How Often to Weigh Yourself?

I have patients who get on that scale several times a day and others who will weigh themselves once a week. What is the best frequency? Myanswer: depends on the person! Our weight will vary daily not always due to our caloric intake. If you happen to have a salty meal and drink lots of fluids, your weight will go up which has nothing to do with "fat"...it is "water" weight that goes on. Similarly, a number of female patients can relate to the fluid retention states that occur during certain times of their cycles. Their weight may go up 4-5 pounds over a several day interval which has nothing to do with "real" weight gain...it is fluid retention.

I think it is important to keep a clipboard next to your scale and weigh and record that number once a week. Do the measurement at approximately the same time every week. Then, depending on that number, have a plan in mind as to what you will do about it. If you know you have libralized your alcohol and caloric intake that week and the scale shows the damages, revert toa phase 1 diet plan for the upcoming week, then in one week, recheck the scale weight. ALWAYS have a plan in mind when you see the weight. When we get into trouble is when we either do not monitor the weight or we have no plan. Let me give you anexample of the former.

I had a patient who lost 68 pounds in our program in 6 months. He did a great job. He is my medical patient as well and threee months after exiting the weight loss program he came in for a medical appointment. I saw immediately there was significant weight gain and I asked him how much he gained back. He sheepishly said that he had reverted to some old behaviors and gained back about 15. We went to the scale and it was actually 39.4. His mind trciked him into thinking the weight gain was fairly modertae but in fact, reality was that he gained back 2/3 of the weight he worked so hard to lose. I convinced him to monitor the weight and get back into the zone. (see yesterdays blog for a discussion about "the zone".)

Weighing yourself daily may drive you a bit crazy because sometimes you will see fluctuations that will not make sense and you will become frustrated. Hence, my recommendations for once a week.

Okay..Blog contest starts tomorrow...but....shhhhh......for you daily readers that didn't need a contest to read this stuff daily...here is a bonus word...bring this one in with the others in August that begin when the contest formally starts tomorrow. If you bring this one in with those others not only do yo get the stated prize for the August contest, I will throw in a lunch with me and the staff some day that fits your schedule. BONUS WORD: BROADWAY

Why a Blog Contest?

On Friday, Auhust 1, we will start a fun little contest to encourage your daily reading of this blog. I will identify a "word of the day", and if you are able to bring in all of the words for that month, you will receive some really cool prize. We will vary the prize monthly from movie tickets to a dinner out (healthy choice of course!) to other free stuff.

Why are we doing this? The answer: We really want to think of ways of staying connected with you daily, especially when you leave our formal weight loss program. I have discussed this previously but I will emphasize this again: Stayng in the "zone" is so important for the long term success in weight loss. What do I mean by the "zone"? This is the mental state you are in when you decide to do something aggressive about your weight. It is that state of mind that keeps you alert, keeps you thinking about it, and allows you to make the best choices. The zone mentality makes you look at those little high caloric food sources as litle saboteurs, not "goodies". Being in the zone allows you to say "no" when well-intentioned (or not well intentioned) friends and family try to force on you alcohol and high caloric foods even when they know you are trying to lose weight. Being in the zone makes your health and physical appearance more important to you than some piece of cheesecake.

There is no doubt that it is easy to fall out of the zone, especially when we are not with you weekly to provide encouragement, tough love at times (that be me and not Linda or Elizabeth!) and "structure/supervision" to your efforts. We am hoping that if you can make it a daily habit tolog onto our blog, perhaps this will help you to some extent to stay in that "Zone".

So this will be fun....and could cost us a fortune if hundreds of our patients bring in that word collection of the month, so let the games begin Friday!!!

The Stress Hormone Effect on Weight

Linda and I are writing a book together entitled "The Stress Eater Diet". This should be out in about three months.

I am working on a section now that discusses the effects of stress on various body functions, and there is a large section focusing of course on the "stress hormones". I don't want you to wait several months for the book to come out and I also want to save you $14.95 so here is a brief snippet from the book. Hmmmm...maybe I ought to just give you a brief glimpse so you will spend the bucks in three months, so here goes...

The hypthalamus is a gland in the brain that makes a hormone called corticotrophin releasing hormone ("CRH"). This hormone, in turn, causes the pituitary gland to secrete ACTH, which then causes the adrenal glands to secrete cortisol, epinephrine and norepinephrine. These are called the "fight or flight" hormones. When they are released, this causes blood pressure and pulse to increase, muscles tighten, awareness increases and sugar is released into the bloodstream. In response to a threat, these actions will help the person respond better. In the more primitive days of mankind, when threatened by a wild animal or another attacking tribe, these hormones would serve to protect humans by making them either stronger to fight or faster to flee.

However, as we have evolved, these hormones can actually be detrimental to us, especially when the stress-inducing event is not acute and life-threatening. Being given an unreasonable deadline at work produces stress and will elicit this chemical stress reaction, but when over a long term, weight gain, hypertension, immune systme dysfunction and other deleterious effects can occur from the chronic release of these hormones. Clearly, when under an acute, body-threatening event, this hormone release is protective, but when the stresses are more chronic, these hormones can hurt us.

Okay, you gotta wait several months for more of this abs0lutely titillating discussion!

We will let all of our patients and friends know when the book is coming out, and we will most definitely have a really fun book signing event complete with HEALTHY food choices! (Okay, some alcohol and unhealthy choices too!)

NFL Football and Weight

The NFL football camps are in full swing now and the kickoff to the regular season occurs 5 weeks from Thursday. Over the past 5 1/2 years, we have put several ex-NFL players into our weight loss program. During their playing careers, they all obviously had to be in great physical shape to meet the demands of their sport. Daily exercise, weigth lifting, practices etc. resulted in enormous caloric burnoff. To support these very strong, well toned bodies, there also needed to be substantial caloric intake to avoid unwanted weight loss. These guys told me that during the training camps and seasons, the meals would be enormous, containing incredible amounts of protein and carbs. Weight gain would not occur however in response to this food ingestion because of the incredible amount of exercise being performed.

Upon retirement, several factors occurred: 1- Getting older, the metabolism slowed down and 2-the exercise and training didn't take place anymore. Because eating so many calories became part of their lifestyle, this did not adjust to the aforementioned metabolism/exercise decline. This was a recipe for disaster on the scales, and indeed, morbid obesity set in. I saw an HBO Inside Sports awhile ago that similarly did a story about some ex-NFL linemen who are so moribund and obese with orthopedic problems, that they are confined to wheelchairs. Many also reported that a major issue was that they never learned to change their eating patterns.

Okay, so what does this have to do with my teachers, lawyers, analysts, engineers, professors, consultants, and my other patients out there? The answer: We all need to think about adjusting our food intake to match our changing age and physical activity. Personally, if I ate now what I ate when I was 21, I would be probably 250 pounds. I think all of us realize that metabolism slowdown dramatically affects are ability to lose weight. Also, perhaps due to responsibilities at home/work we do not have the time to exercise as much as when were in college or before marriage.children. Most of us do not weigh what we weighed 30 years ago, and we should not expect that. What we do strive for is a healthy weight which makes us feel good and look great.

Now, speaking about the NFL, anyone interested in a little contest/pool of some sort that would incentivize weight loss efforts? Let me know: serotab@aol.com

Find the Exercise that is Fun!

For most people, thoughts of setting the alarm early, going to the gym or your rec room and getting on a treadmill is abhorrent. Boring, monotonous, painful at times...these are the mental machinations we go through when thinking about an exercise that we do not like to do. As a matter of fact we will think of lots of reasons why our day i so busy, that we cannot possibly fit in that exercise time. Concerning our weight loss efforts, we do know that exercise is an important component. However, when we find things not fun, we will think of lots of reasons to avoid that activity.

Last night at our fund raiser for Hospice, I noticed lots of people dancing the night away...lots of movement, lots of activity, lots of sweat pouring off people's brows. I also saw lots of shirts (including mine) soaked through. But, everyone dancing seemed to be smiling lots...having much fun doing this activity that was burning lots of calories. I started thinking to myself that everyone out there dancing was not thinking that they were "exercising". Rather, they were just having a really good time.

Personally, when I play tennis I similarly do not feel that I am exercising. I am into the competition, enjoying the match and at the end of 90 minutes of singles I am as soaked as if I just ran 5 miles. But, unlike my 5 mile runs where I am moaning and along the way, during tennis I just do not count the minutes until it is over.

The point here is that each of us should identify those activities that we enjoy as opposed to a dreaded aerobic activity that we despise. The reason is that we will constantly come up with excuses to avoid the latter and find the time to do the former. We are all different and what one person may find a very fun activity, another will find boringly painful.

By the way, your good Doctor will most certainly NOT win any Dancing with the Doctors reality shows...everyone who witnessed me dance told me to stick to my day job.

Tight Clothes as a Motivator

Good morning....Yesterday I had a patient tell me a helpful hint that has allowed her to be more successful in her weight loss efforts. This patient told me that she purposefully wears toght clothes that are somewhat uncomfortable as a daily reminder as to one of the major reasons that she wants to lose weight. She went on to explain that in previous years when she would gain weight, she would put on clothes that accomodated to her incresing size and girth. When she entered our program , she decided to not do this but rather wear some clothes that were snug. This was a great motivator for her to very diligent in her weight loss efforts. As she has been losing weight, the clothes are obviously fitting much better and she is not feeling uncomfortable in the clothes anymore. She now has taken out the clothes that are a smaller size but are snug, and wears them as a motivator to keep going in her efforts.

Tonight is Ellen's poetry book signing party with all proceeds going to Hospice in honor of her mother, Arlene, who succumbed to pancreatic cancer. Hospice is a great organization that has helped so many people confront terminal cancer in a dignified, compassionate manner. Pancreatic cancer, similar to breast and colon cancer, has been linked to obesity. Premature death from cancer and heart disease could be avoided by keeping weight under good control.

Get out and exercise today!!!!

Thank you for your support-We have a new Marine!

As many of you know, my son, Ryan, went to MCRD San Diego in April to begin boot camp to become a Marine. It was a long and painful 13 weeks waiting for the mailman to deliver his letters to me and receiving only two 3- minute phone calls in the 13 weeks. The good news is he has now graduated and is a United States Marine! We are very proud. Some of you actually saw me on the fateful day he left and also the first week when I could barely function from the separation pains and the worry for him as he began his journey with the Drill Instructors. I thank my patients and my friends so much for all of the support that you gave me as you followed his progress with me, worried for me, prayed for us and counted down the weeks till he would graduate. Everyday I wrote him a letter to keep his motivation up and mentioned all of you that were interested in his progress and success. (Actually I was known by all of his platoon buddies and the DIs as the crazy Mom that sent over 90 letters..but that is ok with me). He was truly amazed at this outpouring and he thanks you all. We both thank you and appreciate you very much. I couldn't have made it without you!

During bootcamp he lost 30 pounds and suggested I incoporporate the Marine Corps diet into SP. His suggestion: 10 minutes to eat a meal and powerwalk everywhere!

Weight Loss and OVer the Counter Panaceas

Good morning....funny internet writing was found by Ellen yesterday. It was about an over the counter product called "Alli"...a fat blocker. A number of years ago, a large pharmaceutical company launched a "revolutionary" weight loss product called "Xenical" and the concept was simple: It blocked fat absorption from the intestines. If a person ingested high caloric fat containing foods, there would be malabsorption causeing diarrhea and gas expulsions. This was akin to the alcoholic person taking antabuse. If they drank alcohol while taking antabuse they would get violently sick. It took me 5 patients to realize that this was not a great drug. People had underwear stains, embarrassing gas expulsions during meetings, etc. Recently, the FDA approved the use of this product over the counter under the name "Alli" I was wondering why the neame was Alli and then I thought of a reason: The great boxer Mohammid Ali used to bob and weave greatly to avoid getting punched. Perhaps the ALLI user needed to bob and weave thewir way to the bathrooms to avoid messing themselves.

Okay the point: There are NO MAGIC PILLS to lose weight.(except for Serotonin...okay...not even Serotonin is magic, but at least your underwear stays clean!!!) Life style changes and behavior modification efforts are required. If something sounds too easy, it always is! Enjoy the segment..it is funny.

Alli Side Effects In Layman's Termsby Jeff Kay
Alli is a new over-the-counter weight-loss pill which, predictably enough, has proven to be a massive best-seller from the moment it became available. The drug, manufactured by GlaxoSmithKline, reportedly works by blocking the absorption of excess fats by the body. And folks are waddling, not=2 0walking, to their local drug stores for a chance to start on the Alli "program."As is20the case with most drugs, Alli comes with a risk of certain side effects. Or, as they're known on the company website, treatment effec ts. A person is reportedly limited to 15 grams of fat per meal, and if they go over (or even if they don't), there's a significant chance they'll find themselves out behind a shopping center somewhere, crying and clutching a wad of horrifyingly soiled undergarments, searching for a place to ditch it. As best as I can tell, anyway...Since a lot of this stuff is couched in language that is technically truthful, but very carefully worded, I've taken it upon myself to go through the list of side (treatment) effects and warnings, and translate it all into layman's terms. I'm no scientist or doctor, and don't pretend to have any special knowledge. I'm just a person who's fairly good with words and reading between the lines... The highlighted phrases below are direct quotes from the Alli website, with my translations in between. Undigested fat cannot be absorbed and passes through the body naturally. The excess fat is not harmful.20In fact, you may recognize it in the toilet as something that looks like the oil on top of a pizza.Here the drug makers are trying to soothe the nerves of the skeptical fatty, by speaking their language. Pizza is somethi ng fatties understand, and a big part of the reason they’re interested in Alli to begin with. Pizza is good, pizza is reassuring… even when it’s flowing from your ass like molten lava. The website mentions seeing the undigested fat in a toilet, but that’s clearly a best case scenario. You might also see it on the tops of your shoes, across the hood of a car, or way up the shower curtain, near the loops.
The fat passes out of your body, so you may have bowel changes, known as treatment effects.Bowel changes. Notice how they phrase that? It means stuff will be happening the likes of which you could never have imagined. It’ll be like a daily Dean Koontz novel inside your underwear.You may get:
gas with oily spottingYou’ll be farting Wesson oil straight through your Dockers…loose stoolsand havi ng violent chipped beef explosions...more frequent stools that may be hard to contr olall the time, with a sphincter that can no longer be counted as a friend.Eating a low-fat diet lowers the chance of these bowel changes. Limit fat intake in your meals to an average of 15 grams.The McDonald’s Big Mac has 34 grams of fat, and the Burger King Whopper has 40. Eat either of these while taking Alli, and you’ll very likely be transformed into a diarrhea cannon. Learning how to manage treatment effects is an important part of being successful with alli. Here's how to take control:Start trimming fat from your diet now, even before you begin taking alli. Then pick a day to begin taking alli, such as a weekend day so you can stay close to home if you experience a treatment effect. Make the timing work for you. If you're getting ready to travel or attend a social event, hold off on starting with alli until the event is overBlowing liquid feces down a row of bridesmaids, for instance, could be viewed negatively in certain circles. Further, an unexpected b out of the power-squirts while riding “The Bullet” at the county fair might not ingratia te you with your friends. Or anyone on the fairway. Or the folks in the parking lot walking to their cars.While no one likes experiencing=2 0treatment effects, they might help you think twice about eating questionable fat content. If you think of it like that, alli can act like a security guard for your late-night cravings
You see, when you think about it, shitting yourself is actually a positive.You can't "save fat grams" from lunch and "spend them" at dinner. Spread your daily fat gram allowance of 15 grams on average per meal over the whole day
Cheating can lead to embarrassment, tears, and the introduction of a frantically constructed toilet paper crack-wedge in the bathroom of an Applebee's. It’s simply not worth it. You may feel an urgent need to go to the bat hroom. Until you have a sense of any treatment effects, it's probably a smart idea to wear dark pants, and bring a change of clothes with you to workUntil you get the hang of it, you should pro bably take along a rolling suitcase full of brown clothes everywhere you go, while taking Alli. Luckily, howe ver, turd-colored clothing is in this season; turd is the new vomit.If co-workers ask about it, there is no shame in telling the truth. You might be surprised how understanding folks can be if you simply say, “I dress like this to conceal the poop that's constantly soaking through the seat of my pants.” You may not usually get gassy, but it's a possibility when you take alli. The bathroom is really the best place to go when that happensShowboating is not recommended.You can use a food journal to recognize what foods can lead to treatment effects. For example, writing down what you eat may help you learn that marinara sauce is a better option than Alfredo sauceIn addition to a handcart full of extra pants designed to camouflage your anal leakage, it might also be a good idea to carry a schematic and information wheel, so you don't repeat past mistakes and have a treatment effect halfway up your back.I hope this information has proven to be valuable.

weight loss and age...

Yesterday at our Bethesda clinic I saw two very remarkable ladies who both have lost a substantial amount of weight in our program. They were over 70 years old and although each had very few medical problems requiring prescription medications, their major motivations to lose weight involved aesthetic reasons as well as the improved health: They wanted to look better and feel better about themselves.

Watching their progress has been incredibly fun for me because it ia amazing how much the mood, energy and global sense of self-esteem has improved. From the medical standpoint, blood pressures have dropped, heart rates are lower, aerobic conditioning has improved, etc. The biggest change that I have seen however are the smiles that accompany their visits.

The point of today's story is to emphasize that self-esteem and confidence improvement from weight loss is not restricted to "young" people. Sometimes, we forget that our parents, aunts, etc. care very much about how they present themselves to others as that relates to their physical appearance. Losing weight can dramatically improve the happiness of a person regardless of age.

Non Medical point: Okay....Don't forget...Blog contest begins August 1!!! Prizes!!! Details soon.....

Weight Loss and Credibility

During my internal medicine residency at Portsmouth Naval Hospital in the early 80s I remember that 4 of the 6 attending cardiologists and 3 of the 4 oncologists (cancer specialists) smoked cigarettes. I found this very bizarre, How could physicians who see and treat the suffering of heart disease and cancer have a habit that can cause the very same horrendous problems that their patients present with? What kind of "role model" were they to the patients and young, training physicians?

Let's fast forward to 2003. Linda and I go to the American Society of Bariatrics Convention annual meeting in Las Vegas. I was shocked to see two things: the first was Linda taking out some money to play a little blackjack, but that is not the point of this entry. The second was that over 3/4 of the physicians attending this conference were overweight! What type of credibility could these physicians have with their patients as they are telling these patients how to lose weight?

I have to admit that aside from my personal goal to stay in decent shape in the event that The Giants call looking for a 52 year old backup quarterback to Eli Manning, one of my motivations of exercising daily and not eating some of the stuff I used to eat is trying to maintain credibility with my patients. If I was to let myself become overweight, would my patients "trust" me as much concerning my recommendations?

Similarly, in your role as a parent, community leader, manager at work, etc., is it wrong to feel some sort of "obligation" to be a role model for your children, employees, friends etc. as this relates to projecting a healthy look/lifestyle? I am just throwing this out there as yet another possible motivation to keep those pounds coming off. You are not just helping yourself...you may be helping others!

Excessive Weight and Health Issues

We all know about the potential cardiac issues that may be associated with obesity: Premature coronary artery disease, hypertension, congestive heart failure, stroke, etc. However, a lesser-discussed association is the correlation of obesity with an increased incidence of certain cancers. Colon cancer and breat cancer have been causally linked to obesity. Yet here is another:
http://www.msnbc.msn.com/id/25703096/from/ET/

Pancreatic cancer is most often a death sentence because by the time it is discovered, the cancer has metastasized outside of the gland. The usual life expectancy after diagnosis of this cancer is 1-2 years.

Most often when we decide to lose weight, it is based on clothes not fitting, not being happy when we look in the mirror, etc. The medical issues are always in our thoughts as well, especially for those who have already been prescribed diabetic meds, hypertensive meds, etc. The cancer risk is often forgotten but should also be a great motivator to try to keep those pounds off.

On a non-medical note: for you football fans who know my affinity for the New York Giants: I am THRILLED Jeremy Shockey was traded yesterday to the Saints. The guy was a malcontent, not a team player, always hurt, and was overrated. His absence made Eli a better quarterback. Kudos to the Giants general manager Jerry Reece for dumping Shockey and getting two draftpicks!

Weight Loss and Energy

Good morning...When you ask most people why they want to lose weight, the "politically correct" answer is to improve their overall health. Obviously, wanting to look younger, enhance the aesthetic look, etc. is a major motivation as well.

The lack of feeling good energy levels is a very consistent symptom that our patients describe when they enter our program. There are probably multiple reasons for this, but certainly one of them involves having to move around many excessive pounds doing routine tasks such as climbing stairs, getting in and out of cars, walking around etc. I encourage my patients, after they have lost 30 or more pounds, to go to a Home Depot and pick up a 30 pound bag of mulch and try walking around the store for awhile carrying this bag around. Usually after a feww minutes, the person gets very fatigued and has to drop the bag. When that 30 or more pounds is on the person every second of every day, they cannot "drop the bag" and are forced to move this excessive weight around all the time. This can lead of course to chronic fatigue.

Sleep apnea caused by excessive soft tissue around the neck area (obstructive sleep apnea) is also a contributing part to the lack of global energy. When people lose weight, they often will sleep better causing a global increase in energy.

Please constantly assess your energy levels and if you feel that you do not have the "get up and go" continue to work diligently on your weight loss efforts and this will pay off for you with the energy increase you seek.

Beware of Marketing Hype!

Hi from Atlantic City again....beautiful run on the boardwalk this morning....sound of the waves very relaxing.....

stopped in a sundry shop today and saw "stuff" being offered that made it sound as if they were healthy choices...."sugar-free ice cream..low fat chocolate, a lower calorie three musketeer bar, energy bars....

When i looked at the labels I saw an incredible number of calories in these items. They were being hyped as "healthy choices" and made it seem as if their usage would help weight loss efforts... NOT!!!

Be very careful of the marketing hype associated with snacks and desserts that profess to be "diet-friendly" but in face can derail your efforts.

An aside: late last week I have a gentleman come back for followup who has lost over 65 pounds in 10 weeks...he still has a long way to go but he was almost ready to go for surgery before he decided to try a medical program as a last resort. It is VERY fun to see him losing the weight by behavior modifying and not a surgical approach. We have many people in our program who previously did have surgery and then they start gaining weight back because there was no behavior modification.

Have a great Saturday nite! Elton John concert tonight for me...will give reviews tomorrow (like who cares what a Doctor has to say about entertainment???)

Atlantic City and Weight

Greetings from that classy, refined, cultured part of the United States called Atlantic City. Well, one walk down the boardwalk and it is quite a show...lots of entertainers seeking money for their buckets as they play the drums on cans, sing songs off key, and most just beg for the money...very sad to see the number of homeless people on the boardwalk.

What is amazing to me is that the boardwalk doesn't collapse. Every step along the way are pizza places, ice cream, funnel cakes, sausage sandwiches, Phillie Cheesesteak, etc etc. I have never seen more calories available for the asking and more overweight people partaking of the sinful pleasures.

I suppose every beach venue is similar in its culinary choices, and I guess the purpose of this blog is to remind everyone taking a beach vacation to eat your meals and snacks BEFORE walking down any strip that will have every few feet horrendous food choices beckoning you. As children we all have great memories of having our parents buy us at the beach the high-caloric "treats" that made us feel so good. Carrying this forward to adulthood will most certainly derail our efforts to lose the weight we would like to make us happier and healthier. Choose the high protein/high vegetable meals at restaurants in your hotel or if you are renting a condo, prepare your meals so as not to feel hungry when on that boardwalk.

Regional rates of Obesity

This one is coming from the road...Your good Doctor is in Wilkes-Barre , PA enroute to the Catskill Mountains...business center at the Hilton Garden Inn.(the Ritz carlton in Wilkes Barre was booked for the night) ...no offense to anyone from Wilkes Barre who may be reading this but this sure doesn't seem to be a place where I see myself buying a second home ..

A study was released looking at the states in the US with the highest and lowest obesity rates...Highest??? Louisiana, Mississipi, Alabama, Tennessee Lowest??? Hawaii, Colorado, Conneticut, Massachusetts, Rhode Island... Healthiest and Best Doctor area? 9289 Old Keene Mill Road, Burke, VA. okay, last one was made up but the states listed for obesity rates were true...

Why do the southern states have a greater than 30% obesity rate and the lowest states boast aroud a 20% rate?

The answer seems to be the cultural and socioeconomic differences bewteen the areas. When we think Colorado, we conjure up a skier drinking vegetable juice and taking supplements everyday. Think Alabama and we think of a great rib place to eat at. This obviously is a stereotypic joke, but there is some truth to the issue that certain areas of the country emphasize certain food choices that would be more damaging to a maintaining a healthy weight. From a cultural standpoint, many people who have been raised on fried foods, lots of carbs, lots of fatty red meats will continue this pattern into adulthood. Conversely, if you were raised eating food sources more nutritious and "healthier" there would be a better chance of being at a more ideal weight as you get older.

From a socioeconomic standpoint, education and financial resources allow us to perhaps make wiser food choices and understand the ramifications on our health that obesity can cause. Of course, there are certainly MANY people with very high IQs and education who are obese, despite knowing full well the damage that may occur.

I guess the point of today's blog is to have all of us take a step back and see how much of our eating patterns are based on what we were raised with, and then see how we are feeding not only ourselves but our children. If we are repeating the same patterns that have occurred in our families based on our cultural/regional food "upbringing" and there are weight problems in our family or ourselves, we need to make some changes.

By the way, the numbers listed above are obesity..not just being overweight...the % of overweight Amercians is more than double the obesity rates.

Off to my run and then the travels continue...

weight loss and goodies

Good Morning...first, a couple of random things...I read an article in the Washington Post this morning about some coffee place which refused to serve a patron an iced latte expresso because of the concept of ruining the drink with ice. Apparently the customer became belligerent and demanded his drink, threw out some four letter words, and then proceeded to write on his blog (www.andiamnotlying.com) about this experience. The shop owner then wrote on his company website (www.murkycoffee.com) responding to this irate customer's rants. The article goes on to report that over 100,000 people visited the irate customer's site and over 15,000 visited the coffee website in one day.

Okay..so why the story and what does this have to do with weight loss? Answer: There are over 300 million people in America, 65% overweight which makes for about 200 million people who are overweight, subjecting themselves to early morbidity and mortality. Not that what is being written in this blog is anything that is earth shattering, but I am hoping that at the very least, my readers are helped to some extent by mentating through the issues that we discuss daily. Perhaps by thinking about issues daily, this will allow you to be more successful in your efforts to be healthier and therefore happier. So, for you 10 daily readers who visit my blog site, I want to thank you for taking the time to read the stuff I am writing daily, and for those 200 million americans (minus 10) who are overweight that would rather read about some loser with a blogsite ranting about coffee without ice, I invite you to spend your time a little bit more wisely on the internet. Laughing...okay, my rant is now over for the day..back to weight loss:

Yesterday a patient came into my clinic who gained a bit of weight and she proceeded to explain that she ws with her grandchildren and ate some of the "goodies" that she brought for her grandchildren. I want to propose that small, high caloric food sources that are repetitive (M&Ms, chocolate covered raisens, candies, etc) should not be thought of as "goodies " or "treats" but rather SABOTEURS. Those little evil things will thwart your weight loss efforts, lessening your chances of living longer to enjoy the grandchildren. What kind of "goodie" thing is this that will lessen our lifespan? Try as best as you can to redirect your mindset to look at wight gaining foods as not treats, but as things that hurt us.

Hey....thanks for the positive response to the concept of an organized walk/run in the summer. People are suggesting september instead of August. Please stay in touch with us for an exact date which will be forthcoming soon.

Setting Realistic Goals for Weight

We had two new patients enter our program yesterday who set their total weight loss goals at a very aggressive number. Both people mentioned that these were the weights they were in college, and they were hoping to get back down to those weights.

I think it is an important point to differentiate between what a person could realistically achieve as far as a total weight loss vs. what is sustainable. Clearly, if there was some reality tv show that would pay me a million bucks to get down to my college weight of 155, I have no doubt that I would be able to do that. However, to try to maintain that weight would be very difficult.

Similarly, we all must remember that our metabolisms change, our body habitus changes, and what we used to weigh in high school or college is not a weight that would either : 1-be a realistic goal to maintain and 2- aesthetically look good. If I came to work one day weighing what I did in college, all my patients would think I had a horrible medical disease.

In our clinics we always try to help people set realistic goals for their weight loss. This means trying to reach a healthier weight that would be reasoably sustainable. Once again, there is no "race" to lose weight or see this as some finish line meaning that when you reach that weight it is "over". Reaching your realistic weight loss goal is only the first initial step; maintaining that weight is our lifetime goal for better health and happiness.

Responding to Hunger Signals

When we were children or when we remember raising our small ones, we often conjure up images of coercing and cajoling our children to eat. Sometimes, we were threatened by statements such as not getting dessert unless we ate our main course..not being able to leave the table to play with our friends, etc. We were usually skinny little ones with not one ounce of fat on our bodies and we could care less about eating "real" food. Sure we loved candy, cakes, ice cream, etc, but a juicy steak, potatos, etc...who cared?

When and how does that change? At what point does it switch over and we start making our eating choices based on issues other than hunger? At a restaurant after that appetizer, basket of warm bread, large main course and side dishes, who actually feels the concept of "hunger" when the waiter brings out that tempting dessert tray? Of course we feel no hunger, but oftentimes, a dessert is ordered anyway.

Sometimes we find ourselves eating because it is "eating time" or finishing a large portion at a resaurant because we are not going directly home, the food will spoil in the car and we don't want to "waste" food.

Trying to re-learn the concept of eating in response to actual hunger is important in helping long-term weight loss. Try this as a test today: everytime you are about ready to put in a mouthful of food, ask yourself the question before you do it: "Am I Hungry?"

Different subject: Anyone interested in an organized walk or run at Burke Lake Park on a Sunday in August? I was thinking about advertising this in the office as a fun event...the staff and I would come out..we could gather at the amphitheatre area near the fitness trail around 9am and then do the park trail...4.5 miles..either a walk or run. We would provide the water and drinks...please let me know your level of interest: my e-mail is Serotab@aol.com

Sammy The Dog

Ellen...Great poem and thanks for posting...for those of you reading this blog who have/had a special dog or cat, you know exactly how we are feeling.

No stress eating for us today!!! (hey...had to remember this is a weight loss blog, not a support group for dog lovers!)

Tomorrow I promise a return to the norm.

Weight Loss and Having An Activity Partner

Often, the thought of exercising alone is distasteful and we will find reasons why not to do it. If we look at exercise as "I will do everything I have to do today and if I have time to exercise, I will", exercise will not be a routine.

If you cannot find a human partner to exercise, and you have no allergies to dogs, having a canine walking or running partner will push us to walk or run daily. The dog will need to be outside to do its business several times a day, and they will LOVE to be walked, run or played with. Having this be a requirment (unless you want your house to smell like a kennel) this will enforce you to take those walks as well.

I do need to dedicate this entry to my dog, Sammy, who I need to put peacefully to sleep at 1230 today. Sammy is a very loving yellow lab that I have has for almost 12 years and arthritis is robbing him of his ability to live a life without pain and suffering now. Sammy and I used to run together at Burke Lake Park, come rain or shine, cold or hot. When we would go outside my house with a leash and I would say "Sammy, wanna go to the park?" he would immediately run to the car and wait for me. At that time this Middle Age crisis doctor dude was driving a corvette and sammy would hop into the seat barely fitting his hed into the car. Looked pretty funny. Sammy would bark meanly at strangers approaching the house, yet despite the protectiveness, he was incredibly sweet to all who entered the house as an invited guest. He loved the young ladies in my office who would occasionally watch him when we would leave town. In many ways, he was like a brother to my children Brian and Kim and when I was gone on business at night, he became Ellen's guardian and protector.

For those of you who have dogs, I know you understand the reason for me writing the above. For those of you who do not, please excuse the dog-talk and I promise a return to human issues tomorrow.

Sammy, I saw a cartoon movie years ago when the kids were small called "All Dogs Go To Heaven". I believe Bert Reynolds did one of the voices. There is no question you will be running at the park with no pain this afternoon and my suspicion is that there will also be plenty of pizza places! I will miss you.

Weight Loss and Keeping a food diary/journal

http://www.msnbc.msn.com/id/25573436/from/ET/

Check out the above summation of a study from Kaiser Permanente showing that people who journal their food intake tend to be much more successful in their weight loss efforts than those who do not.

At our clinics, we do ask our patients to write down everything they eat/drink and even provide a diary book to do this. We feel this helps on a number of fronts. One reason is that when people write down their food entries, they are putting much more thought into the things they are eating. Once they train themselves to "I HAVE TO" write everything down, people will think more and more about the foods they are consumming. Another reason to write things down is if you are doing a "counting" dietary program such as the one at the Serotonin-Plus clinics (we allow a certain number of portions from the different food groups daily), the only way of knowing the daily tally of those portions is by writing them down. Yet another important reason to journal food intake is that sometimes we find people eating food they thought were compatible with a good dietary plan...such as an abundance of fruits or nuts, and we are able to educate them that these food sources are not good to do when trying to lose weight.

There is no question that writing everything down that you are eating is a pain in the gluteus maximus, but the above study documents something that we have known for years at our clinic: take the time to journal your food intake because your weight loss efforts will be improved!

On a non-weight loss note: The above study came from Kaiser Permanente, a very large HMO. During open season I always see their impressive television ads trying to recruit customers telling everyone how much individual attention they get, how responsive the system is to getting patients in to be seen, etc. At my medical practice every month I see patients who have Kaiser who get so frustrated with not being able to get immediate help for a "same day" problem, or get a timely referral that they come out of their insurance coverage to see me. Large delivery systems of medicine, especially when the financial incentive is NOT to see the patients, can be incredibly frustrating for a person when they wake up ill, pick up a phone, and want someone to care. I often get asked how, in my medical practice, I have been able to flourish after I decided years ago to not participate with any insurance companies, and I point to the above examples of other medical delivery systems failing to show empathy/caring/same day service to their subscribers.

weight loss and energy

This week I had a patient present for followup and he has lost over 60 pounds in 10 weeks. He started the program weighing over 400 pounds and one one his major symptoms of the morbid obesity was very poor energy levels. Even though he still obviously has many pounds to lose, his 60 pound weight loss has caused him to feel a much heightened level of energy.

We have heard this many times from patients that their weight loss produces a very dramatic increase in their energy levels. As a person gains weight, the lessening of the energy levels may go unnoticed as it is gradual ans subtle. However, over a period of time, the person becomes more and more tired. This becomes a negative vicious cycle, because as the energy levels fall, the person is less apt to have the energy to go out and exercise, further worsening the weight situation. Conversely, when one loses the weight, the person does have the "get up and go" to start burning off more of those calories, thereby accelerating the weight loss.

Assess your energy levels and if not up to the level you would like, keep working on the weight loss so you can get that energy back!

Non medical note: saw a Helen Hunt picture last night with Matthew Broderick and Colin Firth. She is a great actress!!! 2 stethoscopes up for performance!

Hidden Sugars- beware!

We all know the less sugar we consume, the better our diet is and the fewer calories we take in overall. Although many of us tryto use low calories sweeteners like Splenda, Equal, Sweet N Low, etc., to sweeten our drinks, we still as a nation rely on sugar. Today, the average American consumes one hundred and fifty-six pounds of sugar per year, according to the U.S. Department of Agriculture (USDA). However, only about 29 pounds of it comes as traditional sugar, or sucrose, according to The Sugar Association, a trade group of sugar manufacturers. The rest comes from the foods we consume daily, however, they are hidden. Of course, those foods include things like candy, soda, and other junk food. But plenty of sugar is hiding in places where you might not expect it. Some types of crackers, yogurt, ketchup, and peanut butter, for instance, are loaded with sugar and carbs. This sugar hides in the form of high-fructose corn syrup, or HFCS.

In the U.S. diet, the major source of "added sugar" -- not including naturally occurring sugars, like the fructose in fruit is also in soft drinks. According to the USDA, sweetened fruit drinks account for 10% of the total added sugars we consume. Candy and cake come in at 5% each. Ready-to-eat cereal comprises 4% of the total. The biggest chunk, making up 26% of added sugars, comes from a variety of prepared foods like ketchup, canned vegetables and fruits, and peanut butter.

Another high-sugar trap can be low-fat products, which may not be as good for your diet as you think. Some contain plenty of sugar to make up for the lack of tasty fat. For instance, Reduced Fat peanut butter has less fat than the regular, but what you may not know is this Reduced Fat brand actually has more Sugar and more carbohydrates. Food marketers find ways to trick the consumer to think some products are healthier than others, by using health-conscious terms. Is this case, the regular peanut butter would be the better choice; calories are the same as the Reduced Fat brand, however, sugar and carbohydrate amount is lower. This proves how when fat is removed, it is replaced with much higher levels of sugar and carbohydrates.

According to the USDA between 1987 and 1997, consumption of added sugar in the United States grew 20%. This trend is also being seen in the developing world, according to the WHO. That's one reason both the United Nations and the World Health Organization released guidelines in 2003 that say sugar should account for no more than 10% of daily calories. In a 2,000-calorie-a-day diet, that's just 200 calories. So the best thing to do is to be mindful of the calories and total carbs of your food choices. Read the nutritional labels and compare regular versus low fat versions of products.

To keep you on track here is a list of ingredients that are considered an added sugar and can increase the total carb content:
Beet sugar
Brown sugar
Cane sugar
Confectioner's sugar
Crystallized cane juice
Dextrose
Fructose
Evaporated cane juice
High-fructose corn syrup
Honey
Invert sugar
Maltodextrin (or dextrin)
Maple syrup
Molasses
Raw sugar
Sucrose (table sugar or white sugar)
Turbinado sugar

Weekend...Watch those calories!

Friday....the end of the work week for most. Remember the commercial for Miller beer where the moto was "It's Miller Time"...and the commercial went on to show people at a happy hour downing the suds, eating foods and having a great time? In commercials and in real life, we always equate having fun with eating and drinking. Sweating on a treadmill is not usually construed as fun.

As the weekend is upon us, if you are in a mode to lose weight (and if you are reading this blog as opposed to some extreme right wing or extreme left wing political blogger ranting and raving about something my suspician is that you are in this weight loss mode), please keep an awareness of the following weekend saboteurs:

alcohol: this is perhaps the major saboteur that will knock you off your path to weight loss. Almost innocuous it seems to have a few glasses of wine or a few beers...but, there is something about alcohol that slows metabolism down and stalls our weight loss efforts

small, repetitive food sources: that movie theatre popcorn, the nuts we eat at home, grapes...all of these food sources lend themselves to eating more than we consciously think...when you are at the movies, watch people's behavior as that relates to eating the popcorn..hand to mouth, hand to mouth..almost subconsciously...distracted eating at its best as the person focuses on the thrilling moments of the movie they are watching and eating without even thinking about it. Make your plans to go to the movies AFTER dinner and do not pay that exorbitant fee for the popcorn or other snacks.

cookouts/parties: carbs and alcohol will be plentiful at these events...try to make your choices high protein and vegetables.

exercise: weekends are a GREAT time to carve out some exercise time...do something outside to enjoy the weather and burn off some calories. (And for my golfers out there, riding in a cart and drinking beer is NOT exercise!!!)

Okay, there you have it...make your time off not "Miller Time" but try to make it "Deer Park Time" and exercise....remember all those great reasons why you want to lose the weight and keep on the pathway to achieving your goals.

Weight Loss...Sometimes Help Is Needed

We entered a new patient into our Bethesda office yesterday and she said that she had been seeing our television commercials for months. The program seemed intriguing, but yet, she would not pick up the phone to call for an appointment because she felt "weak" admitting to herself that she cannot lose weight on her own. She had tried several commercial plans such as Nutrisystems, Jennie Craig etc, but results were limited. Her frustration was mostly based on the fact that "I know what to do" (i.e. eat less , cut back carbs, exercise more, etc.), but nor being able to follow through. She was embarrased to admit that she needed help.

With 65% of Americans being overwight, 35% obese, clearly most people who are overweight have difficulty achieving their weight loss goals on their own. This doesn't mean that everyone needs to enter a physician-monitored program , but if a person wants a "jump-start" to help get motivated and "into the zone" then reaching out for help is nothing to be embarrassed about. Whether it be a support group, Weight Watchers, or the very best medically supervised weight loss program in the world (sorry..had to get in the plug!), oftentimes it helps to have some type of accountability/support/jumpstart that will allow the person to see immediate success. It is so important to see results fairly quickly because this, in turn, motivates us to keep going.

It is "normal" to need some type of help when embarking on a weight loss mission, and we try very hard to have our patients understand that it is no sign of "weakness" or "character flaw" to have to reach out for help.

On a non-medical note: The Mets are now only 1.5 games out of first...could make for a fun summer pennant race!!!

"I Can't" vs. "I Won't" Eat That

Yesterday I had a patient who told me that a very important mental "shift" for her was the concept of not looking at losing weight as a series of "I cannot eat that" episodes. She went on to explain that when she is involved in social situations with other people, and a high-caloric food source would appear or an alcohol containing drink, she found herself constantly explaining to people that because of her desire to lose weight she would say and think "I cannot eat that". My patient then came to the realization that thinking in this way was making her weight loss efforts burdensome, because almost like a child being told by their parent to "not do that", her food choices seemed imposed by someone else. She then went through a mental exercise of changing this concept to "I Won't have this". What she means by this is that by changing her mindset to making food choices that she is controlling as opposed to some external mandated edicts, my patient is now able to feel better about being sround others during these social events. She is now able to feel better about telling the party host that she will take a pass on the marguerita not because she wants to but it is "forbidden", but rather it is her conscious choice to bypass this in order to achieve a happier and healthier weight.

It is very difficult to be around a social event and watch others eat and drink the food and alcohol sources that we know taste good. But often it is exactly these food sources that put us at a weight that is unhealthy and makes us ultimately very unhappy. Feeling in control of your food choices as opposed to feeling that there is an external parent-like monitor telling you "not to eat this, not to eat that" would be a more psychologically favorable mindset to help you lose weight and keep it off.

Is Stress Causing You To Overeat? Try Yoga Instead When You Feel the Need to Stress Eat

We all know stress plays a major role in our everyday lives. Many people turn to food, especially carbs and high calorie foods, as a source of comfort. However, intaking the comfort carbs and empty calories will produce an excess of calories that will negatively affect weight if this pattern is continued. In addition, stress can lead heart disease if it’s not controlled. When you’re stressed, your heart rate and blood pressure rise, which causes your body to releases stress hormones. These stress hormones put unnecessary pressure to the heart and blood vessels.


Research shows us that yoga and meditation both reduce blood pressure, lower the pulse rate, improve the elasticity of the arteries, regulate heart rhythm and increase the heart's stroke volume. Yoga is a very relaxing and spiritual exercise that can save your life, according to the American Heart Association; coronary heart disease is the leading cause of death for both men and women in the United States, causing about 1.5 million heart attacks each year.


Yoga is a wonderful exercise that is widely known for its ability to reduce stress and promote a calm, relaxed being. This state reduces the stress hormone levels, decreases the heart rate and lowers the blood pressure. If you have ever taken a Yoga class, you will notice they concentrate on breathing. Breathing influences the rhythm of the heart through inner connections in the central nervous system. When you take slow, deep breaths it allows your heart rate to slow and regulates the heart rhythm. The blood becomes oxygenated and feelings of calm and well-being are induced in your body.


If you can practice Yoga three times a week, studies show you can greatly reduce the risks of heart disease. Daily meditation is also good to practice because it can reduce heart damaging emotions, such as anxiety, fear and anger. The next time you are stressed and you feel like you want to reach for the cookies, chips or ice cream, try yoga instead.

Stress Eating

As you may notice, the time on this blog entry is kind of early...why is the good Doctor not sleeping you may ask? Answer: two issues: one reason I will not provide until the end of this entry. Here is the second reason: We are writing a book now about weight loss, and there will be a substantial amount of attention to the concept of "stress eating". When you hear the word "Stress" immediately a negative image appears of feeling ovewhelmed, anxious, heart pounding, gut-wrenching, panic-type of senastions. Stress is usually brought on by external forces...being given too much work with a deadline, having a family member go through a difficult time medically or physically, financial pressures, etc. The usual response of a person to stress is negative both from a physical and psycholgical standpoint. One of the most prominent responses to stress is reaching for "comfort foods", which almost always are high-caloric leading to weight gain. The subsequent weight gain produces its own stress and the vicious cycle is set in motion.

Why i am awake thinking about this is because over the weekend , I saw some incredible performances of star athletes: Venus Williams and Rafael Najar in the Wimbleton finals. Under the stress of being physically pushed to the limit and having millions of people worldwide watching them, these people THRIVED under the stress and rose their levels to an incredible height. They didn't reach for donuts (well, after the match they may have had a snickers bar, I just don't know that) but they did reach inside themselves to bring out their very best.

How can we as normal human beings, not being paid millions of dollars to perform, react to stress in a way that allows us to gather our positive forces and translate the stress to a positive outcome? This is what I am awake thinking about because if we can somehow learn /train ourselves to react to stress in a positive manner, or convert negative stress to positive stress, then our weight will not suffer. More about this tomorrow!

Oh, the second reason Dr. Bob is not sleeping...The New York Mets were winning 10-1 over the Phillies (sorry Philadelphia fans, you truly are much more barbaric than New York fans, and least you doubt that, remember booing Santa Claus at an Eagles football game one December?) and wound up almost blowing the lead and winning by the narrowest of margins, 10-9. Why can't I become a Nationals fan?

By the way, somehow I think the comments to this blog entry will be more about my diss of Philadelphia fans than the medical issue of stress eating!

Weight Loss and Setting Goals

Even though we are always telling our patients that losing weight should not be viewed as a "diet plan" but more of a lifestyle change, sometimes it does help to establish some goals and timelines. For instance, when a person enters our program because there is a wedding coming up in 2-3 months, that person has an incredible motivation to lose weight by a certain date. The problem in this example though is that when that date passes, it is analogous to the sprinter who crosses the finish line: The person stops, relaxes and in the case of the person losing weight, will go immediately back to the old behaviors that got them into weight problems originally. But, during the program, that person does demonstrate incredible focus and concentration to reach their goals.

How can we somehow take that same focus and determination, but yet not see a "finish line"? Perhaps establashing some (non caloric) reward systems along the way may help. Massage therapy, new item of jewelry, a new clothes outfit, etc: all of these could be motivators to stay focused.

Please establish realistic goals and timelines. As we get a bit older, we cannot maintain the same weights we did when we were in our twenties. Also, always remember that the goal is to not just lose the weight, but to maintain that new, healthier weight.

Building muscle and weight

A question was raised concerning one of my blog entries about the effect of muscle building through weight training on the weight seen on the scale. In fact, muscle does weigh more than fat, and when someone goes into a weight training mode, the absolute weight on the scale may not decrease as rapidly, but the person will most definitely notice a change in his/her body habitus. Additional benefits of weight training, especially for females, will be the slowing of bone thinning (osteopenia/osteoporosis).

Thanks for the question!!! Please keep them coming!!!!

Weight Loss and Your Environment

At our Serotonin-Plus Weight Loss Centers we have many patients who travel extensively as part of their jobs. Frequently, they will come in for a followup appointment and only minor weight loss or even some weight gain occurs. Most of these patients will then describe how the travel/being out of their own environment presents a huge challenge to following the dietary plan that is part of our program. When home, they can shop for the "right" foods, prepare and plan their meals, exercise on schedule, etc.

I certainly agree that it is much easier to be "structured" when home, and when conferences are attended out of town, the meal choices, snack choices, etc. become the domain of the sponsoring group, not the individual. The nighttime activities at out of town meetings/conferences also usually involve social interactions and mingling that inevitably revolve around alcohol.

Here is the scoop: If you have an occupation that involves business travel and you do not plan on hitting the lottery for 10 million in the next 6 months, then your enviroment will not be controlled. Moreover, that environment will NOT adjust to you and your goal to lose weight. YOU need to adjust to that environment. I am not saying this is easy, but I am saying this is reality. Almost every hotel and conference center has a workout facility. Set that alarm clock 30-45 minutes early and get to the gym before the day's activities begin. At breakfast, bypass the croissants, bagels, etc. and head to the protein choices that will be available. Consider bringing a good protein bar as your snack as opposed to the cookies and donuts they will put out. Similarly, at the lunch and dinner meals, seek out the protein and vegetable choices. And at nite, when people gather for more social interactions, do not get caught up in the downing of drinks that seems to be an integral part of most out of town business functions.

Once again, you have to be your own advocate and take control of the environment that presents itself to you. If you are able to exert this control, your weight loss goals will be reached more easily.

Make Your Body Burn More Calories

Metabolic Rate is the rate at which the body burns up calories. If your body consumes 2500 calories a day, and burns 2500 calories a day you will stay at the same weight. Whereas, if you consuming 2500 calories daily but burning only 2000 you will gain weight.

In today's busy world, it's hard to get in all the exercise we need so it is important to make our bodies work for us. We can influence our metabolic rates

Try these three suggestions to speed up your caloric burning rate:

1) Build Muscle
Increase the amount of muscle in your body. For every extra pound of muscle you put on, your body uses around 50 extra calories a day. Muscle is metabolically active and burns more calories than other body tissue even when you are not moving. Training with weights just 3 times a week for around 20 minutes is enough to build muscle. Not only will you be burning more calories, you will look and feel better.

2) Aerobic Exercise
As well as the actual amount of calories burned during aerobic exercise, studies have shown that sustained, high-intensity exercise makes you burn more calories for several hours afterwards.

3) Eat Low Calorie Snacks Often
There is evidence to suggest that eating small, regular meals will keep your metabolism going faster. (This is why when you're starting a diet you may find yourself eating more than usual). There are two reasons why meal frequency increases your metabolism. Firstly, levels of thyroid hormones begin to drop within hours of eating a meal, and metabolism slows. Secondly, it may be that the thermogenic effect of eating several small meals is slightly higher than eating the same amount of calories all at once.

Weight Gain....Confronting a Difficult Week

First, I hope your 4th was a very happy and relaxing day for you and your loved ones.

Oftentimes, we have patients at our weight loss centers who cancel their followup appointments when they have a difficult week previously in losing weight. Whether it be a holiday, a birthday week, a vacation, etc., if the person knows they have gained some weight, there is frequently a compulsion to cancel his/her appointment. Why? It would seem that this would be the exact time to follow-up , get "refocused" and start moving the scales down again.

I believe this phenomenon has to do with a psychological issue of not wanting to "disappoint" the doctor or be looked at as some sort of "failure". Additionally, perhaps there is also some fear of being "admonished" for "bad behavior".

In reality, the team and I NEVER are disappointed, judgemental or in any other way upset with any of our patients for gaining weight. We are here to support your efforts in losing weight and realize there will always be weeks much more challenging than others. NO ONE goes through our program and does not have several weeks in which some weight gain occurs.

Okay, let's bring up some gender/style differences that may play a psychological role in the perceived response on our part to a week in which a patient gains weight. I, being the gray haired white coat stethoscope bearing doctor, am probably more apt to be looked at as a "father" figure (no jokes about grandfather figure) and perhaps I will be more intimidating to see than Linda and Elizabeth, or may be perceived as more nurturing and supportive in their roles. When a patient has a weight gaining week and I walk into the room, I often hear a sigh from the patient, nervous laugh and perhaps a joke such as "oops....I was hoping it wouldn't be you".

I truly never get upset, disappointed or in any other way, look at a person who has gained weight that week as some sort of "failure". I am THRILLED they have come back to allow us to get them refocused, back on course and into the "zone" again. I certainly see it as my role to find out what factors may have caused the weight gain, help them analyze the situation(s) in order to futuristically navigate around difficult weeks without gaining weight. I realize that in the big picture, a patient's time with us is miniscule, and for the majority of their lives, they will be in the position of monitoring and reacting to their weight issues on their own. We need to help the person be successful by helping them learn new patterns of eating and self-accountability.

On the "In case you are wondering note but you probably are not" note: Played real well on the clay courts yesterday!!!

What are Empty Calories?

With BBQ's, vacations and beach trips around every corner of your summer, you may have read the term "empty calories," or heard it used by nutritionists or even talk show hosts on TV. But what exactly are empty calories? Why are they so bad for you, and how can you avoid them?

Empty Calories = High Calories but Low Nutrition

These empty calories can also be known as "junk food," because they lack health-promoting nutrients.

Examples of foods containing mostly Empty Calories:

• French fries, fried chicken, chips and all other deep-fried foods
  
  A large order of fries from a fast food chain can contain up to 570 calories with 30 g of total fat and 8 g of trans fat!
• Candy, soda and other sweetened packaged foods
  
  A can of soda contains about 130 calories as well as additives and colorings.
  
• Beer, wine and all other alcoholic beverages
  
  A can of beer contains about 150 calories from carbohydrates and not much of anything else. In addition, calories from alcohol tend to be stored as fat in the abdomen = "beer belly"

• Refined grains such as crackers, cookies, white rice and white bread
  
  Refined grains do provide some B vitamins, but that's it.

How to Avoid Empty Calories?

· Avoid deep-friend foods. Instead of frying, try baking or broiling foods.

· Avoid the high calorie/sugar drinks. Instead try Crystal Light flavored water, or diet juices/teas.

· Try whole grains instead of refined grains (white bread).

· Snack on fruits or vegetables instead of the bag of potato chips

Fireworks, Beer and Carbs

Happy 4th! Truly a great Amercian holiday celebrating the birth of our nation! This week I was asking many of my patients what they are going to do on the 4th and almost 100% told me they would be attending a barbeque at either a family member's, friend's or neighbor's house. The menu at these events will most certainly include lots of protein choices: hamburgers, hot dogs, chicken, steak, etc. Bowls of salads will be put out as well. But watch out, here are the other items that will be in front of you: chips, potato salad, buns, watermelon, high-caloric desserts, etc. Additionally, beer, wine and other alcohol drinks will be readily available.

Try to reconcile the ability to have a great time with food/beverage choices that will not completely blow your hard work in trying to lose weight. Separating a great social event from the foods accompaning that event is very difficult at times. When everyone around you is smiling lots from that third glass of wine or telling you how great that double chocolate cake tastes, it is hard not to feel compelled to join the crowd. Always ask yourself the question as to whether you feel "hunger" before getting a second helping or reaching for a dessert. Many of my patients tell me that if they get a small taste of a dessert this will be enough to satisfy their mental urge for something sweet.

Switching gears: I had a patient yesterday who came in after being on vacation for two weeks at Disney World and he lost 12.5 pounds while gone. Yes, LOST weight on vacation. I always tell my patients that staying even on vacation is a complete victory. I asked him his secret and he told me that the extra walking at the theme parks helped alot and also not eating any of the fried foods or snacks at those parks. I asked him whether "toeing the line" detracted from the fun of his vacation and he said absolutely not and he was very proud of himself for the weight loss.

Your doctor is going to play a tennis match on clay today (I despise that surface...like hard courts better), then write some more in his upcoming weight loss book, then to a barbeque with fireworks. I hope your day is wonderful.

Weight Loss and Self-Esteem/Ego

I had a patient come into the office yesterday and she was beaming from ear to ear. I commented about her very positive mood and she then told me that since her weight loss of over 20 pounds, "I have been asked out about 150% more times for dates." This patient has lost over 20 pounds, but her goal is to lose about 50 more. Along the way to her goal, however, she has noted already a marked ancillary benefit of her weight loss...being noticed in a very positive manner. This, in turn, has resulted in a tremendous improvement of her self-esteenm and ego.

Losing weight is clearly important from a health standpoint to reduce the risks of heart disease, diabetes, arthritis, certain cancers, etc. We all know this and certainly, weight loss for the purpose of improving overall global health is a primary motivation for most people. There are a number of people who come into our program who do not have any known medical problems, take no medications, and yes, they are concerned about the medical ramifications of their weight problem. But, their main motivation in coming to us is to recover a higher level of confidence, self-esteem and improved ego that result from the aesthetic improvement that occurs with weight loss.

I also must add that this is not age-dependent, meaning that when someone is over 50 (an age that I certainly can identify with!), there still is a very strong motivation to lose weight because of the improved "look" that occurs at a more optimal weight. It is amazing to see how much younger our patients look after their weight loss. Concerning "antiaging" procedures, I can think of nothing more powerful than aggressive weight loss.

Weight Loss and Having Support

I know we have touched on this before but the entry of two women into our program made me think that this is a good topic to be broguth up again: Support with another person in your weight loss efforts. When embarking on a weight loss initiative, having someone join you in these efforts can be invaluable in reaching your goals. Often, friends and family are well-meaning sabotours who will try to push food and alocohol on you during your efforts. Having a friend or family member join you allows you to mutually feed off each other's energy to make the right choices and not be distracted from your goals.

I saw how the ladies yesterday had already set up supportive walks with each other, exchanging recipes, scheduled talks with each other daily to encourage each other, etc.

It is difficult to approach an overweight friend or coworker about weight issues because of the sensitivity of such a topis. However, think of it as actually helping prolong the life and quality of life for someone who is important to you. Having support in your efforts can be very helpful.

Stress Eating Part Deux

Okay, before I begin my second day thoughts on stress eating, let's discuss sequels of movies that were pretty good. Sorry for the flight of ideas, but I am hoping that today's discussion of stress eating will be on par with yesterdays...kind of a sequel thing. Now of course, if you thought yesterday's blog was boring and not worthwhile then I guess I don't need to worry about Part 2.

Most often, when a blockbuster movie comes out the sequel usually is horrible...some examples of the horrible ones: The Exorcist Part 2, The Omen Part 2, Major League 2, Analyze That, Basic Instinct 2. Good ones: City Slickers Part 2, The Godfather Part 2, Indiana Jones and The Temple of Doom. Feel free to post your thoughts.

Okay, back to stress eating: Almost instinctually, when we get under stress, we feel compelled to reach for high caloric food sources as a way of somehow mitigating the stress. Such foods tend to be repetitive sources, such as popcorn, chips, nuts etc. Chemically, it may be the case that under stressful periods, we deplete some neurochemicals, including serotonin, and our brain is making us seek the food sources that contain the building blocks of some of the neurotransmitters. In the case of serotonin, the amino acid tryptophan, which is present in high amounts in sweets and carbs, is the building block.

The recognition of stress eating is not enough to block the almost reflex-like response of reaching for high caloric food sources. A few hints: 1- ensure that around your office or home there are NOT these food sources that you would tend to reach for when you feel stressed. 2-Try to convert "negative" stress to "positive" stress. What I mean by this is that there are certain "stresses" that are positive, such as lifting weights, which "stress" the muscles but yet do not stress our psyches. During times of mental stress, it would be beneficial to try to convert this to perhaps a physical activity that allows you to dissipate the stress. In this scenario, not only are you not consuming the calories from the "comfort food" source, but you are also burning up calories with your activity of choice.

This is not easy because the compunction to eat under periods of stress is often very strong. Try to figure out how you can place some type of "delay" mechanism into this behavior pattern, because when you can put off the immediate eating activity, your brain will have more time to think it out and realize that eating in response to stress only INCREASES your overall stress levels because now you will have to deal with the weight gain sequelae.