Published On: Fri, Dec 28th, 2012

Why America Can’t Weight: A Nutritionist’s Perspective

Weight loss programs, how well do they work?

Weight loss programs, how well do they work?

Why America Can’t Weight: A Nutritionist’s Perspective

By LoRayne Haye M.S. C.C.N.
Nutrition Research Director
Eating-4-Energy

All righty folks, it’s the New Year- and with it comes a boatload of weight loss resolutions– which are taking off like pigs with wings. Between the commercials advertising reducing programs, and the latest trendy diet plans, no one is immune from the all-out assault Americans will wage on the post – holiday gain. Indeed, the slimming industry feeds off of people’s good intentions come January-1st –and why wouldn’t they? According to Marketdata Enterprises Inc. a research company specializing in assessing trends, the price tag for American’s desire to lose, brought an estimated 60.9 billion dollars in 2010, which by the way, increased from 58.6 billion in 2009 1. Certainly with an incentive like that, rest assured said companies will be back for more of your hard earned dollars this year too. However, in casting an eye towards weight loss programs, one has to wonder…. how well do they work?After all, America seems to be a nation of overstuffed frequent flyers. Furthermore, since there’s such a plethora of said slimming centers—how does one go about selecting the right one? Armed with a litany of questions, I set my intention—or resolution if you will— to assess the pros and cons of some of the better known programs, as well as a couple of rather controversial philosophies, in an attempt to separate fact from fiction. First, however, I wanted to ascertain just how far Americans waist lines expand post-holiday season.

Weighing In: How much do Americans’ really gain during the Holidays?

Historically speaking, it was thought that the average weight gain for most Americans through the holidays was 5-7 pounds. Yet, over time, studies have emerged, namely a pivotal one published in the New England Journal of Medicine (2000), which suggested that the average weight gain is a mere 1 pound for those who are of normal weight, which currently equates to only 1/3 of the American population 2. Although, for the more than 68% of American adults who are overweight, it is indeed, between 5-7 pounds (C.D.C) 2-3. Moreover, in their published review entitled “Holiday Weight Gain: Fact of Fiction,” authors Roberts and Mayer (2000) assert that weight which is gained during the Holidays— is not lost! It just keeps piling up year after year 4.. Indeed, no one bothered to send any of us the email stating, if the trend from plate to mouth continues, in 20 years you’ll end up with a minimum of 20 extra pounds. Additionally, both of these studies suggest that tendencies for Holiday weight gain can be traced back to one’s childhood and teen years. This statement puzzled me, which lead to another question—what pray tell is taking place in so many people’s lives during that time frame, that’s keeping them from being lighter? Certainly if you throw in an annual chronic sedentary lifestyle and continuous processed food intake, there’s a very good chance you’ll be part of the aforementioned stats.

Why Americans aren’t losing

There are numerous contributing factors involved for being overweight or obese, aside from the obvious ill eating patterns, genetic and environmental factors. An emerging concept that noted energy psychologist Paula Shaw posed, who authored the book “From Tears to Triumph,” stated, “Most weight loss programs are based on choices and behaviors that the conscious mind must make but the conscious mind doesn’t have a chance when weighed against the sub-conscious. The conscious mind fires at one bit per second. The sub-conscious mind fires at one million bits per second! It’s clearly the Goliath in this duo. Another problematic issue can be pleasant associations that the sub-conscious has made with food or eating behaviors. For example, if in childhood there was a period when you were being ridiculed by the school kids and when you came home complaining to your mother about the day, her solution was to give you cookies and milk and talk to you. Your sub-conscious might have made the assumption that sweets are associated with being comforted and nurtured. This can create a powerful drive to eat sweets whenever life feels threatening or stressful. We’re going to need to deal with the Sub conscious mind if the weight issue is to be resolved.” Emotional issues which come into play have not been part of the standard fare of shrinkage programs here in the U.S. Could this be another part of the missing equation in helping people keep their weight off?

Although it’s largely accepted that being overweight cuts through all socioeconomic lines, the zip code where a person resides, has been identified as a strong contributing factor too. “People think of childhood obesity and immediately think about an individual’s physical activity and nutrition behaviors, but they do not necessarily equate obesity with where people live,” stated Brian Saelens, PhD, a professor of pediatrics at the University of Washington, and the lead researcher of the study published in the American Journal of Preventative Medicine (2012) entitled “Obesogenic Neighborhood Environments, Child and Parent Obesity: The Neighborhood Impact on Kids Study,” Dr. Saelens further stated that, “Everyone from parents to policymakers should pay more attention to zip codes because they could have a big impact on weight.” Both of these theories are significant, as they may hold new answers, which will allow us to better understand how America’s weight issues can be resolved.

Assessing Weight Loss Companies: A Nutritionists Perspective

Weight Watchers: Founded in 1963 by Brooklyn homemaker Jean Nidetch, Weight Watchers has undergone several re-brandings over the years, which has now acquired stellar talent representatives, such as Jennifer Hudson and Charles Barkley (“Lose Like a Man”), so who wouldn’t want to join? After all, the entire nation bore witness to both shedding pound after pound, and are now donning slim physiques. The company’s slogan is ‘simple,satisfying and smart,” which has paid off smartly by appealing to one’s taste buds. Of interest is the noticeably absent calorie counting, which has been replaced by their Points Plus Program, and is based on height, weight, age and gender. How it works; processed foods sport the highest points, with nutrient dense foods holding the least. This plan encourages a person to eat more of the latter. For example, you’re allotted a certain number of points per day to keep you on track with your weight loss goals, therefore choosing nutrient dense foods will allow you to comfortably keep your goals on track.

Pros: The program is easy to follow, with oodles of support by way of weekly meetings via in person and on line. Additionally, they offer up an entire cadre of tasty well thought out recipes, which are easy to prepare. Some of the other perks are; phone apps, exercise & fitness tips, as well as resources for preparing foods, and how to navigate through restaurants.

Cons: Prices range from $49-65., depending on whether you sign up for a month, a trimester, or lifetime membership. Although, I listed this factor as a ‘con’ I would encourage people to view this as an investment in their health, rather than just money out the window. Additionally, I’m not a fan of any pre-packaged meals—which Weight Watchers has no end of, including a cadre of deserts. Primarily, because they fall short of complete nutrients and are typically infused with numerous additives and stabilizers that a body doesn’t need. For example Nutrition Data has given the Weight Watchers Pre-packaged Turkey Medallions with veggies and rice a score of 18 out of 100 for the completeness of that meal, which is rather low. Moreover, numerous additives in foods and beverages have been linked to an increase in Diabesity® a term coined by Dr. Mark Hyman, M.D., who states “ being overweight, obese and or having diabetes are all 100% preventable and reversible.” From a nutritionist’s point of view, the best place to start is your kitchen—replace the processed with whole fresh foods—and invest in cooking classes. From my perspective, Americans have relied so much on fast and packaged foods, that they’ve lost their way when it comes to knowing just the basics about cooking. However, if you stick to the recipes that Weight Watchers offers and stick closely to their recommended portion sizes, you’ll be fine.

The Take Away: Attend a meeting first to see if their philosophy is a good fit. Speak with others at the meeting and find out what they’ve liked, as well as disliked. Moreover, seek out those who have been really successful at meeting their goal, and find out how they accomplished it. In general successful people want to share how they got there.

For more info log onto: www.weightwatchers.com

Dean Ornish Heart Healthy Plan: Originally designed to quell heart disease by way of a primarily vegetarian meal plan, the bonus here is that weight comes off too! The principal philosophy imparted by the plans’ namesake, Dr. Dean Ornish, M.D., is “love thyself” and what a beautiful concept to have as part of a healing program. Now in its 3rd decade, the Ornish plan has undergone revisions in its meal plans and theme. However, Dr. Ornish has stuck to his vegetarian roots, which have been a cornerstone since the plans inception, and continues to be the focal point for reversing heart disease.

Pros: The Ornish plan has a hefty success rate for those who need to harness their southbound cardiovascular issues. The vegetarian recipes and meal plans are very tasty. As such, a person’s compliance rate will remain high and thus success will ensue. Currently there are two programs both of which “encourage people to make healthy and sustainable lifestyle changes.” The Spectrum Preventable Program and the Spectrum Reversible Program both arebased on what you eat, how you respond to stress, the amount of exercise you get, and how much love and support you have— all of which are considered benchmarks for healthy life. If you’re lacking in one or more of these areas, these programs and their facilitators will help you bridge the gaps.

Cons: For those who are carnivores, this plan may be a bit difficult to follow. However, the pay-off will be tenfold health wise, if you opt for diligence and follow it.

The Take Away: Review the plans’ overall theme and food recommendations to see if it will fit your lifestyle. However, for those whose lifestyle choices have led to high cholesterol, heart attacks or any of a number of cardiovascular diseases, then this may be the plan for you.

For more information log onto:
http://www.pmri.org

The Most Controversial
The Hcg Plan: Hcg is short for Human Chorionic Gonadotropin, which is a hormone that the placenta produces after pregnancy begins. Thanks to Dr. Oz giving it air time on his show, Hcg has once again hit the revival button. Implemented in the 1950’s by British endocrinologist Dr. A.T.W. Simeons, the Hcg program has managed to ebb and flow within the celebrity circuit for years, recommended primarily as a ‘quick fix’ for those Red Carpet moments. Hcg is used primarily to quell hunger and has the added benefit of imparting feelings of wellbeing, all without being a stimulant. The American Society of Bariatric Physician’s has issued a position stand on the use of Hcg stating that although it doesn’t agree with the use of it for weight loss “no significant adverse effects of Hcg injections have been documented in the literature 5.” Most of the opposition appears to be due to the very low calorie diet (VLCD) which the naysayer’s state is the ‘only reason weight loss takes place.’ Another issue the opposition holds; is that the daily protein requirements are lower than what is safe to have on a weight loss plan. Certainly a viable concern during any weight loss program is muscle wasting, due to the individual’s daily protein needs not being met. However, if you have knowledgeable nutritionists and physicians who know how to calculate protein needs which should be geared to the individual, and not based solely on the RDA, then muscle will remain intact and a healthy rate of weight loss will incur.

Unfortunately, there has been a lot published in recent years maligning Hcg. However, in reviewing the litany of articles and studies, none have bothered to interview physicians that have increased the calories and met with patient’s success while implementing the Hcg plan. According to Dr. Mark Stengler, N.M.D., who has utilized the Hcg for over 6 years, “I generally begin patients at 660 calories per day. Certainly, there have been numerous cases where I’ve held the person on 800-1200 calories due to the physicality of their job and stress levels, height, weight, as well as other individual nuances 6.” Common sense would dictate that with any weight loss program, adjustments up or down within a person’s meal plan, have to be made. Otherwise patient compliance will be low and the failure rate will be high.
Pros: If patients are monitored closely for adjustments to their meal plan, and not started out of the gate at 500 calories per day, this can be a beneficial program for those who need to lose 30+ pounds-to the morbidly obese.

Cons: The low calories do not allot for any exercise above brief periods of moderate walking, although there are those who have continued exercising with a higher calorie count per day and have lost weight. Certainly, cost can be a deterrent, as a 30 day supply, either sublingual or the traditional injection form will run anywhere between $650-$1500, which includes an initial office visit and follow up appointments. Lab fees would be an additional charge. There have been reported side effects ranging from vivid dreams, dizziness, and headaches, to name a few. According to Dr. Mark Stengler, N.M.D., “some of these side effects such as the headaches can be traced back to the body detoxing, as fat holds a lot of toxic debris, and therefore, as fat is shed, the toxins will shed and be released6.”

The Take Away: The Hcg plan needs to be viewed as a short term jump start for weight loss. Make sure you find out who will be monitoring you and how often. Weekly follow up meetings for support and tracking are tantamount to any successful well run weight loss program. Moreover, find out what the medical directors’ philosophy is on making adjustments to your meal plan ahead of time. If their prevailing view is ‘just tough it out,’ then I’d recommend looking elsewhere. This is not for those who are on a regular frisky exercise program, as cutting 40%+ calories per day would be contraindicated. According to Dr. Ben Gonzalez, M.D., of the renowned Atlantis Medical Wellness Center, “Patients must be evaluated and followed by a medical provider, which includes a prior health screening to determine if they’re is suited for the Hcg protocol 7.”

For more information log onto:
http://aestheticmedicinenews.com/hcg-in-medically-supervised-weight-loss-programs.htm

The Dukan Plan: Developed by French Nutritionist Pierre Dukan, this program’s claim to fame is” you can eat anything you want”—-well—kind of. This is the plan that Kate Middleton—of British monarchy fame— used to drop gracefully into her royal wedding gown. Allegedly, there are 100 foods you can eat, 72 meats and 29 plant based foods. The Dukan plan is divided into 4 phases. The first is The Attack Phase, a brief a period which boasts to reward the participant with immediate weight loss results. During this phase, the diet is made up of 72 high-protein foods enabling “quick weight loss.” The second is The CRUISEPhase, which can lead to a person’s True Weight. During this phase, the diet alternates Pure Protein days with Vegetable days. Phase three is TheCONSOLIDATION PHASE that consists of 10 days, where the desired amount of weight is lost, and prepares a person for the return to a balanced diet. However, the only way a person will be able to return to a balanced diet is if they know firsthand what one is. According to their web site—“There is monitored freedom with a target of establishing this freshly conquered and still vulnerable ideal weight.” This phase sees the gradual return of pleasurable foods with two festive meals. The fourth phase is The Stabilization Phase, which they claim is the easiest and most essential phase to their ‘slimming method.’

Pros: A quick fix that is intended to be a jump start for weight loss. The plan includes and encourages what most are not eating these days—vegetables. The sheer simplicity of the plan with its broad yet seemingly endless selection of foods would be very attractive to many.

Cons: The amount of animal protein over the course of a week –sans other foods. The open admittance (on their web site) that “95% of people who follow a diet put back on the weight they have lost,” does not offer up a warm and fuzzy feeling. However, this is not a plan that would be easy to do for most people past 2 weeks, due to the nonexistence of grainy carbs and fresh fruit. Another downside is there’s no long term plan for lifestyle changes such as incorporating a fitness plan and teaching people what constitutes nutrient dense whole grains carbs, such as quinoa et al. Moreover, there’s no accountability for tracking the amount of food one consumes, after their off the Dukan Plan. Without a maintenance plan to follow, the weight will invariably trot back on.

The Take Away: Review what the plan entails before buying into it, and know that this is a short term weight loss plan. This one is not big on imparting how to employ healthy lifestyle philosophies.

Pivotal Philosophies

On the horizon are two philosophies which go completely against the grain of current nutrition and dietetic practices. Both include a form of calorie denying, one is called Calorie Restriction (CR), and the other is a form of abstinence, dubbed Intermittent Fasting (IF). Both researchers and health professionals are taking a closer look at the studies, and so far the data for both have repeatedly demonstrated improved health, with biomarkers to back it up.

Calorie Restriction (CR): The concept was founded by Dr. Roy Wolford a professor of pathophysiology at U.C.L.A. circa 1975, and is based on “replacing calorie-dense foods with calorie-sparse, nutrient-dense foods,” which is certainly a sound principal that more people need to live by. The CR society advocates avoidance of simple sugars (i.e. white flour products), as they are devoid of nutrient density, are high on the glycemic index scale, and chalked full of calories—in other words—low grade fuel for your body.

Unfortunately, most of what the CR Society rests its philosophy on is the Wisconsin Primate Research Study that ended in 2009 which has largely been dismissed. Primarily due to the unhealthy diet, the monkeys were fed (38% sucrose), as well as the animals were free feeding daily throughout the study—hardly calorie restrictive 8- 9.. However, there are enough well done studies on a variety of species that all suggest that inhibiting calories does extend life, as well as the quality of life. In a recent study headed by lead researcher Julie Mattison, and published in the Journal of Nature (2012), suggested that nutrition composition was much more important than reduction of calories in the healthy ageing process 8- 9. This 30 year study found that biomarkers for cholesterol, triglycerides, insulin and diabetes all improved with a measured amount of healthy food. Moreover, there remains numerous studies spanning a decade or better that all have the same or similar outcomes in respects to favorable biomarkers being improved, along with sustained longevity. Additionally, the CR Society recommends a battery of tests that people should run, while they’re participating in the CR plan—these are listed on their web site.

According to Dr. Leonard Guarante, a professor of biology at M.I.T who heads the Glen Laboratory’s Science of Ageing, “We really didn’t anticipate that the science would break this way—it wasn’t obvious that there were anti-aging genes—sirtuins—that you could take advantage of—which are there to with stand stress… lean periods when there wasn’t a great harvest.” In other words, what researchers found during these studies, was an increased amount of anti-aging genes popping up due to the low ebb of food availability. These results are significant for several reasons, namely were living longer, but not necessarily better. Certainly, the concept would have applications for those who are overweight, as biomarkers such as blood pressure, insulin, and weight, drastically improved across the board throughout all of these studies.

However, the concerns I have as a health professional are misinterpretations of what calorie restriction is and isn’t for humans—which to recap needs to be based on the individual’s needs—and assessed accordingly. Most of the studies have backed the daily calories down by at least 40%—which if you looked at most weight loss plans, is what has been implemented. (If a person is consuming 2000 calories of predominately junk food, replacing it with nutrient dense foods, by way of a 1200 calorie plan—that would be cutting calories by 40%.) However, in the real world, many C.R. advocates determine a time during their day to eat, which can be up to a 6 hour window—and then shut down their foraging until the next day during that window of opportunity. Concurrently, many of these studies have successfully mimicked this eating pattern.

For more information log onto: 
http://www.crsociety.org and www.leaonardgurante.com

Intermittent Fasting (IF): Another interesting concept that has been gaining traction over the past couple of years is intermittent fasting (IF), which entails anywhere from 1-3 days per week of fasting. The concept now has some viable research to back it up. Recently, Dr. Satchidananda Panda, an Associate Professor in the Regulatory Biology Laboratory at the Salk Institute, whose research focuses on the effect of the biological clock regarding the behavior of metabolic pathways, stated that, “scientists have long assumed the cause of diet-induced obesity in mice is nutritional; however, our discovery shows that the spreading of caloric intake through the day may contribute, as well, by perturbing metabolic pathways governed by the circadian clock and nutrient sensors. For decades, our society has focused on calorie in, calorie out, exercise and eat healthy, however, this is a novel study that has shown when we eat could be just as important as what we eat.” So, when we eat, as well as what we eat are important concepts that most savvy nutritionists teach their clientele—the research and the reality are finally matching up.

Certainly, at the mainstream academic level, budding nutritionists and dieticians are taught that for weight loss and health purposes, eating throughout the day, or grazing is best, as it doesn’t overload the system, and thus bringing a person’s weight down, will be much easier. Yet according to Dr. Andrew Weil, the practice of eating throughout the day has had dire consequences for the majority of the population. “These extra small meals aren’t vegetable intensive home cooked ones. These days they are likely to be ‘energy bars, which are a euphemism for candy bars, or unhealthy snack mixes. In-other-words, high glycemic-load processed snacks.”

The glycemic index, and moreover the glycemic load of foods, are what needs to be kept in balance in order to keep weight in check and inflammation down. The key for any well thought out meal plan is a balance of protein, carbs, fats and fiber—good fats Omega-3’s and unprocessed carbs. He also added that “when people are told to eat many small meals, what they actually hear is eat all the the time”—which he asserts, “could be translated into compulsive eating.” Additionally, Dr. Weil feels that it’s been no coincidence that obesity rates began rising in the 1980’s with the ‘eat frequently’ slogan—which simultaneously was combined with the “government’s scientifically shaky endorsement’ to inhale low fat foods—of which the U.S. population quickly turned to carbohydrates —and lots of them

Conclusion

America has no end to weight loss centers, diet products, books and philosophies. Make sure when you’re shopping for one of these that you assess if their program meets what you had in mind, as well as how it will fit into your lifestyle. Remember, it’s your money—ask the tough questions and learn to interview them!

From a nutritionist’s perspective, it’s frustrating for me to see the annual statistics— as year after year, the U.S. continues to lead the skyrocketing global obesity rate. We as a nation have to come together to help those that need to loose—or we’re all going to lose. Not only monetarily, to the tune of 270 Billion in annual health care costs, which are directly related to being overweight, but to the ethical consequences of losing more than one generation of children to the obesity epidemic. Small steps can make such a big difference–such as replacing one processed or packaged item in your pantry with one item that’s whole grain or gluten free. Repeat this once per month.

If you’re not exercising begin walking 10 minutes per day and increase it by 10 minutes each week. By the end of one month you’ll be walking 40 minutes daily. Make sure to get a physician’s clearance if you are under their care. We can all become agents of change………… for the better, if we start small and aim for big changes in the future.

 

References

 

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