I have often wondered why I see so many seriously overweight and morbidly obese vegetarians in my clinical practice. I realize the answer is mainly because I specialize in weight loss, both with medically based methods and with surgical weight loss. So it stands to reason the cross-section of people with obesity will be seeking my help, this will include vegetarians as well as all kinds of other eaters.
Yet, when speaking to these individuals who are struggling with unhealthy weight gain that is wreaking personal havoc on their heath, I have delved into some of the details of what it is they are eating and drinking specifically to help understand why they suffer from obesity. A few of the points that have emerged from these conversations are offered here in hopes that other people may be able to avoid this unfortunate progression to morbid obesity.
The primary danger of choosing a philosophy of vegetarianism is in believing that doing so will lead to improved weight control or even weight loss. That is very unlikely to be the case. Simply shifting from animal sources of nutrients to vegetable sources will have very little to no impact on a person’s weight.
The second danger of vegetarianism and the risk of obesity is that so many so-called vegetarian foods contain high amounts of the very nutrients that are most closely associated with obesity: simple carbohydrates. Many snacks and treats, juices, fruit based products, syrups, flavorings, pastas, rice, noodles and a host of other foods consumed as vegetarian consist mainly of high calorie, high carbohydrate food sources, precisely the kind of nutrient most closely associated with the obesity epidemic. On the other hand, a healthy vegetarian may consume whole grains, legumes, a wide range of beans, vegetables and a wide array of fruits while avoiding all of the previously listed simple carbohydrates and find themselves losing weight and becoming much healthier.
The third danger is the psychology of “good food vs. bad food”. In the “good food/bad food” syndrome, we tend to help ourselves stick to a particular dietary plan by labeling certain foods as “bad foods” and acknowledging other foods as “good foods”. The problem with vegetarianism is that often all animal based foods become as labeled as “bad foods”, leaving all of the non-animal products available as “good foods”. The trouble here is that many of these non-animal foods are absolutely terrible. I am thinking of Twinkies, fruit juice drinks and French fries just to name a few of the millions of obesogenic foods many vegetarians do consume. Don’t get me wrong, if your goals of being vegetarian are purely to avoid animal products then you may succeed with this strategy, but if your goal is to lose weight and be healthier, such a strategy is doomed to failure unless your focus is on reducing foods that cause obesity.
Number four; I call this the danger of the white foods. Many of the obese vegetarians I have met gravitated toward the dreaded white foods: foods that tend to be white in color and dominated by simple carbohydrates. These include potatoes, potato chips, French fries, white sugar, white rice, white pasta, treats with vegetable based frostings and, of course, all sorts of baked goods…breads, crackers, cookies and treats made with white flour. I can throw in high fructose corn syrup, but what’s the point? These are the most harmful foods and nutrient sources in our diet, the ones most closely associated with hunger, fat storage, weight gain, diabetes and obesity. In terms of health and weight, it is a very poor trade-off to get rid of animal products, but gravitate toward these white foods. In fact, it is a recipe for obesity and diabetes.

Recent reports offered some disturbing news: a series of drugs commonly prescribed to treat mental health conditions in adolescence cause weight gain as a side effect. This is not terribly surprising news as it has long been noted that many of the antidepressants and anti-psychotic drugs have been associated with weight gain in numerous previous studies. What is disturbing is there has frequently been lack of full recognition of the deleterious effects of weight gain on the mental health conditions themselves. This is perhaps most aptly demonstrated in the relationship between obesity and depression. It is well known depression itself often leads to over-eating, inactivity and weight gain. Likewise, it has been demonstrated that weight gain and obesity lead to depressive feelings and a cycle of downward mood spiral.
These latest reports offer further disturbing news that sometimes our pharmacologic answers to serious health conditions can often have a dangerous side effect: obesity. It also speaks to the fact that when any prescribers are offering drugs to treat one condition, it would be terribly helpful to consider the negative effects of weight gain just as other side effects are factored into the decision of the prescribing the medication. In the past, weight gain has often been thought of as a relatively minor side effect, but in today’s obesogenic environment, I don’t think that should be the case any longer. Obesity is more widely recognized now as a quite serious health problem in its own right and drugs that lead to weight gain and obesity as a side effect must be scrutinized closely before they are prescribed. I would argue that patients, who are embarking upon any drugs that include weight gain as a typical side effect, should concomitantly enroll in a weight controlled program or weight reduction program to actively combat the effects of the drug.
Some of these drugs directly stimulate appetite. Others lead to inactivity, but many of them have in common the empirically noted finding that patients on the drug gain weight when compared to patients on placebo.

In my practice serving seriously overweight people seeking medically based solutions, I see a very high number of obese patients who described themselves as vegetarians. Many of these individuals chose vegetarianism out of a belief that doing so would help them lose weight or maintain a lower weight. Unfortunately, that is not usually the case.
While there are many reasons a person chooses vegetarianism, selecting this diet to lose weight will be unsuccessful as a strategy in and of itself. At the end of the day, or at the end of the year, one’s weight is determined by the balance of net calories in, against the net calories the body has burned. A great many vegetarians are consuming far more calories than their bodies’ burn through the course of the year and are thus gaining weight. The successful strategies for losing weight or maintaining a healthier weight involve a conscious, mindfulness of overall calorie intake and a reduction in the net calorie intake to levels below that which the body is burning through resting activity and exercise. One can dramatically improve that equation by increasing exercise, using muscles and cutting down on the types of foods that tend to stimulate appetite and stimulate fat storage, namely simple carbohydrates.
Evidence has mounted over many years that simple carbohydrates serve to provide rapid, transient satisfaction when we consume them, but this is followed by increases in our appetite and even cravings for those nutrients, in addition to the hormonal cascades stimulated so potently by the simple carbohydrates leads, in fact, to storage of fat and stimulus of more appetite. Epidemiologic data reinforces the understanding of simple carbohydrates as being the most closely linked nutrient group to the obesity epidemic. There is a virtual parallel increase in the prevalence of obesity in the last thirty years and the per capita consumption of high fructose corn syrup and other sweeteners over the same time period (something that is not the case for consumption of fats and proteins).
If a person wishes to change his/her diet to lose weight, the most compelling strategy would appear to lie with a shift away from the consumption of simple carbohydrates to other nutrient classes. Certainly, this strategy is further born out in our clinical practice where we have success employing such a strategy in the real world of medically based weight loss programs. There is little data to support a shift away from animal nutrients toward vegetable nutrients as a successful weight loss strategy.
This is not to say that a vegetarian philosophy cannot be a successful weight loss strategy if one works not only on the vegetarian aspect, but also on the weight loss aspects, which should be viewed as independent objectives.

A recent study in the British Journal of Sports Medicine confirms the findings of many previous studies showing that vigorous, supervised, aerobic exercise programs also result in very disappointing weight loss. In the study, fifty-eight obese individuals completed twelve full weeks of vigorous, supervised, aerobic training without changing their diet, and each individual lost an average of around seven pounds.
What gives?
The truth is that it is exceptionally difficult to burn high amounts of calories through exercise. For example, for most people, thirty minutes of vigorous exercise is only going to result in 200-350 calories burned. Sadly, but indisputably, we all replace those few hundred calories in a few seconds with a sports drink, a snack or one cookie.
In counseling, overweight and obese individuals seeking to lose weight, I often find that a great many of them are prepared for a monumental challenge, but they imagine the wrong challenge. Many times people envision what it will take to lose the weight now that they finally decided to get serious about it and they picture themselves undergoing a Rocky Balboa type training regimen and enduring long and difficult training regimens, physically pulling sleds and doing an unfathomable number of push-ups. The truth is, the real challenge is equally monumental, but, in many ways, far more difficult. The challenge actually consists of cutting out large numbers of carbohydrate calories from our diet day in and day out. We are typically very unprepared for that sort of challenge. It involves living with hunger, retraining our minds and bodies and sacrificing to achieve rewards that are difficult to see for weeks or months. In the end they are well worth it.

I had a great conversation with Louie Free, the Ohio talk radio host, who himself is a vegan. He said something I thought was very important to point out and that was he knew, as a vegan, he had to eat a “healthy” vegan diet and pay attention to all of his food selections to avoid weight gain. As he mentioned, it is possible to eat snack chips and soda pop and be “vegan” and yet such a diet would be unhealthy and would lead to weight gain and obesity.
I, myself, see a great many people who are vegans with obesity.
It is not veganism that is healthy per say. A vegetarian or vegan diet is not going to prevent obesity or solve obesity or even lead to weight loss. The food choices that will lead to weight loss are a shift away from high calorie, high carbohydrate foods and toward foods with a lower glycemic index and lower overall calories. Then combine that change with increased exercise and you have a winning formula.
It’s certainly possible to eat a nutritionally sound diet that is a vegan diet. And it is certainly possible to maintain a healthy weight and be fit and well nourished as a vegan. It is also quite possible to do the same while eating meat as part of a healthy diet. The key for vegans is to not be lulled into a sense of “healthy dieting” in believing that a vegan diet that is high in simple carbohydrates and high in calories in somehow better for the body than a diet that is lower in these things or one that might even contain meat. As I have discussed elsewhere, there are many reasons individuals choose to pursue a vegetarian diet including ecological choices, environmental awareness and an appreciation of the role that animals play on this earth and how humans should interact with them. But as a physician specializing in weight loss and the treatment of type 2 diabetes , I must point out that the real enemies for human health are not animal proteins, but are high calorie, high carbohydrate foods, especially including the sweets, treats and snacks that are packed with simple sugars. Those are the worst culprits that lead to rampant obesity, diabetes, high blood pressure, sleep apnea, hypertension, blindness, renal failure, amputations and early heart attacks, even among vegans.

In an interesting article by Tara Parker-Pope, food labels get a new look. A consumer advocacy group called the Center for Science in the Public Interest proposes giving the standard food labels a makeover. Miss Parker-Pope does a nice job illustrating what the new food labels would look like and itemizes how each of these changes would occur.
The Nutrition Labeling and Education Act passed almost twenty years ago and is the law governing the descriptions that we now read on the foods we buy. Many of us have noted the problems with food labeling and my pet peeve has always been that food producers can still play fast and loose by choosing ridiculously small serving sizes and thus offering a misleading low amount of calories and carbohydrates. The new food labels would put calorie and serving size information in larger type at the top of the label. It would make changes in the ingredient list by separating them with bullets instead of allowing all the ingredients to run together. Similar ingredients would be grouped together and their percentage shown by weight. Miss Parker-Pope notes this would be especially important for sugars including things like sugar, corn syrup, high fructose corn syrup and grape juice from concentrate, all of which are forms of sugar that would be listed under a catch-all heading of sugars. In addition, the new labeling proposal would add the word “high” if a particular food had more than 20% of the daily recommended allowance for fat, sugar, sodium or cholesterol. It would also display the percentage of whole grains contained in the product. The proposed food label would also list the milligrams of caffeine contained in the product.
All in all, the new label makes some improvements. It will highlight the serving size more prominently and make is somewhat less easy to mislead consumers with unrealistically small serving sizes chosen. It is unlikely, however, to end this practice. The recommendations though do make a good deal of sense and highlighting which products are “high” in fat, sugar, sodium and cholesterol may help consumers make better decisions.
These recommendations do make a big assumption that fat, cholesterol, sugar and sodium are all similarly important to highlight and presumably for consumers to reduce or control consumption for these nutrients. It’s not entirely clear that is in fact the case. The best evidence would certainly suggest that calories alone would be the most important thing to highlight and control followed closely by sugars. For some people, especially those with hypertension, controlling sodium also makes sense. Controls on consumed fat and consumed cholesterol may be a bit harder to justify from a scientific basis, but the concept may have some validity. It does confuse body fat and serum cholesterol with consumed fat and consumed cholesterol and the link is not nearly as clear in science as such labeling would suggest.
Nonetheless, I support the proposed labeling makeover for the most part. In my position as head of organizations aimed at combating obesity and preventing childhood obesity, I would like to see greater emphasis placed on highlighting the serving size and preventing food manufacturers from choosing misleading and unrealistically low serving sizes. I would also like to see more emphasis on calories and sugar and less emphasis on consumed fat, cholesterol and caffeine, none of which have anywhere near the kind of impact on obesity and diabetes as calories and sugars.
What are your thoughts?

Don’t wait for the actual New Year to make your resolution. Make it now. Take a few minutes to think about what your goals for health and fitness are for 2010. Where do you see yourself going? What would you like to do? What fun physical activities would you do if only you could lose fifteen, twenty-five or even fifty pounds? What would it be like to feel more energy and be more active?
One of the plainest truths in the world is that we simply cannot ever hit a target unless we aim at it. And, make no mistake, losing weight takes effort and hard work, and, yes, taking aim. So New Year’s resolutions are really a form of taking aim, of setting an important goal, of setting your site on the target so that you can work to hit it.
So I recommend taking time out over the holidays when you are not frenetically running around shopping, wrapping presents or cooking holiday meals. While you are sipping your warm chocolate whey protein shake by the fire, let your mind wonder through some potential New Year’s resolutions so that when the big day comes you can choose one you have thought about carefully then commit to it and put your heart into it. I suggest that you make it a resolution that you can stick to and a resolution with a special meaning to you and a resolution that is specific. Do not resolve to “lose some weight.” Do resolve to lose twenty pounds by April 1st and do so with a medically based program regular weigh-ins and support groups.
Then create for yourself a non-food reward such as then I will take my daughters horseback riding, or then I will treat myself to a massage, or then I will buy myself that new jacket I have wanted.

I have noticed that so many of us enjoy the time during the holidays, but with the high level of consciousness of weight gain and obesity in our office, we all approach the holiday season with a little bit of trepidation. The usual array of goodies, candies and treats appear in the office (and even I am guilty of giving some rather delicious chocolates from time to time), but all of us laugh about enjoying small tastes here and there and not devouring the whole plate.
Many of us also talk about looking forward to the New Year and to our New Year’s resolutions. People in the office have been talking about what sort of New Year’s resolution to make and for many people it does center around targeted weight loss and health improvement.
I think it is a wonderful notion to take stock of one’s health and imagine one’s new goals as the New Year begins. The key is to be specific and if you have gained pounds over the holidays, the first goal is to lose them. Be specific. How many pounds and by when? I would suggest if you gained the pounds in the weeks between Halloween and New Years, roughly eight weeks, then you give yourself eight weeks to lose all of those pounds. And then set a goal for losing more weight beyond that.

The New Year is the perfect time to think of opportunity, to think of renewal and to think of new goals. It is also a time to set aside some of the distractions and the temptations that the holidays brought and focus instead on seeing how some of our deepest desires can be realized.
We all have strongly, deeply felt desires to feel better about ourselves, to live with more energy and enthusiasm, to become healthier, and to be better people to others around us including those loved ones who depend upon us. It is often hard to put those thoughts into action and it is hard to know how to achieve some of those goals.
Check back for some more posts about resolutions and goals for weight loss and better health in the New Year!

The acai palm is found most commonly in Brazil, but is native to a number of Central and South American countries. Acai berries are harvested and widely consumed in Brazil in various preparations including in ice cream, mixed with granola, in smoothies, cold in a bowl or in the traditional gourds called cuias with tapioca.

The dietary supplements come in the form of powders, tablets, juice, smoothies and even some whole fruit. Various companies have promoted acai preparations as aid for everything from improved heart health to penile enlargement. Companies like MonaVie in a sophisticated multi-level marketing construct, promotes an acai juice preparation for various health ailments.

To date, there are no scientific peer reviewed, controlled studies that support any of the particular claims of health benefit. But before we throw the baby out with the bath water let’s look at what is in the acai fruit. Like other dark berries, acai fruit contains a mixture of antioxidants including chemicals called flavonoids and a small amount of anthocyanins. A tiny amount of the red wine chemical resveratrol is also found within acai. In studies, the acai fruit and preparations thereof turn out to be fairly average in terms of their antioxidant power with a variety of other fruits scoring a bit better and exhibiting higher antioxidant capacity.

Like a lot of people who follow the science of nutrition and enjoy reading some of the anti-aging potential of wonderful things like dark berries, red wine and chocolate, the truth is that very little evidence exists that would support any claim of significant health effects of these foods of these compounds. It is more like indirect evidence and profoundly hopeful thinking of lovers of red wine, chocolates and dark fruits (like myself!) that these compounds and foods will prove to be as helpful as some laboratory evidence suggests that they could be. To date, keep in mind the studies have not demonstrated any convincing benefit and we’re a long way from knowing what sort of doses, concentrations and specific compounds might provide the answers to solving the mysteries of atherosclerotic disease, heart attack, stroke and diabetes.

In a February 2008 study by Seeram, N.P. in The Journal of Agriculture Food Chemistry; volume 56, page 1415-1422, three available juice mixes of the acai juice were compared with respect to their antioxidant capacity and some number of other antioxidant beverages. Acai juice ranked below pomegranate juice, grape juice, blueberry juice and red wine and was roughly equivalent to black cherry and cranberry juice.

I am certainly not condemning the acai palm, its fruit or the preparations there-of, I just am helping to keep it all in context. By all means, enjoy them along with other healthy fruits, vegetables and whole grains.