Friday, December 24, 2010

Top 5 Traits Of Successful Weight Loss Clients

Losing weight and keeping it off is not an easy thing to do.  For over 15 years, I’ve been studying weight loss both academically, in graduate school and clinically, working with weight loss clients.  In that time I’ve found that successful losers tend to share common traits.   Conversely, these traits are lacking in those that are not successful.  I thought I’d use this post to list the top 5 traits and explain a bit why they are so important.

Trait #5 Ability to do cardio at home
If you are serious about losing weight, cardiovascular exercise needs to be a just about daily activity for you.  The research literature is beginning to paint a very clear picture of this fact.  If you need to go to the gym to do your cardio, it just doesn’t happen with enough consistency.   I always strongly recommend that my clients have a piece of cardio at home to help them get their minutes.   If you missed my previous post on the Gazelle Edge, here is the link.  This provides a low impact, portable, inexpensive solution to this problem.

Trait #4 Resiliency
Just about every aspect of our lives now distracts us from a healthy lifestyle.  The wrong food is just about everywhere, our schedules are getting busier and busier and physical activity is no longer built into our day.  You will get off track from time to time with your diet and exercise habits.  Count on it.  It happens to all of us.  Holidays, vacations, birthdays, stressful periods at work/home all contribute to this.  The key is to get back as soon as possible.  Some people let a bad meal choice become a bad day, then a bad weekend, then a bad week and then a bad month.   Those who are successful don’t think like that.  They get back right away, I mean the next day!  I played a lot of hockey growing up and the best goalies had a very short memory.  In other words, they may let in a really bad goal but they quickly forgot about it.  They focus on the next shot like the last one never happened.  Have a short memory when it comes to your dietary and exercise indiscretions.

Trait #3 Plans ahead
My clients that are most likely to hit their weight loss goals are quite organized and plan ahead.  Here are some examples:  1) Doing grocery shopping early in the week and making sure they have what they need to prepare healthy meals when they are home. 2) When going out to eat, suggesting restaurants where they know they can make good choices. 3) When traveling, making sure that they will have access to the type of foods they need to stay on plan even if it means bringing non-perishable food items with them on their trip.  We all run into trouble when we find ourselves in situations with tempting foods and no healthy alternatives.  Minimize these situations by planning ahead whenever possible.

Trait #2 A realistic attitude about what it will take to lose weight.
Lose 30 pounds in one month eating your favorite foods and doing no exercise!  Claims like these sell a ton of books and supplements but what they don’t do is help you lose weight.  One of my old professors you to say “The only way to lose 20 lbs instantly is to cut off a leg!”.  My most successful clients don’t fall for these claims.  They know that weight loss will take a lot of effort.  They know they need to eat right, they know they need to do just about daily cardio and they know they have to hit the weights at least twice a week.  They accept the facts and go about making their changes.  They know there will be struggles but they accept them and work to overcome them.

Trait #1 They seek out the research based science of weight loss.
The individuals I work with who do the best with their weight loss realize that there is a science to it all.  They don’t care to learn about how to eat from a famous celebrity or actress who never even cracked a book on nutrition.  More than half of the weight loss best sellers on are written by authors that have literally never even studied college level nutrition.  They are either actors, look really good or are amazing marketers fooling consumers.   The people who buy these books would never go to a doctor that didn’t go to med school or go to a tax accountant that had never studied accounting.  People that are truly successful losing weight get the facts from the experts and are immune to all the nonsense.

Tuesday, December 14, 2010

Feature Article: Alcohol

            A topic that comes up every time I give a nutrition lecture, start with a private client or meet a doctor’s referral is alcohol.   Here are some of the most typical questions:

Is alcohol good for you or bad for you?
What is considered a drink?
Can I drink alcohol if I want to lose weight?
Does it have to be red wine only?

            I figured I’d use this post to answer these questions and more.  Alcohol continues to be an interesting and controversial subject.   However, current research has taught us much about the effects of alcohol consumption on our health.

Basic Information On Alcohol
            Humans have been drinking some form of a fermented beverage for over 10,000 years.   The main active substance in alcohol containing drinks is ethanol.  Ethanol exerts a direct influence on the stomach, brain, heart, gallbladder as well as the liver.  It has an effect on inflammation, blood coagulation, insulin sensitivity, serum cholesterol and triglycerides.  As many of us know, it also has a direct effect on mood, concentration, coordination and most definitely, judgment.  

Alcohol contains 7 calories per gram.  As a reference, carbohydrate and protein have 4 calories per gram while fat contains 9 calories per gram.  A drink generally contains 12-14 grams of alcohol which equates to 12 ounces of beer, 5 ounces of wine and 1.5 ounces of hard liquor. 

Health Effects
            Alcohol’s impact on human health is a rather complicated issue.  Depending on the dose, alcohol is either extremely healthful or quite literally a poison.  Heavy drinking causes severe damage to the liver and heart, increases risk of a number of cancers and is involved in roughly half of all fatal traffic accidents.    For those individuals prone to alcoholism, excessive drinking can destroy virtually every aspect of their life.

            However, the health benefits of a moderate consumption of alcohol are undeniable.   Let’s start with the heart.   There is strong evidence that alcohol increases HDL cholesterol which is probably why it is associated with a reduced risk of coronary heart disease. (1)  Alcohol also improves the factors that influence clotting which is probably why it is associated with a reduced risk of stroke. (1) Finally alcohol tends to improve insulin sensitivity and there is evidence that it reduces the risk of type 2 diabetes. (2)

            Many wrongly feel that the benefits are only from red wine due to the antioxidants in the grapes.  This is not the case.  In our cohorts at Harvard, similar benefits were found for wine, beer and hard liquor, so feel free to drink what you like.

            So what is considered moderate consumption?  1-2 drinks per day for men and 1 drink per day for women.  You need consistent intake here, you can’t save all 7 of your drinks for Saturday night at the bar, you have to drink on a just about daily basis to get these benefits.  One other thing to mention is that even a moderate consumption of alcohol has been associated with an increase risk of breast cancer in women, about 40% increased risk with 2 drinks per day (3).  However, getting enough folate seems to minimize this risk.

Alcohol And Weight
            I hate to complicate things further but I have found that alcohol can have a profound influence on your ability to lose weight.  Alcohol provides 7 calories per gram and if you have 1-2 drinks every day, trust me, the calories begin to add up.  I have read that alcohol also slows down your metabolism but I haven’t really seen a lot of hard evidence that this is true.  What I can say is true, in my experience and others, is that after a few drinks we all develop a kind of “You only live once” mentality and the late night fast food stop or trip to the diner becomes all but inevitable.  

            If you work with me privately or read my book on weight loss, you know that to limit alcohols affect on weight, I restrict my clients to 4 alcohol containing drinks per week.  This way you get some of the benefits of drinking without the negative effect on your weight.

Take Home Message
            At the end of the day, the recommendation for alcohol use depends on the individual.  Drinking in moderation (1-2 drinks for men per day and one drink for women per day) has definite health benefits.  If you have a family history of alcoholism, it’s probably a good idea not to start drinking if you currently aren’t.  If you are a female, make sure you get adequate folate if you drink even moderately to help reduce any increased risk of breast cancer.  If you want to lose weight, limit yourself to a maximum of 4 drinks per week.  This way you are obtaining some of the benefits without sabotaging your weight loss efforts.

1) Annals of Epidemiology 2007 175:24-31.
2) Diabetes Care 2005 28:719-25.
3) Journal of the American Medical Association 1998 279:535-40.

Saturday, December 4, 2010

Research Update: Carbohydrates And Inflammation

Carbohydrate Nutrition And Inflammatory Disease Mortality In Older Adults
Buyken, AE et al.
American Journal of Clinical Nutrition 92:634-43 2010.

Objective: To examine whether dietary glycemic index, dietary fiber, and carbohydrate containing food groups were associated with mortality attributable to inflammatory disease.  These diseases include diabetes, Alzheimer’s, Parkinson’s, infectious disease, respiratory diseases, immunologic diseases, digestive diseases and others.

Study Population: 1,400 postmenopausal women and 1,245 men aged 49 or older.  This was an Australian cohort that was followed for 13 years.  By the end of follow up, 84 women had died and 86 men had died.

Results:  Women with the highest dietary glycemic index had a 2.9 fold increased risk of death from inflammatory diseases.  Increasing intake of foods high in sugar or refined starches also independently predicted a greater risk of death from inflammatory diseases.

In men, increasing consumption of fruit and fruit fiber decreased risk of death from inflammatory disease.

Comment:  This study is interesting for a variety of reasons:

#1- I’ve seen literature suggesting that a diet rich in high glycemic carbohydrates increases C - reactive protein (a marker of body wide inflammation), but this is the first study I’ve seen that looks at death caused by inflammation.

#2- A tripling of the risk of death in a 13 year period for women with the highest glycemic index is a very significant finding with a huge public health relevance considering the high glycemic nature of the current American diet. 

#3- The fact that the results were not the same for men was interesting.  It’s not the first time that I’ve seen the effects of glycemic index attenuated in men.  The authors mention that the reason for this may be that men have a higher antioxidant status than women until age 75.

Take Home Message:  The explanation for these results may stem from the hyperglycemia (high blood sugar) that results from chronic consumption of high glycemic carbohydrates.   This may result in an overproduction of free radicals and a greater release of inflammatory cytokines.  

If you read my book or work with me privately, you already know how heavily influenced my nutritional recommendations are by the glycemic index and glycemic load.  This is further evidence to avoid refined carbohydrate containing foods such as white bread, pasta, white rice and most importantly, sugar.