Friday, February 13, 2009

Weight Loss Principles -- for free

Sorry it's been so long since I've written on this blog... life keeps marching, and if you don't keep up things rapidly get left behind. Will revive this forum into something more applicable to general questions about medicine, becoming a doctor, and various anecdotes from my training. In the meantime, here's a post about a topic many people are interested in -- and many others are trying to make a buck off of. But (theoretically), it should be pretty straight-forward without being expensive. Of course, I myself have been wanting to lose weight and "working at it" for about 8 months now -- with poor results. Somewhat puzzling, considering the apparent simplicity:
  1. Consume fewer calories than you burn.
  2. Drink plenty of water.
  3. Make nutritious food choices.
  4. Exercise at least 30 minutes per day, as many days per week as possible.
...and then the hardest one,
  1. Be consistent (my downfall!).
Here's a brief run-down of how all these things can work together.

#1 is obvious, and a basic effect of our physiology -- you CANNOT FAIL to lose weight if you are taking in fewer calories than you burn. You have to pay attention to both sides of that equation though; starving yourself is not a wise way to go, it can slow down your metabolism. Burning calories comes from activities of daily living, as well as from exercise. So get off your couch, use the stairs, walk from a further parking spot -- all those things can help.

I do NOT put any stock in these weight-loss schemes involving "fat-blocking" and "detox" and drugs that "speed-up metabolism." There is no short-cut. Inducing malabsorption can have a role under close medical supervision (and is one intended effect of bariatric surgery), but should not be attempted on your own and with over-the-counter weight-loss aids. Most of the weight-loss gimmicks out there are just that -- gimmicks. Save your money for healthy food.

#2 is often overlooked. Not only is water essential for our bodily processes, it can also reduce hunger and keep you feeling full. Instead of reaching for that 4th cup of coffee (caffeine can dehydrate you) or that calorie-rich soda or latte (we often forget to consider calories from our beverages), make it a point to drink plenty of water throughout the day. You should drink enough to *prevent* thirst, not just to quench it. Especially important if you are exercising or dealing with a hot environment. And water is free (from the tap), and less expensive than Starbucks if you prefer bottled water.

#3 is a pretty tough one in our day and age. Everyone wants the fast, cheap, easy solution to meals on the go. Eating healthy is rarely cheap, and can become boring if you don't make the effort to try creative recipes. At least consider replacing unhealthy snacks with fresh fruit and whole-grain items -- the less processing the better. Try to have a bowl of fresh, cleaned fruit available for those times you would reach for a donut or muffin. Chop up celery, carrots, and broccoli (or other veggies) and keep them in visible containers in the fridge, or throw them in your packed lunch, for a quick, filling snack with a satisfying crunch. Some people invest in programs like Jenny Craig or Weight Watchers -- if you need the extra help with meal choices and have the money to burn, try that. Otherwise, just remember to:
  • take small portions
  • stop eating BEFORE you feel full, and
  • DON'T EAT when you are not hungry -- no boredom- or social-grazing.

#4 really requires a change in behavior. Not only do you have to make time to hit the gym, take a vigorous walk, or play an exercise tape / DVD, but you need to make it a regular part of your day. Don't just phone it in, but also don't overdo it too quickly and injure yourself. Start off slowly, and gradually challenge yourself at a level that is comfortable but works up a good sweat. If you are morbidly obese, see how long you can walk before getting out of breath, and work toward increasing your endurance before jumping into an exercise routine that might be dangerous.

#5 is why most people cannot do this well on their own (including me). It supposedly takes about 2 weeks to develop a habit. Work toward all these changes together -- but if you fall off the wagon in one respect, don't throw in the towel and revert to all your old habits. Pick yourself up, dust yourself off, and realize that "today is the first day of the rest of my life -- again." One reason these group programs seem to work a bit better (Weight Watchers, etc.) is because of the support system. If you can hook up with a work-out buddy or enroll friends and family as your coaches, they can help keep you on track. But don't let an inconsistent work-out partner or a fellow dieter caving-in to cravings throw you for a loop. Be strong for yourself, and have a back-up plan for meals or exercise if you are afraid of being tempted toward bad habits.

Most important with this aspect -- examine your current habits and see where you most often go wrong. For me, when I stay up late trying to get work done, I find myself munching to stay awake, and craving foods that are not healthy. Readjust your schedule so you go to sleep before the late-night munchies hit you. Have a bottle of water at hand, and drink plenty to fill-up before meals and snacks. Eat slowly, so you have a chance to feel full before you've scarfed-down everything in site. Eat off smaller plates, so you take less food. Don't automatically finish what is in front of you -- especially at restaurants. Plan to take half home, or split a meal with your dining partner. If you insist on eating in front of the TV (like me), don't keep eating just because the program is still on. When you condition yourself like this, you tend to ignore internal signals of satiety and keep eating while the TV is on. When you break a good run of days working-out, restart it as soon as possible to keep the habit alive. And mix up your exercise routine to keep it interesting, and to minimize overuse injuries.

And finally, evaluate your progress weekly. Jumping on the scale every day will not show you much -- too many variables from water retention and digestive processes.... A good goal should be to lose a couple of pounds each week (anything more will likely just be water weight), so monitor your efforts and adjust diet and exercise as needed. For real weight loss, you may need to bump exercise up to 60 minute sessions. You may not see results right away, but remember that muscle weighs more than fat -- if you are building up muscle it may reduce your expected weight loss. Regardless, you should notice an improvement in your endurance. And note that increased muscle-mass should result in higher metabolism -- helping you along your path to weight loss.

Get plenty of sleep (hey, you can even burn *some* calories doing nothing!), and you will feel more energized to attack each day and avoid temptation. Will post more on this topic in the coming months. Best of luck!