We are all aware that overeating and excessive weight gain are bad for us. I've often had patients say to me, "Doc, I know that the food is killing, but I just can't not eat it. I am driven to eat, as hard as I try not to." If you can identify with this problem, if you think you weigh too much, or if you think your child weighs too much, this article is for you.
Weight Gain as Addiction
Section titled “Weight Gain as Addiction”Several studies have shown similarities between excessive weight gain and methamphetamine addiction. Both addiction and obesity affect the dopamine receptors in our brain, receptors that give us a sense of well-being. Normally, our daily activities are enough to keep these receptors happy. Taking drugs over-stimulates the receptors so that they decrease in number. Without healthfully functioning dopamine receptors, feelings of contentment don't come naturally. Eventually the addict cannot feel normal without the drug.
Unfortunately, the same thing happens with weight gain. The heavier a person becomes, the more these dopamine receptors disappear. After a while, in order to feel somewhat normal, even for a short time, the person must eat.
No wonder there are thousands of articles reciting the dismal statistics and giving this or that advice that everyone knows is difficult to follow. Reading these articles is like trying to watch a football game with great cheerleaders, but you can't see what's going on in the field or which team is winning.
Study of Success
Section titled “Study of Success”Finally, there is a look at how the teams do on the field, a report on what success looks like. The National Weight Control Registry keeps statistics on people who have been successful at weight loss and weight maintenance. These university investigators don't just take the participant's reports about successful weight loss; they require documentation from medical or other official records. They give no advice to participants; they just collect information on weight, health, and lifestyle choices. Currently they track about 4500 individuals. People must maintain a weight loss of at least 30 pounds for at least a year to qualify for the study. As a group, these individuals have lost an average of sixty pounds and kept it off for an average of five years.
That meets everyone's criteria for success, yes? So, how did these people do it?
Any Diet Works...At First
Section titled “Any Diet Works...At First”About half did it on their own without formal outside help; half took advantage of some formal program. They reported using a wide variety of methods, but most used both diet and exercise. Apparently almost any type of diet, faithfully followed, was effective.
Maintaining Weight Loss
Section titled “Maintaining Weight Loss”Weight loss and weight maintenance are two quite different animals. As many people tell me: weight loss is easy; weight maintenance is hard. How did these people maintain their weight? Here's what the researchers found.
1. There are no metabolic differences between this group and ordinary overweight people. Apparently, what separates those who fail from those who succeed is not their genetic makeup.
2. People successful at maintaining weight loss had two things in common: they restricted calories and kept a low percentage of fat in their diets. Participants ate a diet containing about 24 percent fat. Total carbohydrates were fairly high. (Word to the careful reader: A celery stick and a potato chip both count as carbohydrates, but have quite different effects on weight maintenance!) Investigators estimated the participants' total calorie consumption at about 1800 calories per day. Were there some differences? Sure. Some participants reported using lower carbohydrate diets, but all maintained fat at less than 30 percent of total calories and all restricted total calories.
3. Most of these people ate breakfast every day, often cereal and fruit. See my favorite healthy breakfast recipe below.
4. People successful at maintaining weight loss kept their eye on the ball. Three-quarters of them weighed themselves at least once a week; about one half weighed daily. About half still counted calories when needed. They allowed themselves a three-to-five pound variation around their target weight. They had a strategy to use to reduce weight if their weight went out of the desired range, and they used that strategy promptly.
5. Over nine out of ten participants exercised regularly, averaging an hour a day of moderately intense activity, equivalent to walking 28 miles a week. Walking was the most common form of activity, but three-quarters engaged in other activities, such as cycling, weight lifting, aerobics, running, and stair climbing. Most weight-loss counselors recommend using a step-counter (available at many pharmacies and sporting goods stores) and working towards a goal of 10,000 steps per day. This group reported an average of over 11,000 steps per day. This compares with 3000 to 5000 steps per day in people who had not yet started a weight loss program. Program investigators believe that once a person has become overweight, it takes more exercise to maintain weight loss than it would have required to prevent the original weight gain.
6. Lest you think that preoccupation with weight and calorie counting can lead to eating disorders, the researchers found that not to be true. These people had a low incidence of eating disorders and depression, both of which can reduce weight but at a serious overall health cost. Conclusion: lifestyle changes to maintain a normal weight require attention to eating, but do not increase risk of pathologic behaviors.
7. Weight maintenance became easier after the first two to five years. After people get their weight under control, their dopamine receptors grow back and states of well being become easier to attain. I am reminded of the alcoholism counselor who told me that it took about three years for self-identified alcoholics to become comfortable with a life without alcohol. Could this be true of major life changes in general?
Useful Links
Section titled “Useful Links”You can learn more about the National Weight Control Registry study at http://www.uchsc.edu/nutrition/WyattJortberg/nwcr.htm
You can buy a step-counter and a book about its use at http://www.coopercomplete.com/store/detail/211.php
We have more weight-loss information on our website at /health-information
Not Perfect, Still Healthy
Section titled “Not Perfect, Still Healthy”You weigh 220 pounds and you are 5 feet 9 inches tall. You'd like to get down to 170, in the normal weight range. You lose down to 190 pounds. You exercise vigorously for an hour a day. You eat wisely. You walk 10,000 steps per day. It has been two years, and your weight wanders up and down around 190, twenty pounds short of your goal.
Have you failed?
No, you have not. You are much healthier than you were two years ago. You have greater muscle mass, a more rapid metabolic rate, and a better supply of nutrients from your diet. You have dramatically lowered your risk of colon cancer, diabetes, heart disease, high blood pressure, and high cholesterol.
You are healthy at your weight. You have succeeded at losing significant weight and keeping it off. Before you "pooh-pooh" this idea, put a thirty-pound pack on your back and carry it around for just one day.
Moreover, if you exercise regularly, but don't get in an hour a day, you are still doing yourself plenty of good. Research shows that people who exercise for half an hour a day five days a week have half the death rates of those who exercise least. Certainly, more is better, but those first two and a half hours are the most valuable exercise hours of the week.
Summary: be proud of your achievements as well as your plans.
Helping Overweight Children
Section titled “Helping Overweight Children”Since losing weight and maintaining the loss is difficult, parents can do their children a favor by preventing the problem. Here are some actions you can take to reduce the risk of your child gaining excessive weight
- Don't buy sweets and concentrated carbohydrates such as breads, pasta, and potatoes. Don't keep them in the house. Complex carbohydrates such as fresh vegetables and whole grains are excellent. Make them available to your child.
- Prepare foods from our "Best Foods" list.
- Decide if having a TV set in the house is worth the price your children are paying for it. Childhood obesity has been linked to excessive television viewing.
- Integrate exercise into your lives. When driving somewhere in the car, park some distance from your destination and walk with your children. If they are sitting around the house, make them "go outside and play."
- Respond to "I don't have anything to do" by enlisting their help around the house, the more active the chore, the better. They'll become better adults.
- If you need help with parenting, get some coaching from a skilled mental-health professional, your pastor, or your physician. Don't be shy; we all know that parenting is not easy.
My Favorite Breakfast Recipe
Section titled “My Favorite Breakfast Recipe”Whole Grains with Ginger and Fruit
Section titled “Whole Grains with Ginger and Fruit”3/8 cup whole oats, barley, or rye
8 slices fresh ginger
1 cup of water
cut fruit as desired
The grain should be whole grains: not rolled, not steel cut, but whole. The grain may be labeled "oat groats" or something similar. The grain should be brown and about the size of a rice grain or slightly larger.
Simmer in the grain and ginger slices in water for 25 minutes.
Spoon into a bowl and add cut up fruit such as apple, pineapple, orange or peach.
Enjoy!
Correction!
Section titled “Correction!”The article we referred to in our mid-September note (about online evaluation of physicians) was withdrawn from free circulation by the time we published our newsletter. The article reported that an embarrassing number of physicians have objected, often in court, to websites that allow patients to share criticisms of physicians. It also pointed out that some sites have been able to avoid litigation and permit people to share their ratings of physicians, such as one at http://ratemds.com/index.jsp .
CJK January 23, 2006