Thursday, May 31, 2018

Obesity is complicated — and so is treating it

Obesity is complicated — and so is treating it

Many people don’t think of obesity as a disease, but rather as a moral failing. But Dr. Fatima Cody Stanford, instructor of medicine at Harvard Medical School and researcher and practicing physician at the Massachusetts General Hospital Weight Center, points out that obesity is a complex, chronic disease. Stanford’s recent fascinating and informative presentation explains how the body uses and stores energy, and describes the complex interplay of the genetic, developmental, hormonal, environmental, and behavioral factors that contribute to obesity.

Obesity isn’t just “calories in versus calories burned”

Obesity isn’t just about energy balance, i.e., calories in/calories out. “That’s simplistic, and if the equation were that easy to solve we wouldn’t have the prevalence of obesity that we have today,” Dr. Stanford explains. She goes on to say that not only is the energy balance theory wrong, but the focus on that simplistic equation and blaming the patient have contributed to the obesity epidemic. Stigma, blame, and shame add to the problem, and are obstacles to treatment. Indeed, over 36% of adults in the United States have obesity, and the world is not far behind.
She describes her research and experience in the treatment of obesity, including several cases from her own clinic. These are the cases that capture my attention, as they demonstrate most clearly the effects of different treatment approaches (and combinations) to obesity: diet and lifestyle (i.e. behavioral), medications, and surgery. Stanford has seen remarkable, long-lasting positive results with all, but she always emphasizes diet and lifestyle change first and foremost. The program (called Healthy Habits for Life) offered at the MGH Weight Center is a huge commitment, but it can help reframe a person’s relationship with food, emphasizing a high-quality diet, and not calorie-counting.

The components of a successful treatment for obesity

Abeer Bader is a registered dietitian and the lead clinical nutrition specialist at the center. She described the program to me in more detail: it’s a 12-week group-based education and support program with a structured curriculum and frequent contact with patients. The classes are 90 minutes long and led by a registered dietitian, and cover everything from the causes of obesity to healthy eating to debunking popular diet myths, plus recommendations for dining out, grocery shopping, meal prep, physical activity, and more. “The goal of the HHL program is to provide patients with the education, support, and tools to lead a healthy lifestyle.”
The diet they promote is loosely based on the DASH diet and the Mediterranean diet, as these eating plans are rich in vegetables, fruit, lean protein, and whole grains. They use the Harvard Healthy Plate to illustrate a healthy, well-balanced meal.
But it’s also a highly individualized program. “We work closely with the patient to put together realistic goals. I think the most important part of approaching goal-setting and behavior change is to first determine what it is that they would like to improve. Often as providers we tell patients what they need to do, but when you allow the patient to highlight an area that they would like to work on, you may see better adherence,” says Bader.
Other similar comprehensive programs have been shown to help patients achieve lasting diet and lifestyle change, lose weight — and avoid diabetes. The Diabetes Prevention Program helps those with obesity and risk of developing diabetes lose 5% to 7% of their body weight, and decreases their risk of diabetes between 58% and 71%.
As Bader states, “I think it’s important to note that the diet that “works” is the diet that a person will adhere to for the rest of his or her life. We really emphasize the importance of lifestyle change versus short-term diet fix in order to have the greatest success in achieving a healthier weight.” This statement is evidence-based, as a recent review of multiple research studies looking at different weight loss diets found that all worked about equally as well.

Medications to treat obesity

What can surprise people (including doctors) is how helpful weight loss medications can be, though it can take some trial and error to figure out what will work for someone. “These medications affect the way the brain manages the body’s weight set point, and how the brain interacts with the environment. But sometimes there’s no rhyme or reason why one medication works for someone, but another doesn’t.” Unfortunately, as research shows, weight loss medications aren’t prescribed often enough.
In summary, obesity is a complex, chronic disease with many contributing factors. Primary care doctors and obesity specialists can guide treatments that include lifestyle approaches like diet, exercise, and addressing emotional factors that contribute to obesity. For some people weight loss surgery may be an option (a subject for another post).

Selected references

Centers for Disease Control Adult Obesity Facts.
Media and its influence on obesityCurrent Obesity Reports, April 2018.

Related Information: Lose Weight and Keep It Off

Source: Harvard Medical School

Sunday, May 13, 2018

18 Healthy Recipes to Make With Cucumbers That Aren't Just Salads

When was the last time you cooked with a cucumber in a creative way? I know for me at least, it's been quite a while. Every now and then I'll one eat sliced up with a side of dip, or in a Greek salad, or maybe even in pickle form. But that's pretty much it, even though I consider cucumbers one of my favorite vegetables.
Cucumbers may not have a ton of flavor, but they're full of nutrients like potassium and vitamin C, and they don't deserve to be the side act in salads forever. That's why I'm committing to using them more creatively from now on. Since it's finally warm outside, it's the perfect time to whip those cool cukes out and start experimenting. From creamy cucumber gazpacho to infused cocktails, there are many things you probably never realized you could do with them.
These 19 recipes will show you how to take advantage of cucumbers in only the most exciting ways. And only some of them are salads.
Get recipes here:

These 75 Vegan Breakfast Recipes Will Have You Saying "Is It Morning Yet?"

From tofu and veggies to protein smoothies to overnight oats, here are over 75 recipes to satisfy your morning cravings. They'll make you realize that breakfast really is the most important delicious meal of the day. All of these recipes are under 400 calories, are completely vegan, and are full of delicious plant-based ingredients. You'll get to bed early just so you can wake up to one of these!

Get recipes:

Sunday, May 6, 2018

‘I Lost 50 Pounds When I Learned How To Stop Eating My Feelings’

I’ve struggled with depression for years—I was diagnosed with clinical depression and anxiety in 2012—but in 2016, it took a turn for the worse after a relationship ended.
I began using food as a coping mechanism. I’d start each day with a 20-ounce soda, eat way too much junk food, and continue to snack at all hours of the night. Oh, and you couldn’t pay me enough to step foot into a gym.

At one point I’d gotten so fed up with my weight gain—I was 190 pounds, and I’m only 5’2”—I tried the “Lemonade Diet,” where all I consumed for 15 days was a mixture of Grade B maple syrup, lemon juice, cayenne pepper, and water. Did it work? At first, yes; but once I stopped the diet, I quickly gained the weight back because I didn’t learn healthy eating habits.

'I knew I had to do something to get my weight under control.'

In September of 2016, I realized I couldn’t make any significant changes on my own, so I started training regularly with a personal trainer who also specialized in nutrition. At first, she suggested I cut out soda, chips, candy, and fast food, but I still found myself falling for trendy “diet” foods with empty calories. I clearly had a lot to learn.
I started eating five times a day—three meals and two snacks—following a high-protein diet laid out for me by my trainer. Here’s what a typical day looked like:
  • Breakfast: Two egg whites, chicken breast, and spinach
  • Lunch: A small salad with tuna
  • Dinner: Ground turkey, brown rice, and tons of veggies
  • Snacks: Hard-boiled eggs or sugar snap peas (a great alternative to chips!)
    But, because I also learned balance is key, I’d splurge a little every Saturday and treat myself to one cheat meal. I ate this way for two months and lost 10 pounds.

    'I totally revamped my fitness routine, too.'

    I began working out six times a week for an hour, focusing on an equal mix of weight training and cardio. My trainer always had something new for me to do during our sessions, so my body was constantly challenged. Throughout my training, I also learned to focus on form and consistency instead of rushing through my workouts.
    Once summer 2016 rolled around, I had lost about 40 pounds (I went from a size 18 in jeans to a size 9). From that point on I began to focus less on fat loss and more on building muscle.

    'I never want to be where I was when I started this journey.'

    Now, it’s all about maintenance for me: I meal prep all of my meals to ensure I won’t choose quick foods when I’m short on time so I can just pop one in the microwave and go. I also continue to exercise regularly and I try to journal often—both have helped with my mental health, as well.

    'But the best part of losing weight, for me, has nothing to do with the scale.'

    Source: Women's Health

    Trump appointing Dr. Oz to his sport, fitness and nutrition council

    CNN-The White House announced Friday that President Donald Trump intends to appoint Mehmet Oz, better known as Dr. Oz, to his council on sport, fitness and nutrition.
    Oz is well-known as a host of an eponymous television show on health and medical issues and, before that, for appearances on "The Oprah Winfrey Show." But he has become a lightning rod for controversy for featuring what critics say is unscientific advice on his show.
    In 2014, a congressional panel questioned Oz over his promotion of weight-loss products on his television show.
    "The scientific community is almost monolithic against you in terms of the efficacy of the three products you called 'miracles,'" Sen. Claire McCaskill, a Missouri Democrat, said during the Senate Commerce, Science and Transportation subcommittee hearing.
      The following year, a group of doctors criticized him harshly, saying he manifested "an egregious lack of integrity" in his TV and promotional work and called his faculty position at Columbia University unacceptable.
      Oz defended himself in a written statement at the time, saying, "I bring the public information that will help them on their path to be their best selves. We provide multiple points of view, including mine which is offered without conflict of interest."
      The President's council on sports, fitness and nutrition is part of the Department of Health and Human Services and "engages, educates, and empowers all Americans to adopt a healthy lifestyle that includes regular physical activity and good nutrition," according to HHS's website.
      The White House also announced on Friday that Trump will appoint former bodybuilder Lou Ferrigno, famous for playing the Hulk in the television show "The Incredible Hulk" in the 1970s and '80s, and New England Patriots coach Bill Belichick to the council for two-year terms.

      Healthy Table: Cucumbers skins provide beneficial nutrients for eyes

      Today’s recipe mashup takes creamed cucumbers and combines it with pasta for a perfect, chilled, springtime salad.
      Although cucumbers are generally low in nutrients, their skins are a surprisingly good source of lutein, a beneficial phytonutrient that may keep our eyes healthy. So, don’t remove the peel in today’s recipe. Cucumbers are also low in calories, one cup sliced has just 14 calories.
      Cucumbers grow in a wide variety of shapes and sizes, from inch-long gherkins to oversized English or hothouse varieties that can measure two feet. Seedless cucumbers worked well in this pasta salad. Look for cucumbers that are very firm and rounded on the ends. The skin should be deep, rich green in color, not pale or yellow.
      I used white fiber pasta by Barilla in today’s salad. Made with semolina wheat, durum wheat, whole durum wheat flour, and corn starch, a 2-ounce serving (about 1 cup cooked) has six grams of fiber. That’s three times more fiber than regular pasta. And, it looks and tastes like regular pasta.
      According to Barilla, some of the fiber comes from the corn starch. While most starches we eat are digested and absorbed in the small intestine, some escape or resist digestion and move to the large intestine where they function like dietary fiber. This type of starch is called resistant starch and is found in legumes, whole grains, seeds, under-ripe bananas, and the type of corn starch used in white fiber pasta.
      Research suggests that resistant starches may help with weight control, better blood sugar control for people with, or at risk for type 2 diabetes, and promotion of a healthy gut. One thing I’ve noticed with this type of pasta is it maintains its texture. Even after a day in the refrigerator, the pasta in today’s salad held its shape and did not get mushy.
      Darlene Zimmerman is a registered dietitian in Henry Ford Hospital’s Heart & Vascular
      Institute. For questions about today’s recipe, call 313-972-1920.

      Creamy Cucumber Pasta Salad

      Serves: 8 / Prep time: 20 minutes  / Total time: 30 minutes (plus chilling time)
      8 ounces whole-grain penne pasta
      ½ cup reduced-fat sour cream
      ⅓ cup reduced-fat mayonnaise
       2 tablespoons white vinegar
      1 tablespoon minced fresh dill weed
      1 tablespoon sugar
      ¼ teaspoon salt
      ¼ teaspoon black pepper
      1 ½ cups sliced and halved seedless cucumbers
       ⅓ cup diced red onion
      In a large saucepan of unsalted boiling water, cook pasta according to package
      directions. Drain pasta and rinse under cold water; drain well and transfer to a
      large bowl. In a small bowl, whisk together sour cream, mayonnaise, vinegar, dill
      weed, sugar, salt, and pepper. Add cucumber and onion to pasta. Pour dressing
      over pasta mixture, stirring gently to coat. Refrigerate 2 hours before serving,
      allowing flavors to blend.
      Created by  Ashley Allmond, Henry Ford Hospital
      Dietetic Intern, for Heart Smart and tested by Susan Selasky for the Free Press Test Kitchen.
      169 calories (27% from fat), 5 grams fat (1 gram sat. fat, 0 grams trans fat), 26 grams carbohydrates, 5 grams protein, 137 mg sodium, 10 mg cholesterol, 37 mg calcium, 3 gram fiber. Food exchanges: 1 vegetable, 1 fat. 1 ½ starch.