to exercise? Try a low-cost option such as walking instead of driving.

Exercise CAUTIONS

Moderate exercise is safe for most people. To be safe, start slowly and gradually increase the intensity of your exercise. However, if you can answer “yes” to any of the following questions, talk with your physician before beginning an exercise program.

• Do you have heart trouble?
• Do you have undiagnosed chest pains?
• Do you have high blood pressure?
• Do you have arthritis or other bone or joint problems that might be aggravated by improper exercise?
• Do you  have diabetes? You may want to talk with your physician about how increased exercise affects your insulin needs.

Men over age 40 who have been inactive or who have 2 or more risk factors for heart disease* and who plan to start a vigorous exercise program (running or fast bicycling or swimming) may wish to talk with their physician about any possible risks.

*Cholesterol over 200 mg/dl, blood pressure over 140/90, smoking, diabetes, or family history of heart disease before age 45

Losing weight and sustaining weight loss are not the same for everyone. Each of us is unique.We are born with our own genetic makeup, we make life choices (for example, to smoke, to have children), and we develop a personal biology that affects our ability to achieve lasting weight loss. Although there are individual factors that make weight loss more or less of a challenge, each can be overcome with knowledge and the right tools.

MYTH: You can’t lose weight if you have the wrong metabolism or genes!

Some people can lose weight and keep it off, but others simply cannot. For them it is not even a remote possibility. There are many factors working against weight loss, so for many people longterm weight management is an unrealistic dream. Some folks are just big-boned, and big-boned people are destined to be big. Some have the wrong body shape for thinness—naturally big hips and thighs, a round stomach, or overly broad shoulders. Those with slow metabolisms just don’t burn a lot of calories. It’s especially frustrating for those people because they exercise and don’t eat a lot, maybe just a few hundred calories per day, but they can’t overcome their body’s slow engine.

Some people are born with fat genes. Their mom and dad are big, their grandparents are big, and their cousins are big. The people who come from “big” families have no choice about being big too. Then there are those life events that cause weight gain that can’t be reversed: stopping smoking, being pregnant, especially with a second or third child, and menopause. It’s impossible for women to combat the natural body changes that come with being female. The weight just piles on even though they’re not doing anything differently.

Just as there are people destined to be overweight, there are others who are naturally thin. If they gain a few pounds, they take them right off. Pounds just melt away as soon as they start eating less and exercising more. They are the lucky people. The unlucky ones cannot lose weight.

The Whole Truth

Body Shape
A body shaped like an apple accumulates extra weight around the abdomen. A pear-shaped body adds extra pounds in the hips and thighs.Traditional thinking has been that it is better to be a pear than an apple—people with an appleshaped body are at greater risk of developing type 2 diabetes, high blood pressure, high blood cholesterol, and heart disease. Body shape, however, does not affect one’s ability to lose weight. Apples can lose weight just as quickly or slowly as pears.

Frame Size
Old ideal height and weight tables that were based on bone frame size: small frame, medium frame, and large frame. These tables were widely used, even though they were not based on good science.

Many people assumed that because they were large, they had a bone frame size classification that justified weighing more. The chart allowed people with big bones to be heavier than people with small bones. Today, some people believe that body mass index (BMI) does not apply to them because their extra weight is from their big bones or muscle, not from fat. The truth is that while people do have different frame sizes and it is possible to be overweight on the BMI chart because of extra muscle, most people who weigh too much for their height do so because of excess body fat.

That said, a few studies have been done on the relationship between bone frame size and BMI. What the studies found is that medium and large bone frames are closely related to their percent body fat and BMI—as the bone frame gets bigger, the percent of body fat and BMI both go up. Small bone frames, however, do not have less body fat.This finding helps explain why Asian-Americans, who tend to have smaller bone frames, have a higher disease risk at a lower BMI than people from other ethnic backgrounds. They may have a higher percentage of body fat even though their BMI may be in the normal range.

Genes
It seems logical that people from“big” families are destined to be overweight. Science has made great strides in understanding the very complicated issue of why some people are more predisposed to gain weight than others. Almost every week we see new studies published about various genetic components of weight gain and obesity.

A few years ago, there was tremendous interest in the discovery of leptin, a hormone thought to be the messenger sent from fat cells to the brain to regulate eating. Rats that did not produce leptin became obese just as people who do not produce insulin get type 1 diabetes. It was argued that people who were overweight or obese somehow had a genetic breakdown in this system and did not produce enough leptin. It was quickly discovered, however, that obese people tend to have higher levels of leptin than those who are thin, and the way leptin works in the body is much more complicated than being a matter of a simple deficiency. In fact, leptin functionality resembles the insulin resistance found in the metabolic syndrome that leads to type 2 diabetes. It seems that when fat cells send leptin through the bloodstream to the brain to tell the brain to stop eating because the body has plenty of fat, the brain somehow does not get the message and the individual keeps eating. It is as though the phone is ringing and no one is answering it!

Leptin seemed like a wonderful answer that might explain a genetic tendency toward obesity. Unfortunately, we now know that the body’s regulation of weight and body fat relies on more than just one messenger. It now looks as if there may be twenty, thirty, or even hundreds of different messengers that interact with each other.

This is not to say that genetics do not affect obesity. In fact, obesity researchers believe that there is a strong relationship between a person’s genetic makeup and his or her vulnerability to become overweight. But the human genome, or genetic map, changes excruciatingly slowly—probably less than 1% every one hundred thousand years. So how can we explain the fact that obesity rates have soared by 40% in the United States in the last decade? Certainly our genetic makeup has not changed.With the exception of the rare mutations that cause severe morbid obesity, it seems that numerous genes, each with modest effect, contribute to a person’s tendency to become overweight.The answer is that we are eating too much and burning off too little.

Many of us do have bodies that are genetically programmed to make us more vulnerable to gaining weight. But biology is not destiny. Weight gain only happens in an environment that leads to eating too much food and getting too little physical activity. For people who find the right balance between food and physical activity to maintain weight loss, having fat genes does not make a difference.

Foods contain just three major nutrients—protein, fat, and carbohydrates. It is not the total amount of food people eat that causes them to gain weight. Rather, one of those big nutrients is playing havoc with the body. The key to weight loss is to eliminate foods that contain the one nutrient that causes weight gain. These days, following this strategy is possible since specialized foods that have reduced or eliminated the weight-causing nutrient are so widely available.

Maybe fat is to blame. Fat in the diet is broken down into triglycerides that are taken in by body fat cells. Fat cells put triglycerides into storage and burn them very slowly and efficiently only after all other energy sources are used up. This works against weight loss. Eating fat also leads to heart attacks and cancer.

Maybe carbohydrates (carbs) are the macronutrient that causes weight gain. Carbs make us fat because they force the body to overproduce the hormone insulin, the metabolism cop in the energy in/energy out equation that rules body weight. To keep
blood sugar steady, insulin converts blood glucose from carbs into fat and pushes the fat into the fat cells. Insulin also prevents fat cells from releasing fat to be used for energy. Carbs make the body produce too much insulin, so blood sugar drops very fast. Since insulin will not let fat out to be used for energy, our brain tells us to eat more. If that food is a carb, the vicious cycle starts again. Eventually, the body becomes insulin resistant, and you gain weight. The answer is to eat very few carbohydrates. After cutting carbs, weight loss is quick and dramatic.

Maybe it is protein. After all, vegetarians avoid animal-based protein for overall health and long-term weight management.

Eat that yogurt, lose that weight? Not so fast…
For years the dairy industry touted studies presumably showing that the more dairy you eat, the more weight you lose. Did these ads and the “research” they quote tell the whole story? In a word, no. In fact, the Federal Trade Commission’s Bureau of Consumer Protection saw to it that the ad campaign went the way of the dodo bird, at least “until further researcher provides stronger, more conclusive evidence of an assosiation between dairy consumption and weight loss.”

But despite the fact that the ads were pulled off the air, the idea that milk promotes weight loss remains in our minds. So let’s take a look at the research that formed the basis for the claims. Most of it was done by one researcher, Michael Zemel, Ph.D., professor of nutrition and medicine at University of Tennessee, Knoxville, and sponsored by the dairy industry. Although the headlines frequently proclaimed a link between dairy and weight loss in the studies, the fine print told a different story. One study, for example, found that those eating three servings of milk, cheese or yogurt did indeed lose a bit more weight, but what was lost in translation was the fact that those who lost weight were low in calcium to begin with (and therefor likely to benefit from added calcium) and were eating a reduced-calorie diet (500 calories a day less than usual).

Another often repeated news story announced, “Calcium and Vitamin D Linked to Weight.” But the details revealed that although postmenopausal women who take calcium and vitamin D supplements may gain slightly less weight that women who don’t, the effect was – get ready- .28 (that’s decimal point 28) pounds less over the course of seven years. Do the math: that’s anout 1/25 of a pound – slightly more than half an ounce – of weight annually.

What is true, points out Walter C. Willet, M.D., Dr.P.H., chairman of the department of nutrition at Boston’s Harvard School of Public Health, is that a diet high in dairy and calcium has been implicated as a risk factor for prostate cancer. Milk has also been linked to acne, and there is a possible connection to ovarian cancer.

Bottom line: By all means, get your calcium, from a variety of sources including sardines, green leafy vegetables and seeds. Just don’t think for a minute that drinking or eating dairy products is going to help you lose weight.

Of Milk and Men
The Prestigious American Journal of Clinical Nutrition published a study confirming milk’s ineffectiveness as a weight-loss food. According to lead author Swapnil Rajpathak, M.D., Dr.PH., “Men who increased their dairy/calcium intake did not lose more weight. In fact, they gained slightly more weight in the 12-year period.” Still, we do need calcium-particularly in combination with other, often neglected bone-building nutrients such as magnesium, vitamin D, boron and vitamin K. Fifteen minutes of sunlight a day on bare skin should help keep vitamin D levels up. Boron is found in almonds, avocados, and peanut butter; magnesium is in dark leafy greens, legumes, tofu, peanuts and unpeeled potatoes. Vitamin K is in Spinach, lettuce, broccoli, brussels sprouts, cauliflower and cabbage.

Understanding the body-mind connection

Have you ever had an argument with someone and then been so flustered that you stubbed your toe on a footstool in the room? This example shows how your feelings affect your movements. Because you’re upset, your heart is racing, your breath is shallow and rapid, and you may even be sweating. That’s an example of your mind-body connection.

When you train your muscles, you tap into your mind-body connection through your neuromuscular system. Before you can contract a muscle fiber, the nervous system must run a communication network from the brain through the spinal column and out to the individual muscle fiber. In the early stages of training, before you start seeing visible external results, your body is laying down this neural network. The more extensive your neural network, the more individual muscle fibers contract.

Studies show that by concentrating on the muscles that you’re training, you can get results faster. In one study, a group of people performed a simple exercise, another group of people imagined doing the exercise but didn’t actually do it, and a third group served as the control and didn’t do anything. Of course, participants who actually lifted the weight gained the most strength. However, the people who simply imagined doing the exercise had more gains than those who did nothing.

Physical therapists are also conducting studies on the use of motor imagery with patients who’ve lost neuromuscular control due to stroke or Parkinson’s disease. Patients visualize walking with a perfect gait, as well as practice specific gait exercises. Studies show that this visualization helps improve performance. The bottom line, therefore, is that you have nothing to lose and possibly more effective training results to gain by focusing your mind on your target muscles as you do your exercises.

Psyching up and visualizing yourself strong

Studies also show that psyching up before you perform a weight training exercise can improve performance for people with at least one year of training experience. Psyching up strategies include the use of imagery, positive self-talk, affirmations, and focusing attention. So, when you’re ready to train, clear your mind, see yourself going through your workout smoothly and successfully, visualize your strong and toned body, and believe in your ability to lift your weights. It makes a difference.

1. Preheat oven to 400°F. Line a baking sheet with parchment paper and spray with nonstick cooking spray. Using a pastry brush, coat each piece of chicken with Dijon mustard.

2. In a food processor or blender, combine the cornflakes, sage, thyme, and salt and pepper to taste. Pulse to a coarse meal and transfer to a shallow dish. Dredge each chicken strip in the cornflake mixture until evenly coated. Place on baking sheet and bake until cooked through, 8 to 10 minutes. Serve with dipping sauce, if desired.

Makes 4 servings. Per serving: 170 cal,
0.5 g fat (0 g sat fat), 15 g carbs, 1 g fiber,
360 mg sodium, 27 g protein

Written by Katie Lee

Even the most dedicated workout warriors can fall off the wagon from time to time – especially when there’s a make-or-break moment on the job or an unexpected crisis at home. Here’s how to keep your body a top priority, no matter which of these fitness-derailing transitions life throws your way.

INJURY
A pulled hamstring or torn rotator cuff can send you to the couch for weeks-even months.

Set a goal. First, ask your doctor how long you will be sidelined. To avoid a workout withdrawl, find out what else you can do to stay in shape and set a doable goal to achieve by the time you’re all healed up. Let’s say swimming gets a green light. Aim to swim the equivalent of half a mile (that’s about 32 lengths of a 25-meter pool). “A goal helps you let go of your immediate disappointment and look beyond the injury,” says Edmund Acevedo, Ph.D., chairman of the health and human performance department at Virginia Commonwealth University.

PROMOTION
Moving up to a better position has certain perks, but spare time is usually not one of them.

Identify the workplace athlete. “You’re more likely to maintain a fitness routine if the responsibility doesn’t rest entirely on you,” says Edward Etzel, Ed.D., a sport psychologist at West Virginia University. Approach the lunch-hour runner or the after-work gym fiend and find out how she makes it work. Does she keep gym clothes in her desk? Does she do short-but-intense workouts so she’s finished in an hour? Adopt aspects of her routine and you’ll soon have one of your own.

NEW BABY
Yeah, the bambino is a blessing, but the extra pounds can feel more like a curse.

Add gym time to your to-do list. Even if it’s nowhere near the grand scale of your pre-baby regimen, Check with your doctor and then make some form of exercise part of your regular schedule, alongside feedings and naps. Make yourself the priority a couple times a week. This may be the one time you can cut yourself a little workout slack. “Women can become obsessed with dropping the baby weight and get frustrated if it doesn’t happen right away,” says celebrity trainer Gunnar Peterson, who got Jennifer Lopez back into shape after the birth of her twins. “All that does is add stress, and we all know that doesn’t help you get the body you want.” Yes, until you are ready to do more, walking around the house toting a 10 pound bundle of cuteness counts.

BIG MOVE
Between hunting for new digs and packing up your life, your running shoes may get buried in the boxes.

Scope out your fitness options before you pack the moving van. If you join the local gym or ID new running routes prior to your move, you’ll have a workout at the ready once your stuff is unpacked. “You’ll create a subconscious commitment to exercise regardless  of geography,” says Chris Carr, Ph.D., a sport and performance psychologist  at St. Vincent Sports Performance in Indianapolis. To find running routes in your new neighbor-
hood, go to usatf.org/routes.

Body mass index (BMI) is an estimate of body composition that correlates an individual’s weight and height to lean body mass. The BMI is thus an index of weight adjusted for stature. Body mass index is figured by dividing weight in kilograms by height in meters squared and multiplying by 100. It can also be figured by dividing weight in pounds by height in inches squared and multiplying by 705. High values can indicate excessive fat stores, while low values can indicate reduced fat stores. In this way, the BMI BMI has also been associated with mortality, with lower values generally correlating with longer life.

However, when evaluating the BMI, several characteristics of an individual need to be known. An individual’s age, gender, ethnicity, and level of fitness must be considered when using BMI to determine health risk. Also, the significance of the BMI is affected by disease state and hydration status. As with most assessment tools, the BMI is most effective when used in conjunction with other measurements.

Tables are available to identify the significance of the BMI. Calculations based on values for ideal body weight suggest the BMI for normal men and women should be in the range of 19 to 27 kg/m2. This range corresponds to the 25th to 75th percentile values recorded from adults followed in the 1971–1974 National Health and Nutrition Examination Survey (NHANES). Tables also list levels of protein-energy malnutrition and obesity. These values were determined by research in which height, weight, and age were associated with functional measurements and health outcomes. A BMI between 13 and 15 corresponds to 48 to 55 percent of desirable body weight for a given height and describes the lowest body weight that can sustain life. Body weight at this level consists of less than 5 percent fat. The maximum survival body weight is about 500 kg, which corresponds to a BMI of about 150.

Research with children indicates annual increases in BMI are usually due to increases in lean mass rather than fat tissue. Not until late adolescence does fat mass begin to affect the BMI—and adult values begin to be achieved.

There is a strong correlation between BMI and total fat mass, though individual variation in body type or height can cause misclassification. Un-fortunately, the same BMI value can correlate with a range of body-fat percentage.

For example, athletes usually have large skeletal muscles (which weigh more than fat) and therefore a high BMI, but they are not obese. Shorter individuals can also be identified as obese, since their BMIs are usually high. An older individual may have a higher body-fat percentage than a younger individual, but have the same BMI. Adult females can have a BMI of 20, which correlates to a body-fat percentage of 13 to 32 percent, while adult males can have a BMI of 27 and a body-fat percentage of 10 to 31 percent.

Findings from the third NHANES (1988–1994) describe misidentification of the elderly when self-reported height, rather than measured height, is used in the BMI equation. Height decreases over an individual’s lifetime due to vertebral compression, loss of muscle tone, and postural slump. An individual may, therefore, report a height that is no longer accurate, and the resulting value will be lower than the value that actually describes the individual, possibly leading to the wrong intervention.

Research has shown that both high BMIs and low BMIs can indicate increased morbidity and mortality. A low BMI, usually an indication of proteinenergy malnutrition or the effects of wasting or a disease process, is a significant predictor of mortality among young and old hospitalized patients. A high BMI has been shown to be predictive of mortality only among young hospitalized patients, usually an effect of cardiovascular disease and obesity. Risk of mortality is only slightly elevated at the highest BMI for elderly hospitalized patients.

Because ethnicity has been shown to require adjustments to the levels of concern for the BMI, care must be taken when comparing different population groups. For example, Asian populations may require a lower BMI to describe health risk, while Pacific populations, specifically Hawaiian, may require a higher threshold to indicate that an individual is at risk. This variation can be explained by body type.

BMI and waist circumference have been used to evaluate health risks associated with overweight and obesity. Because both are easy measures to do, standardization of both are encouraged for widespread use as a reference. Additionally, the two measurements have been used in an algorithm with a cardiovascular risk index to determine which individuals would benefit most from weight loss.

BMI is an easy measurement to make—only requiring a tape measure, scale, and, perhaps, a calculator. However, for individuals who have trouble standing up straight for an accurate height measurement—either from disease process, weakness, or kyphosis (abnormal backward curvature of the spine)—BMI may not be an easy or accurate assessment tool to use. Comparisons between BMI and mid-upper arm circumference (MUAC) measurements show that they identify the same level of malnutrition in individuals. MUAC is also easily measured (it requires only a tape measure), and it is a good indicator of change in body weight and muscle mass. Standardization of these two assessment tools for reference would benefit the science of nutrition assessment.

SEE ALSO Aging and Nutrition; Body Fat Distribution; Diet; Malnutrition; Nutrition Assessment;
Obesity; Overweight; Underweight; Waist-to-Hip Ratio.
by Carole S. Mackey

Bibliography
Collins, Steve (1996). “Using Middle Upper Arm Circumference to Assess Severe Adult Malnutrition During Famine.” Journal of the American Medical Association 276(5):391–395.

Kiernan, M. (2000). “Identifying Patients for Weight-Loss Treatment: An Empirical Evaluation of the NHLBI Obesity Education Initiative Expert Panel Treatment Recommendations.” Archives of Internal Medicine 160:2169–2176.

Kuczmarski, Marie Fanelli (2001). “Effects of Age on Validity of Self-Reported Height, Weight, and Body Mass Index: Findings from the Third National Health and Nutrition Survey, 1988–1994.” Journal of the American Dietetic Association 101(1):28–34.

Landi, F. (2000). “Body Mass Index and Mortality Among Hospitalized Patients.” Archives of Internal Medicine 160:2641–2644.

Maskarinec, G. (2000). “Dietary Patterns Are Associated with Body Mass Index in Multiethnic Women.” Journal of Nutrition 130:3068–3072.

Maynard, L. M. (2001). “Childhood Body Composition in Relation to Body Mass Index.”
Pediatrics 107:344–350.

Pike, Ruth, and Brown, Myrtle L. (1984). Nutrition, An Integrated Approach. New York: John Wiley.

Seidel, J. C. (2001). “Report from a CDC Prevention Workshop on Use of Adult Anthropometry for Public Health and Primary Health Care.” American Journal of Clinical Nutrition 73:123–126.

Shills, Maurice E.; Olson, James A.; and Shike, Moshe. (1994). Modern Nutrition in Health and Disease, 8th edition. Philadelphia: Lea & Febiger.

White, Jane V. (1999). “The Utility of Body Mass Index in Predicting Health Risk.” Consultant Dietitian 24(2).