So this may seem like discouraging news to some, but a recent study from the Brigham and Women’s Hospital demonstrated that average middle age women need to exercise a full sixty minutes every day in order to avoid weight gain through the course of the year. That’s right, that is the amount of exercise simply to maintain your current weight, and that is if you are currently living at a reasonably normal weight.
For a lot of women with busy lives including chauffeuring children around to schools and lessons, maintaining a household and managing their own jobs and careers, a full hour of exercise everyday is practically unthinkable. Yet, those seem to be the facts.
But what about women who are already overweight or obese (and this is becoming most women and most men)? Well, guess what, sixty minutes was actually not enough. Yes, while maintaining their regular diet, overweight and obese women would have needed to exercise more than sixty minutes a day to avoid further weight gain.

How do we use this information? Well, I have put this question to a number of women who fit the demographic of “middle age” around my own office. Most of them feel as though these data indicate they would have to undertake a major lifestyle change in order to successfully maintain weight or lose weight. An hour or more of exercise everyday simply does not fit into their current busy life and lifestyle. What sort of lifestyle change would this involve? Well, some suggest it would involve working less, not likely, given the current financial realities and the current economy. For others it would involve simply changing and reorienting one’s life toward one that acknowledges a balance and celebrates physical activity to a much greater degree. It involves orienting one’s life much more athleticism and exercise. Alternatively, or let’s call it complimentary to this idea, would be the parallel notion of reducing caloric intake. This is really the main way to maintain weight and lose weight. Keep in mind that an entire hour of exercise may burn somewhere in the neighborhood of 700 calories if done vigorously for most people. And then think how easy it is to consume 700 calories in a few quick bites.

So my advice is to focus on both: markedly reduce calories by cutting out carbohydrates and high calorie foods, drinks and snacks. Then seek to slowly incorporate more and more exercise and activity into your daily routine and aim for the full one hour of daily exercise. If you are significantly overweight or obese then you must do even more: cut calories even further and increase exercise even more. It is difficult, it’s painful, but there are tools to help.

Mother’s Day, May 9th, 2010, kicked off National Women’s Health Week. A special week promoted by the U.S. Department of Health and Human Services and their office on Women’s Health. This year the theme of the week long campaign is called “It’s your time” and the idea is for women to take steps to improve their health and to make their health a top priority.
While there are many important things that women can do to improve their health, number one among them in this day and age is to maintain a normal body weight and avoid weight gain and obesity. If a woman has crept up to a body mass index greater than 25 than a serious effort at calorie reduction and increased exercise is in order. For a body mass index greater than 30, a more rigorous and structured program is warranted, and the evidence strongly favors taking a very proactive and serious approach including consideration of a Lap-Band operation in conjunction with such a program. For a body mass index of 35 and greater, a small percentage of women can lose the weight successfully without weight loss surgery, but for more this would be a very challenging undertaking. Even with weight loss surgery, successful return to normal body mass index will require diligence, hard work and a structured program. But these efforts are well rewarded with vastly improved health, longevity and quality of life.
Various events are planned around the country to celebrate National Women’s Health Week and these can be found at:
http://www.womenshealth.gov/whw/events/
The Surgeon General, Dr. Regina Benjamin emphasizes the importance of empowering women to make their own health a top priority.
Our recent Health Moms campaign dovetails importantly with National Women’s Health Week and the project this summer aimed at helping moms lose the pregnancy weight and promoting health families in obesity prevention among children will succeed in improving the health of not only women in our community, but the entire families that women lead.

So where do we get the motivation? Where does it come from? Because, if there were a place, a shelf perhaps somewhere some identifiable reservoir in our consciousness or bodies, how do we find it? How do we tap into it? How do we keep finding it and accessing it long after the initial enthusiasm for a new goal has long since waned?
These are some of the most challenging aspects of long term weight loss. In one moment we may think, we may know, in fact, that we will feel better. That our lives will be better if we can lose weight and keep it off. Our health will improve, our relationships may improve, we may feel more energetic, we may get more things done, we may accomplish more, make more money, look better, etc, etc. And in that flash, some motivation is tapped and we may even act upon it. But the process of losing weight is not like the process of accomplishing a project around the house or acting upon the one lingering item that has been sitting upon our desk. It is a long term process, a long term process, a journey, really. So how do we tap into that reservoir of motivation so that we may succeed in such a long term journey?
Our patients have taught us a few things and I will share a few of them with you here. One of them is a simple notion that the ideas that we keep in our consciousness are fairly few at any given moment. And each of us is certainly bombarded with many other messages through the course of our day and through the course of our week. Think of all the countless messages about food, snacks, eating at restaurants and buffets and desserts that we experience on a daily basis. Now think how often do you go out of your way to reinsert thoughts of your long term weight loss goals? When you add it up this way, it becomes quickly apparent that our own noble thoughts about change are often drowned out by these other messages we are bombarded with. So what’s the solution?
Well, here’s a simple one. Write down your main goal. Keep it very simple. “Lose 20 pounds by October 1st.” Write it on a note card in big black magic marker and post it where you will see it very single morning. In fact, make three and post one in a place on your dashboard in your car, one on your computer above the screen and one at home in the bathroom mirror. That way you are forced to think about your goals at least several times a day.
Then there is more. It involves digging very deep into what truly motivates us. This is more than simply that you would like to look trimmer. It is the important stuff such as the specific ways in which you would like to be a better parent, or a better partner. It is achieving personal goals like riding your bicycle with your kids or completing a 5K race or some of the other hundred things you would like to do before you die. It means recapturing and not giving up on your dreams. So spend a little time and dig deep and find out what you would really like in life and how being overweight is keeping that from happening. Then put pen to paper and write down some of those deeper, more important goals, the good stuff; the things that make life really wonderful and worth living. Now you have something powerful that you can refer to and tap into when your motivation is ebbing.

A recent study out of Singapore, which examined over 60,000 people over the course of fourteen years, found that those subjects who drank two or more sugared soft drinks per week had doubled the risk of developing pancreatic cancer than those who did not.

It is not known why increased soft drink consumption could lead to an increased risk of pancreatic cancer or whether this effect is going to be born out in other studies. Some facts we do know about cancer: many cancers are markedly increased in obesity. Colorectal, breast cancer, endometrial cancer and others double or more than double among obese individuals when compared to normal weight individuals. We know there is an association between soft drink and sugar consumption in obesity, so it stands to reason that some link may exist between the soft drinks and cancer development. Pancreas cancer in particular may be one that has some special sensitivity to the elevations and hormonal surges of insulin, leptin and other hormones associated with carbohydrate consumption and obesity.

Whether some subtle toxin could be present in soda cans or whether there is something specific about the soft drinks as opposed to other sugar drinks like fruit juices remains to be seen.

What is known is that drinking lots of sugared soft drinks is bad for your health. It leads to weight gain and obesity, which increases cancer risks markedly. This latest study is one more, small piece of data that should discourage drinking high carbohydrate soft drinks.

A real energy drink should give good, solid energy for a period of many hours.

A real energy drink should not make you jittery and “hyper” and impair your concentration; it should focus it.

A real energy drink should definitely not lead to a short spike in energy followed by a big fall in your energy level – instead it should give good, long, sustained energy that is even.

The ideal energy drink would have a few other characteristics too. It would come from natural ingredients. It would not only provide some energy, some calories, but also some other important nutrients like vitamins and minerals. And for the vast majority of us who want energy, but not in the form of empty carbohydrate calories that lead to weight gain and obesity, it should help us maintain a healthy weight and healthy, long term energy. A true energy drink should not leave you craving more food, more calories, more energy drinks shortly after you have consumed one. It ought to provide some real, solid satisfaction. Also, an energy drink can have a little caffeine, that’s fine, but not hundreds and hundreds of milligrams of caffeine. Those kinds of doses are shown to cause tremors and make one feel jittery. They also often interfere with sleeping and actually make people more tired through the course of the week.
Oh yeah, and it should taste great.
So for my money the best energy drink is going to be a nice mixture of vitamins, minerals and natural whey protein to give a clean energy boost instead of all that sugary, make you fat and tired kind of energy that the big drink companies have promoted in the past.

It’s not that we want to be fat. In fact most of us find ourselves gaining weight and are struggling to find ways to stop it. But these energy drinks, sport drinks and just plain ole’ drinks taste so good and are so cleverly marketed to us that we can’t stop drinking them. At least we can’t stop drinking them unless we think about it and use our own free will a little bit.
What a lot of people don’t realize is that big jolts of simple carbohydrates make us fat. Not immediately of course, not that day or that week even, but over time. Big doses of simple carbohydrates, say those in the sucrose and high fructose corn syrup of an energy drink or other soft drinks, the simple carbohydrates are digested quickly and enter the blood stream quickly and result in a very rapid surge of circulating blood sugar or serum glucose level. This also leads to a rapid spike in the important hormone insulin and leptin followed by a rapid fall of the blood sugar level. The next step is a sense of hunger which is often even stronger than before the jolt of sugar. It is no wonder this cycle leads to obesity as it repeats itself over and over.
The make-you-fat drinks have awesome, inspired and expensive Madison Avenue advertising and marketing. They look cool, we think they’re cool and, of course, they taste great. Some of us even like that rapid spike and jittery feeling; the surge of energy, even if it is very short lived, but with a little thought we could all do a lot better.

There has been quite a bit of press coverage about Kevin Smith’s experience while flying on southwest airlines. For those of you that are unaware of what happened:

Kevin Smith was asked to exit the aircraft after flight crew had deemed him to be too large to safely fly in one seat. This is in accordance to a “customer of size policy” implemented 25 years ago which requires said passengers to purchase a second seat when traveling to accommodate their larger size. The interesting nuance here is that Mr. Smith was aware of this policy and had purchased a second seat.

He was flying stand-by to get on an earlier flight which had only one seat available. When asked to exit the plane. Kevin Smith was obviously embarrassed and insulted. He immediately began expressing his feeling on his Twitter account. With over 1.5 million followers it wasn’t long before everyone was watching this situation unfold pretty much as it was happening.

Now there are several aspects to this story that probably warrant their own blog posts and perhaps I will spin back to touch on those at a later date. But I wanted touch on something in this post regarding the treatment of obese individuals during travel. There are two sides to this story and both have very valid arguments.

The “customers of size” are people with feelings who have paid to fly or ride on whatever means of transportation. They are not intentionally infringing on the space of fellow travelers nor do they choose to be a safety concern. Often they are willing to pay more for additional seating space to accommodate their size and adhere to the policy of the company they are traveling with. Do they not deserve to be treated better? If and when a situation arises that is caused by a violation or concern related to their weight or physical size should that situation not be handled with greater discretion?

On the other hand, put yourself in the seat next to the “customer of size”. Did that traveler not pay for the entire seat? Should that traveler be forced to be more uncomfortable then today’s air travel can already be?

What could be a better solution to this problem?

What if we simply charged people as if they were freight. I think most of us would agree that air travel today often feels like you are being treated as human cargo anyway. Why not use the same model for pricing. Instead of weighing your bags to determine if they qualify for penalty fees or charging for extra baggage, just have the traveler and their bags get on the scale and charge per pound. This would be a fairly easy equation to figure out. Airlines can simply set the per pound price they would need to charge to make their targeted profit on a given flight. The traveler would simply stand on the scale with their baggage. Total weight x price per pound = Ticket price. In this case if a “customer of size” takes up more space on the plane then a smaller traveler, well, they paid extra money to do so, and there would be no reason to treat that person with insensitivity after they had boarded. Of course, a thoughtful method of weighing us all with our baggage might have to be conjured up, to avoid casting unwanted attention on anyone at the ticket line. Lots of issues here: is our weight our own private matter, or does it become relevant when jet fuel costs more per pound and we plan to fly? Can a better way to accommodate larger people be found than simply yanking them off airplanes?

Logistically, speaking there are obvious issues that may occur from this suggestion, but what can we as travelers think of to make this situation better for all involved?

Here is a funny thing: When the time comes around for us to eat, let’s say lunchtime, many of us can think of only one thing: food. Plus, when the opportunity arrives to eat that food, most of us can hardly contain ourselves as we anticipate the satisfaction of eating it. It is furthermore difficult to stop midway through a meal with so much more food, delicious food, still available to eat on our plates or on the table or in the serving area. In fact, many of us experience this phenomenon something akin to a biological imperative. We feel a strong compulsion to eat the food that is presented to us. One could imagine some biological programming that speaks to ensure we do in fact the calories that become available because one could never know if a reliable source of calories would be available later. Such a strong behavioral instinct to consume the calories currently available, would serve to guarantee a strong nutritional intake for a species that struggled to obtain reliable sources of food through difficult harvests, bad weather, poor hunts, etc.
So if we are seeking to lose pounds and achieve a healthier overall weight, how in the world are we supposed to overcome such a strong and deeply engrained behavior to eat at mealtime and to eat all the food available to us? Well, here is one trick that works well and has served many of my patients well. Put simply, think of the next meal.
What I mean by this is force yourself to stop focusing on the food that is currently right in front of you and instead think about the meal you are going to eat in just a few hours. For example, it is lunchtime and you are being served a mediocre burger with some nothing-special side dishes and wilted lettuce salad, nothing great here, right? Yet, of most of us are driven to eat that meal and we take satisfaction from eating most of it or all of it. It is very difficult to overcome that drive, and instead simply eat a small portion of the meal that would be more appropriate for achieving weight loss. But if you stop focusing your mental energies on the meal that is currently in front of you and instead think about the next, that is the really delicious dinner, that is something you actually look forward to, say, your favorite marinated meatballs with yummy spices, then it becomes far easier to overcome the temptations to overeat in the present meal.
I know this all might sound a little strange, but is it a behavioral trick that often works. Let me give you an extreme example and you will see how you might use this in your day-to-day weight loss efforts and your goal of cutting down portion sizes. Let’s say you have a dinner planned for a special evening at your very favorite restaurant. Now if you are at all like me, you love those special meals with your favorite chef cooking your most favorite recipe (think of a mouthwatering sizzling steak from your favorite steak joint or think of what you know as your special favorite dish). Many of us with such a special, special meal coming up would “save room” and eat less during the day approaching the special meal in order to more fully enjoy the dinner. Many of my patients and I, myself even have entirely skipped lunch and all food through the afternoon on a day when a special gourmet feast was planned. So the trick here is to tap into that sort of thinking on a more regular basis and when you are presented with food at mealtime, pause for a second and think about the next meal. Then remind yourself you have a plentiful steady supply of food and it is really not important for your health or nutrition to eat everything on your plate at lunch, in fact it is really not that important that you eat any of it. But a small healthy portion is good for you to maintain your metabolism and stave off hunger later in the afternoon. Reminding yourself that a whole other meal is just a few hours away will often help you find the willpower it takes to cut down your portion size and stop eating. This type of psychological trick is just the sort of thing that may help you regularly avoid excess lunchtime calorie consumption and lead to a healthier new you over the course of the year.

There is no doubt that a certain satisfaction comes from eating a large quantity of food. I will be the first to admit I have overindulged in some meals when the food was particularly delicious and I found it satisfying, albeit in a strange way. For example my favorite Indian, Thai or Chinese food seems to be gobbled up so fast that it practically vanishes from the plate and I find myself dishing out more from those white cardboard boxes before I even know what I’m doing. Or a really great pizza made from terrific dough and delicious sauce is so hard to resist before 3, 4, 5 or 6 pieces disappear.
More disturbingly, however, we often find ourselves overeating quantities of food that isn’t really that great. Think about it: How many times have you been served a lukewarm burger and lousy fries, but for some reason continued eating until every last crumb was devoured?
What I am saying is it is time for a new way of thinking about food. Pure and simple, it is time to start thinking about quality and not quantity. At first, you will have to trust me that it can be at least as satisfying to emphasize quality over quantity. You will probably have to take it on faith to begin with that a few bites of something truly amazing, enjoyed slowly, can be equally as satisfying as demolishing a large quantity of something mediocre, but it can be and it is. Once you begin to enjoy the real satisfaction that comes from watching the number on the scale move downward, watching your body look healthier and seeing a person in the mirror who feels better and more energetic, then you will truly begin to see the light.
Be selective, be choosey, don’t eat anything that isn’t truly delicious, emphasize quality and not quantity.

After some delays, we have received the shipment of my newly released book: Life Changing Weight Loss. In these times, everyone could use a guide to real, successful weight loss.

In radio interviews on stations around the country, I have been so pleased at the reception the book has received so far. One of the common threads I hear is that media people are inundated at this time of year with weight loss books and information, most of which has very little basis in the practical science of what truly works. Much of it is based on wishful thinking, marketing plans or fanciful obsessions with obscure root extracts and proprietary blends of unregulated secret, magical herbs. The truth about successful weight loss is much simpler and yet, also much more complicated.

At the end of the day, to solve a weight problem and keep the pounds off, we must find a successful strategy to consume less calories every single day, burn more calories every single day, and find satisfaction and contentment despite this. Many of us can muster the motivation on a short term basis to consume less calories and burn more calories, but we feel like we are starving ourselves or doing the impossible. That won’t work for the long term. Long term success lies in mustering that motivation, but making an internal life change, a new look at how we view ourselves, our weight, our diet and our activity. Only then does the “light switch” flip on, only then do we successfully lose the weight and keep it off for the long term.