Keeping off the weight

I officially start the maintenance phase of my diet tomorrow. Thirty pounds of my body has been converted, principally from fat to energy. Curiously, in the process of losing those thirty pounds, I have avoided regular exercise. Whereas, when I was gaining weight I was in the gym three times a week or so doing aerobics and lifting weights, all to stay “healthy”. Exercise was probably good for my cardiovascular system as opposed to doing nothing. However, exercise was a bad way to think I could lose weight. To the extent it made me hungry and caused me to gain weight, exercise was bad.

For me, the value of exercise came from reading Jim Fixx’s book on aerobics. Aerobics opens more blood vessels, and that means you require more energy for the same amount of body mass, which means you need more calories. The exercise pros know to have that protein bar before starting exercise, so you don’t tend to crave food afterward. However, I saw eating food in general as “bad” as it was “calories” so I avoided eating before exercise. Sometime after the exercise was over my body noticed my blood sugar was low, so it sent me eating. Unsurprisingly, this often meant eating more in calories than I had just burned off. This silly strategy of mine recalls the legend of Sisyphus, who was doomed to repeatedly push a rock up a mountain knowing that at some point it would tumble back and he’d have to do it again. Using exercise to lose weight is a lot like that.

I’m not suggesting that exercise is unimportant. Doctors recommend regular exercise because it promotes cardiovascular health and body integrity. However, it’s based on the assumption that you are already at a normal weight. It’s not a bad thing to have muscle mass. It came in handy recently when I had to haul my daughter’s crap from Richmond back home (she finally got her degree!) and never once panted. Yet most of us are not laborers, farm hands or professional movers so we probably don’t need a lot of well-toned muscles. Mind you looking like one is not bad, if that’s your thing. I find it is curious that the weight lifters I mostly see at the local Gold’s Gym are obese. Yes, they have a lot of muscles but they also have large rolls of fat.

My takeaway from this weight loss experience is that to lose weight you should avoid exercise. Losing weight is really about calorie reduction. You don’t want to give into temptation, and exercise is likely to make you hungry, and thus you are likely to cheat. Moreover, diet marketing is mostly full of bullshit in an attempt to sooth your anxieties by parting you from your money. Any diet will take off the weight if you have the constitution to stick with it. Few though will work with your body rather than against it. Almost all of them will set you up to put the weight back on. Having just taken off thirty pounds, I remain skeptical about the long term success of the Ideal Protein Diet I used to take off the weight, particularly as I add back into my diet fats and carbohydrates. But at least their maintenance strategy makes sense. It helped me cut through a lot of the dieting bullshit.

Most of us Americans have gotten the message that the Western diet is bad. We know we should not eat a lot of junk food, and that stuff we do eat like pizza generally is not good for you. What almost no diet will tell you though is that a calorie is not a calorie. All calories are not created equal. Your body needs both fats and carbohydrates to maintain a healthy weight. You are doomed to fail if in your maintenance phase you do not get some of both, like the Atkins Diet. You just need to keep them apart. Put them together and you are asking for a heap of trouble. Basically, you are back on the Western Diet.

There are so many zillions of diet strategies and ideas out there it’s really hard for anyone to tell the good ones from the bad ones. From painful experience I can now recommend an article, one of the one percent or less of diet articles that actually imparts some useful information. Go read it. This is what happens when you eat carbs and fats together, at least in significant quantities. This is why it wasn’t a problem in the past. Most importantly, once you take off the weight, this is how you keep it off. Don’t mix the carbs and fats. You need both, just don’t put them together. Enjoy a nice Caesar salad for lunch but easy on the croutons. At dinner, have a plate of spaghetti but go easy on the cheese. Your liver will be much happier. It will be very confused if you throw them together, and it will attach the byproducts to your waist.

Americans like knowing that they should eat fats and carbohydrates. The part we overlook though is that the body also needs proteins and vegetables. What you need is a healthy balance of all four food groups. Every meal except maybe breakfast should include a vegetable or two. Every meal should also have a protein. These foods are essential to maintaining a healthy body, plus since they are relatively low in calories they will make you feel fuller.

So pick the diet of your choice to take off the weight. But to keep it off:

  • Protein at every meal
  • Vegetables at every meal but perhaps breakfast
  • Make one meal fat heavy and carbohydrate light
  • Make one meal carbohydrate heavy and fat light
  • Preferably, eat vegetables and proteins first
  • Watch your portions
  • One to three small snacks during the day will keep you from getting cravings

Resume exercise after you have lost the weight. Aspire to be an athlete or weight lifter only if that is your passion. Otherwise low impact aerobics like walking is fine. Lifting weights once a week or so is probably a good way to keep the muscles tuned as well.

If you have struggled keeping weight off before, I hope that I have saved you thousands of dollars and a lifetime of misery.

The plate of brownies diet test

The worst thing about going to the doctor is not when they tell you that you have incurable cancer. It’s when they put you on the scale. I don’t want to know how much I weigh so I don’t peek, but doctors care. They are obsessed with weight, body mass indexes and other warning signs like blood pressure and cholesterol levels.

It seems that once again I have succeeded in taking off weight and then slowly but incrementally putting it back on again. Here I am hardly unique. In fact, it is hard to find the case of someone who after taking off large amounts of weight doesn’t put it back on again.

Permanent weight loss after decades of being overweight or obese most of the time is actually quite hard. Given our ever-expanding American girth, it seems like Mission Impossible. It is made harder by the tons of disinformation about healthy eating and weight loss out there, plus the heaping doses of guilt you absorb. You would think with all the money spent by the National Institute of Health they might have a study that would indicate the most effective ways of losing weight and keeping it off. Even if there were such a way, most doctors operate on the illusion that weight loss is handled through a one size fits all solution. “Eat less and exercise more,” is basically what they will tell you.

In fact, I had been eating less and I get plenty of exercise. While I get vegetables and lean meats on a daily basis, I clearly have been eating too many carbohydrates, which my body promptly turned into fat. This comes in part from exercise, which burns blood sugar and makes me crave carbohydrates. The Dark Chocolate M&Ms addiction has also contributed to my carbohydrate problem. Anyhow, my cardiologist felt the need to give me a stern lecture about my weight last week.

“Look doctor,” I told her. “I’m good at taking weight off. Like most Americans, I have done it lots of times. The only problem is keeping it off. I don’t want to waste my time with another trip to Weight Watchers when their success rate is as miserable as anyone else’s in the diet industry.”

This doctor though was prepared. Cardiologists see lots of overweight and obese people. They deliver this lecture dozens of times a day. Apparently this practice got so sick of not having any real solutions for their patients that one of the practice doctors decided to do something about it. He thoroughly researched the problem and then set up a clinic down the hall from their office. “If you want to take weight off and keep it off, go see them,” she told me. So I did.

Of course, what I really wanted was a diet where I could literally have my cake and eat it too. Every dieter wants a painless weight loss plan. We particularly want one that requires us to eat lots of easily processed sugary carbohydrates. Of course, no such plan exists that actually works. Lots of plans, including Weight Watchers’ newest one, wants to convince you otherwise. Weight Watchers has a relatively new “Fruit is free” plan. Their market has always been “eat what you want, just a lot less of it.” The new plan lets you eat as much fruit as you want but ups the points on everything else. You can lose weight if you follow their plan. But more than likely because your carbohydrate addiction craving has not really been solved, you will put the weight back on. It’s not bad for their business model. You reenter the program, take the weight off again, and their cash registers go ching.

Thus I found myself yesterday talking to my new diet coach at The Healthy Weigh Now down the hall from my cardiologist. While the doctor in charge and the nurses and coaches there actually work for the cardiology practice, the program they are following is really the Ideal Protein plan. No fruit allowed on this plan, or pretty much anything in the way of carbohydrates. Not much in the way of calories either. The plan is 900-1000 calories a day. It’s no surprise then that those who follow the plan take off weight, and quickly. Women lose on average 2-3 pounds a week; men 3-5 pounds a week.

This plan stuffs you with vegetables, but also “ideal” proteins. To burn fat, you must first use up sugar in the blood. The body will then turn to muscles for energy and finally resort to burning fat. Their “ideal” protein supplements keeps your muscles from losing muscle mass and convinces your body to instead burn fat. And so it goes if you can stick to the diet.

The first twenty-four hours has been a bit challenging but not too difficult. I find myself mildly hungry for much of the day, but that should pass in a couple of days. “Meals” though stretch the definition. Two out of three meals come from their prepared food packages, which are often powders combined with water. There is a daily snack from one of their approved snacks. All emphasize protein. Dinner consists of eight ounces of lean protein and certain vegetables. There are also numerous vitamin supplements, olive oil, fish oil and lots of water to drink. The food categories so far taste better than I thought, but calling a half glass of fruit flavored high protein “juice” a breakfast is a bit much. Just follow the protocol, they tell me, and those pounds will quickly disappear. “You will soon be punching new holes in your belt,” they assured me. It just works.

And I am confident that it will make me lose weight quickly. So I have really only one question: will my body rebel and I find myself at a Dunkin Donuts scarfing down boxes of French Crullers, the food I would prefer to eat?

If so then comes the real challenge: keeping the weight off for good. Here is where the plan will hopefully succeed where others have failed, as I transition from Phase 1 to Phase 2 and eventually all the way to Phase 4, with a doctor and coaches weighing and watching and adjusting and advising all along the way.

When I can pass a plate of brownies at the dessert bar without instinctively wanting to reach for one of them, that’s when I know I will have succeeded.

Real Life 101, Lesson 15: Dieting, Fitness and Nutrition – do you know the difference?

This is the fifteenth in an indeterminate series of entries that provides my “real world” lessons to young adults. It is my conviction that these lessons are rarely taught either at home or in the schools. For those who did not get them growing up you can get them from me for free. This is part of my way of giving back to the universe on the occasion of my 50th birthday.

(Note: If you like this, you might also like Lesson 7 and Lesson 11.)

Young adults, you cannot get online without see articles on dieting, fitness and nutrition. Do you know the difference?

I confess I find it confusing at times. I know people think dieting must make them healthier. It can, but it can also make you sick. In some cases, if done without medical supervision, it can even kill you. So dieting is not necessarily healthy. I also know people who eat very nutritiously and yet it hasn’t made them any healthier. In addition, I know people who get plenty of exercise yet who are unhealthy. All these practices contribute to good health, but none of them guarantee health. Each has their pitfalls and misconceptions. Voluminous media reports on the latest scientific studies only muddles answers. I may be able to help you see through the mist a bit.

Let’s start with dieting. My bet is that any one time, most Americans are either on a diet or wish they had the willpower to go on a diet. They want to lose weight because the media drums it into them that being overweight or obese is unhealthy. They figure: if I can get to a normal weight, I’ll be healthy!

This is not necessarily true. I see many skinny things that are not healthy at all. Maybe it is because they smoke, take narcotics, are anorexic or never exercise. Having normal or below normal weight does not mean you are healthy and dieting to achieve a normal weight may or may not leave you healthier. You can be morbidly obese and still be healthy, with low cholesterol and blood pressure. However, a normal weight combined with good nutrition and regular exercise dramatically raises the probability that you will enjoy a healthy and a long life. Yet, there are never any guarantees. Even the healthiest person can contract a cancer or pick up a virulent infectious disease. Dieting alone is not a solution to your health. It is one of many means that may allow you to be healthy.

A legitimate diet followed rigorously will lower your weight. Nothing else is guaranteed. Losing weight is simple, but not necessarily easy. You must burn more calories than you take in. Diet plans merely offer different approaches for losing weight, but they can only succeed if you burn more calories than you ingest. Losing weight is often associated with reducing blood pressure and cholesterol levels, among other welcome changes, but there is no guarantee that these healthy goals will be achieved by losing weight.

Dieters often make the mistake of thinking they can lose weight by exercising more while they diet, reasoning they will burn more calories and thus take off weight more quickly. The research is now compelling: exercising has a number of healthful benefits but it may defeat your attempts to lose weight, at least if done to excess. If you do a lot of heavy work, like chopping wood, your blood sugar is lowered. This may cause your body to taunt you to eat more food to make up for the extra calories you burned. You may end up healthier from the exercise but your diet may fail. Over the years, I have experienced this, and I have seen it happen to too many of my friends as well. If you really want to lose weight, I would avoid the heavy cardiovascular exercises until after I was at my desired weight. Especially if I were obese, I would check with my doctor first about doing any heavy cardiovascular exercises.

Exercise, while a healthy practice, is actually a very inefficient way to burn calories. The vast majority of your calories are engaged in a much more Herculean task: maintaining your body. How inefficient is exercise? Men’s Health Magazine recently estimated that to consume a popular six hundred calorie entree, you would have to walk the stairs from the ground floor of the Empire State building to the observation deck twice. So counting calories to lose weight is much more effective than vigorously exercising and dieting, as it is more likely to succeed. Choosing mild, moderate or even no exercise is probably more effective at succeeding at dieting than heavy exercising. The most effective way to lose weight is actually simple: consume many measured, small mini-meals during the day so you never get hungry.

Is there a point to fitness given that it may not help you lose weight? Yes! Assuming you are exercising correctly, not overdoing things and not overly stressing joints and such, you are likely to have fewer aches and pains, you will feel a lot better and will have more energy to engage in life. If it’s been a long time since you have felt that way, you will be amazed how wonderful you will feel after a couple weeks of moderate exercising. In fact, the value of exercise arguably increases with age. What is the key factor for living to ninety and still being in good health? Good genetics certainly helps, but falling is what often kills or disables old people who haven’t succumbed to other disease. What causes most falls? It is a lack of exercise, both walking religiously and strengthening the muscles that maintain your balance, such as your thigh and hip muscles. My father, age 84, remains an avid and religious walker. He may be 84, but he goes to the gym regularly. That he walks without a stoop is proof of the value of regular exercise late in life.

While exercise is in general good, exercise is vastly improved by marrying it with good nutrition. Eating healthy while not exercising and being obese may help a little, but if you suffer from problems like high blood pressure, it is likely not a cure. As I mentioned in Lesson 7, nutrition is about giving your body the right stuff so that it can work optimally. If you are overweight or don’t exercise, it may make symptoms like adult diabetes less chronic, but it will probably not solve the problem. Proper nutrition does help you think clearer, feel better about yourself and aids all parts of the body.

Putting this all together: diet to lose weight but as a part of a plan to keep yourself at a healthy weight for life. Yo-yo dieting is not healthy, and may be worse than not dieting at all. Exercise to feel better and so that you can live a long life with minimal health issues. Eat nutritiously so that your body is primed to work optimally.

While these are foundations to health, there are also many other factors that contribute to health. Washing your hands regularly, flu shots, dental checkups, physicals, getting eight hours of sleep a night and avoiding many of the preventable stresses in life, like toxic bosses also contribute enormously to your good health. Your goal should be optimal mental and physical health. All these strategies help achieve it but none of them by themselves guarantees it.

My sad prediction for today’s “biggest losers”

My blog seems to be on something of a health kick lately. This is because over the last year I have been dealing with more than my usual number of health issues. It’s not just me. This week, my mother in law complained of chest pains. Doctors found a blockage near her heart and put in an emergency stint. She then suffered a heart attack that was followed a day later by another and worse heart attack. She was technically dead for ten minutes until they finally managed to restart her heart. She is still in intensive care and is delusional, a condition I saw my own mother go through since she also suffered from congestive heart failure. Her long-term prospects look dubious, but she is about eighty years old. She is fortunate to be alive in any condition, because she made lifetime habits of smoking and not exercising. My wife plans to fly out to Phoenix tomorrow to be with her mother. Her return date is unknown. If all this close-to-home health news were not enough, one of my sisters called me today to tell me that she has been diagnosed with the onset of adult diabetes.

So feeling my mortality, I am focused on healthy living, as are many other people including First Lady Michele Obama. Obama is busy planting a vegetable garden on the White House lawn, demonstrating healthy eating and fitness, and working to end childhood obesity. This is long overdue but of course, this being America, there is fierce resistance. The processed food industry is all up in arm about taxing nutritionally empty foods like soda that give us sugar highs and put us prematurely into the hospital. I heard one C-SPAN caller the other morning (a self professed Tea Party member) dreadfully upset that “big government” was trying to regulate sodium in our food and was thinking about raising taxes on nutritionally empty foods like sugared sodas. To me these are “better late than never” proposals, but it makes other American hopping mad. I wonder if they also object to nutritional information on packaged food. Apparently, it is more important to be nutritionally ignorant and cause millions to die prematurely and deal with wholly preventable diseases than it is to increase the size of government. You have to wonder if the nutritionally empty crap these people are likely eating is affecting their judgment.

I avoid “reality” TV shows but about a year ago, while stuck in a hotel room, I watched an entire episode of The Biggest Losers, which now has many international spinoffs. As with most of these “reality” shows, it seems to be much more about fostering unhealthy relationships between fellow contestants than losing weight. The more weight your team loses, the “better” you are doing. The grand prize of $250,000 would certainly be nice to win, but at what price? In any event, in addition to the constant sniping you can watch contestants downing protein shakes, dehydrating themselves, working with personal trainers and engaging in the vigorous cardiovascular exercise they ignored most of their lives.

If you are obese, losing weight is usually vital for your long-term health. If you are overweight, it is also a good idea. Still, losing twenty, 40, 80 and in some cases more than 100 pounds is not by itself healthy. First, if the calories you are ingesting are not nutritious, you are not being good to your body. Second, as I discovered, dehydration can result in syncopes (fainting spells), falls, concussions and even death. No wonder Biggest Loser contestants in case they should they end up in the hospital or drop dead sign forms disclaiming NBC from all responsibility. Perhaps the most likely thing that will happen when you lose weight is that soon after the cameras are tracking your progress, you will quickly rebound, putting back the weight you gained and often more, such as happened to actress Kirstie Alley. Arguably, if you were just going to gain it back, you might have been better off not dieting in the first place.

Granted I only watched one episode, but what I saw on The Biggest Losers appalled me. Not only does the extreme competition glorify sniping at fellow team members (hardly the sort of harmonious living the Dalai Lama would encourage) but extremely rapid dieting almost guarantees that you will gain back the weight. A real competition for The Biggest Losers would not emphasize how much weight contestants lost per week, but track the contestants on how long they maintained a healthy weight, ate sensibly and followed a moderate exercise regime. The show should reward those who took off lots of weight in a sensible manner: by taking off a pound a week. They should reward those who have also successfully kept the weight off. This, of course, would make for very uninteresting television, but seeing how others did it would be very instructive to the sixty percent of us either overweight or obese.

How do people manage to lose and keep the weight off? My last post is perhaps instructive, but my method is but one of many. Methods that work will be tailored to the personality of the person and work with their eating and exercise preferences. Like alcoholism, I see obesity as a lifelong disease. I will forever be at risk of being overweight and obese. It is only through incorporating effective eating and exercise strategies into my life in a natural way that I will succeed in my real goal: being at a normal weight and remaining at a normal weight. Of course, I want all this, plus I want to be fit, to have a healthy heart, get optimal nutrition and never have to worry about high blood pressure or high cholesterol. I want to pass away gently in my sleep sometime in my nineties. I’ve kind of figured out this means I won’t be eating many French fries or getting double cones at Baskin Robbins.

In sum up, The Biggest Losers contestants are almost predestined to be tomorrow’s biggest gainers, an inconvenient fact that the producers will not bother to highlight. What we need is much more clinical research into the best techniques for losing and maintaining a healthy weight. In addition, we need research on staying optimally healthy while spending our working days in office buildings typing on keyboards.

I would like to see billboards highlighting people who have taken off significant amounts of weight and have successfully maintained a healthy weight for five, ten or more years. These billboards should come with URLs to websites so people can learn more about how they did it. Like Miss America contestants, these real Biggest Losers should tour American classrooms and give public lectures spreading their gospel. Maybe this way, along with reducing sodium, calorie and fat content in our foods and restaurants and encouraging fitness both at home and work, Americans will revert to being fit and healthy again.

I would not waste your time looking for useful tips on how you can weather our obesity crisis by watching The Biggest Losers. Instead, you might want to make an appointment with your physician.

One year later: my healthier living update

About a year ago, I wrote that I would periodically keep you abreast on my journey of weight loss and healthier living. (Actually, I wrote this mostly to remind myself so I would not slip.) Based on previous attempts at dieting, I discovered a truth: taking weight off is relatively easy. Keeping it off is harder. So how am I doing a year later? How am I doing after about nine months of Weight Watchers, giving up Weight Watchers because I wasn’t learning anything new and am now all on my own? Did I balloon to the size of Orson Welles (or for that matter Kirstie Alley)? Did I make it back to the same weight I was at when I was married and was a skinny thing? Did I yoyo back and forth? What great wisdom have I learned that I should share with the rest of the world?

A year later, I find myself within a couple pounds of where I was when I left Weight Watchers. That part is good. When I weighed myself on Monday, I was one pound above what is considered a healthy weight for my height. That part is not ideal, but being one pound overweight is better than being twenty three pounds overweight, which is where I was when I began my journey in January 2009.

So I can say I succeeded, with an asterisk. My goal was always to take off a chunk and then maintain it, since that was where I had failed many times before. The asterisk means that I slipped a bit. Over the holidays, I indulged too much, exercised too little, and not coincidentally, I also picked up five pounds. I knew what to do (start counting using Weight Watchers points again) but it took me a month or so to find the wherewithal to do it. When I did, it worked reliably again and the pounds came off. Yet, once I lost the few pounds I put back on, I found little incentive to keep reducing. Getting back to the weight when I was married continues to be an elusive and perhaps not very important goal.

Nevertheless, maintaining a near healthy or healthy weight for a year is a genuine accomplishment. I went back to some bad habits, but not all of them. When I wasn’t counting points on a sheet of paper, I had a good idea how much I could realistically eat and not gain weight.

I am usually fastidious during the week. For example, for breakfast this morning, I had one cup of Cheerios with skim milk and a cup of blueberries. This carried me over nicely until lunch. I packed a banana and a cup of grapes to have with lunch. When I eat at the cafeteria at work, four times out of five I am getting a soup and salad for lunch. It’s nearly automatic. My sweet tooth will not wholly be denied. I try to fit in one chocolate treat, which often means a bag of Dark Chocolate M&Ms, a favorite. My salads are quite low fat and full of healthy vegetables. I skip salad dressing and garnish the top with just a little cheese. Dinner, at least when I am eating alone, often consists of an entrée of from the diet part of the frozen food aisle. Lean Cuisine gets a fair amount of my business. Many of their entrees are quite tasty and reasonably healthy. (I particularly enjoy their Shrimp and Angel Hair Pasta, one of the best diet entrees ever, except for the sodium.) Their main value is portion control. I may supplement it with some bread, add in a banana or some other fruit. If my sweet tooth calls, have a 1-point Weight Watchers Fudge Stick.

On the weekends, I am more lax. On my Fridays off, my wife and I still engage in the fatty practice of breakfast at Silver Diner. Once or twice a month doesn’t make it a bad habit. Instead, it’s a treat. Otherwise, I have given up most restaurant eating. Recently, someone at work has been leaving out chocolate Easter eggs and I confess it is hard to pass them by without doing some grazing. I do binge at times, but not egregiously.

Over the last year, I have also been challenged by other physical problems. It is hard to follow Weight Watchers when you are having vein or tarsal tunnel surgery, and two hospitalizations these last two months hasn’t helped either. It is much easier to be good when your life is not topsy turvy.

My doctor is still not happy because my cholesterol level is still elevated, but not dangerously (110 bad cholesterol). He would like me to eat a lower fat diet than I do, but my diet is markedly lower in fat than it used to be. It would be difficult to excise too much more fat from my diet, but if driven by necessity I am sure I could. In my near future, I may end up on statins or other drugs to reduce cholesterol. Over the last eighteen months or so, I have also developed an irregular heartbeat. It is likely though that dieting has reduced heart problems rather than caused them.

My exercise is reasonably consistent, but at a lower level than when I weighed twenty pounds more. When I ate too much, I tried to make up for it by exercising more. Exercise is still a good idea, and I typically hit the health club three times a week as well as walk up many staircases. While beneficial, if you want to maintain a healthy weight, excessive exercise has no particular advantage. If anything, burning those calories makes you want to eat more. One of the lessons I have learned is that although you need enough exercise, you do not need to go overboard. If you are concerned about having and maintaining a healthy weight, calories matter more. In general, Americans consume far more calories than we need. I have trained myself to demand fewer calories than I used to. If you are struggling with this problem, I suspect you can too.

So here’s to me and my mostly successful first year, and here’s hoping a year from now if I write about my adventures in healthy living and weight loss again, I will at least be where I am now. Perhaps I will find the impetus to take off another fifteen pounds and literally be the man I was when I was married. It would make a good goal for my 25th wedding anniversary in October.

Real Life 101, Lesson 11: The skinny on nutrition

This is the eleventh in an indeterminate series of entries that provides my “real world” lessons to young adults. It is my conviction that these lessons are rarely taught either at home or in the schools. For those who did not get them growing up you can get them from me for free. This is part of my way of giving back to the universe on the occasion of my 50th birthday.

An indigent and obese friend of my wife tonight sits critically ill in a hospital in Lanchester County, Pennsylvania, her abdomen a mass of bloated polyps and at least one large tumor. She has had one surgery already that removed many of them and is scheduled for another shortly, however her prognosis for a full recovery is almost nonexistent. She is in her fifties. What is unstated, but is quite possible, is that she is dying. With so many masses in her abdomen, the chance that one of them is malignant is very high.

I have met her only twice. While a nice person, she appears to have spent a lifetime treating her body with contempt. Between her regular smoking (which she only recently she gave up) and the voluminous crap she has been eating over the years, she passively chose the miserable experience that she is now enduring. (Yes, I am aware obesity is a disease like alcoholism. It required treatment that it appears she either could not afford or refused.) She also chose the substandard life she has lived these many years because the result was she became officially disabled and is hobbled by her obesity. Her joints often hurt. She is rarely mobile enough to even take a shower, and she is able to move only with great effort. She is morbidly obese.

When she visited us recently, she asked her partner to make a run through the local Burger King drive thru. I do not know whether her partner indulged her or not, but it is clear that to her junk food has the lure of a narcotic. Like too many of us overweight and obese Americans, she is addicted to stuff that seems destined to kill her prematurely.

I hope all that food and nicotine that she enjoyed earlier in her life is worth the pain, misery, inconvenience and heartache that she is now experiencing and has been experiencing for probably at least a decade. What is clear is that she allowed these forces to control her, rather than the other way around. Had she embraced other choices earlier in her life she might have a couple more quality decades of a life ahead of her. She might have the time to watch her young granddaughter, who she dotes on, graduate college. She may also have enjoyed much more the last few decades instead of being hobbled by the consequences of these addictions.

Particularly in your younger years, the consequences of eating pizza, drinking sugar-rich beers and sodas, and smoking are fully reversible. As you age, the effect of these choices takes an increasingly larger toll on your body. The probability of gaining control over these demons lessens too with age.

Many young adults reach maturity with little to no training on nutrition. Maybe they studied the USDA food pyramid in class, but it is unlikely they received the coaching to use it effectively. The more I learn about nutrition in my middle years, the more I understand how complex it is. What is clear is that temptations abound, and the unhealthy food is artificially cheap. Paradoxically, the healthy food is increasingly more expensive.

How do young adults in particular navigate the complex issue of basic nutrition, particularly when their forebrain tells them they should eat healthy but their emotional side has them craving a processed food diet? Perhaps it starts with some understanding of what nutrition is. Based on younger adults in my own family who shall remain nameless, I don’t think most teenagers and young adults really understand. On one level, they may understand there are “bad foods” and that they tend to be the ones they want. They may also infer that “good foods” are boring and not very tasty.

The essence of nutrition is readily understandable. It is about giving your body the food it needs to operate optimally. It is also about giving your body the right amount of food so that you can maintain a healthy weight. The good thing about eating nutritious food is that it tends to naturally correct the desire to overeat. Conversely, one of the many bad things about unhealthy food is that it tends to make you want to eat more of it. You can enjoy an apple. Will a tasty apple make you reach for a second? Perhaps. Will one slice of pizza be enough? Probably not.

What is the difference? Aside from the ingredients in an apple, which are either benign or healthy, and a pizza, which is overloaded with saturated fats and quickly absorbed carbohydrates, an apple has two important attributes. First, it is not calorie dense, which means there are fewer calories for the same volume of food compared with a pizza. An apple also is rich in something called dietary fiber. Dietary fiber is simply benign non-food, or bulk if you will. It has zero calories because it is not absorbed; it just passes through you. While it does not go to your waist, dietary fiber is also good because roughage helps keep you regular and reduces your chances of colon cancer.

If an apple were a candle, it would burn slow and steady. A pizza is more like a fuse. It burns brightly and quickly. Because a pizza’s carbohydrates and fat are readily absorbed (they are rather simple), the excess is not needed by the body, so it tends to get stored instead. In addition, since the carbohydrates are quickly absorbed, your blood sugar will spike and then drop like a rock, and you will feel hungrier. You get a double whammy and unsurprisingly your waistline is likely to expand.

Nutritious food is also often loaded with natural vitamins and minerals. Many fast or processed foods are enriched with vitamins. Does this make them healthy? No, these foods are no healthier than eating a wheat donut is healthy. In other words, these processed foods still have virtually all the bad stuff, and the manufacturers are hoping to convince you that by adding vitamins and minerals it has morphed itself into something healthy. It’s still junk.

If you are overweight or obese, you might think that exercise will take off the pounds even if you keep eating the same fast and processed foods you are used to eating. Yet, most people who try this strategy fail. Why? Because exercise also depletes the body’s immediate stores of energy, i.e. your blood sugar. Your body will try to make up the difference by burning fat, but it will also send a strong signal to your brain: feed me. Exercise is still good, but you need to do it smartly. Eat a small snack with slow burning carbohydrates before and after exercise instead, this way you will not feel so hungry. While exercise has many healthy aspects to it, it is not a silver bullet for losing weight. In particular, if you are trying to lose weight, exercise in moderation, as too much exercise will simply drive you to eat more calories. Eating the same processed food you always ate while regularly exercising will not help your body be healthy either. Nor does exercise add any nutrition to your diet, unless you exercise outside in the sunlight and catch a little free Vitamin D. Fifteen minutes a week of sunshine (skip the sunscreen) is all you need to get your Vitamin D.

And speaking of Vitamin D, there is likelihood that you are Vitamin D deficient. Many Americans are these days. Why? Because we have become indoor denizens. Our jobs put us in cubicles. Moreover, we prefer to be tethered to our televisions and computers. Vitamin D deficiency is bad because it puts you at even greater risk of health complications, and markedly increases the chance of acquiring heart disease in particular. At any age, you should never take your health for granted. Make sure you are getting regular physicals so you can detect and correct these problems early.

Do not feel proud of yourself if you do not smoke but you do overeat. The evidence is clear: overeating and eating the wrong foods is at least as unhealthy for you as smoking. Overeating can trigger cancers, just like smoking. You are unlikely to die from heart disease because of smoking, however you can die of either cancer or heart disease because of poor eating habits and overeating. If I had to choose between the two habits, I would take up smoking, as disagreeable as the idea is to me.

How do you learn new habits that will last a lifetime? There are plenty of programs out there but if I had to pick one, I would choose Weight Watchers, for reasons I document here. Need more help? Try this site and buy a couple of their books, which are widely available. I think you will find them quite insightful.

Please, think carefully about what you put into your mouth, why you really do it and the long-term consequences of sticking with your habit. It may be too late for my wife’s friend, but your life is just unfolding. Do not eat yourself into an early grave.

A Tale of Two Cities

This post has been running around my brain for a few weeks. It is a tale of two cities. No, not Paris and London, the two cities that Charles Dickens wrote about in his 1859 novel, A Tale of Two Cities. This is the tale of Tallahassee, Florida and Boulder, Colorado. I have been to both. It would be hard to find two cities where the fitness levels of its residents diverge so much.

Okay, in some ways Tallahassee and Boulder are similar. Tallahassee is the larger of the two cities and the state capital. Boulder has around 90,000 residents. Tallahassee has around 160,000 residents, but as city sizes go, they are not that dissimilar. Both are college towns. Tallahassee has two colleges of note: Florida State and Florida A&M. Boulder has the University of Colorado at Boulder. Both are in the United States, but otherwise that’s about all the similarities worth noting.

I became acquainted with Tallahassee in 2007 when life finally took me there for a few days. I even blogged about it. There are possibly other cities in or around the Gulf Coast where the residents are more obese, but it is hard to imagine such a place. Tallahassee must be something of a Mecca for endocrinologists and Glucophage manufacturers. Its population appears to consist mostly of adult diabetics in the more advanced stage of the disease. Not that its many obese residents actually appear to be treating their diabetes. First, most of them appear too poor to afford treatment outside of an emergency room. Second, where would they find the health food? The eating choices in Tallahassee seem to be largely limited to the greasiest of the greasy joints. Burger King is the most predominant grease joint in Tallahassee, but in reality, it is just one of many. Within a quarter mile in Tallahassee you can find the following greasy spoons: Dominoes, which is next to the Taco Bell, which is across the street from Moe’s Southwest Grill, which is next door to Firehouse Subs, which is adjacent to Momo’s Pizza and Shane’s Rib Rack. Across the street is a Papa John’s Pizza. A little further down the street you will find Qdobo Mexican Grill and, of course, a Burger King. If you need groceries, there is exactly one Winn Dixie on the southern and predominantly African American side of town. Winn Dixie, Circle K and Albertsons have close to a lock on the grocery business in Tallahassee. Good luck finding a Whole Foods. There are none.

If it were not for the college students, the situation would appear far worse than it is. Those out of towners help, but cannot begin to hide the extent of Tallahassee’s obesity problem. Why is obesity so bad in Tallahassee? It likely has a lot to do with the relatively low average income of citizens in the city. Thanks in part to massive farm subsidies, we have made grain and sugar artificially cheap, which means that it costs little to eat the wrong food and proportionally a lot more to eat healthy, if you can find healthy food at all. Healthy food is not easy to acquire because I paid careful attention while I was there and found nothing resembling a health food store. The culture of the city though seems to be saying, “It’s okay to be morbidly obese and to eat junk. You’re just like everyone else.” If I were a health insurance provider, I would redline the whole city.

Boulder, Colorado on the other hand is its polar opposite. If there is a healthier (and more environmentally correct) city in the country, I would like to know about it. I doubt it exists. Having spent many pleasant days in Boulder in the company of my brother and sister in law, I find much to like about Boulder. Obesity is not unknown in Boulder but it is hard to find. That is because the city’s culture seems hardwired toward healthy eating and exercise.

Fast food can be found in Boulder, but it can be challenging. There is one Wendy’s downtown close to Pearl Street. Otherwise, you have to travel to the edge of town. There are three McDonalds in the city, and a few more along its edges. If you want a supermarket, you had better prefer organic supermarkets because they are far more plentiful. There are six Whole Foods markets in Boulder alone.

Don’t move to Boulder and expect to be a couch potato. It is not allowed. I think they must have citizen organizations that hunt for couch potatoes and make them work out. Boulder takes exercise seriously; it is practically a commandment. It is not just that you live right next to the Rocky Mountains and there are abundant hiking trails within easy walking distance. In Boulder, it seems like there must be an ordinance requiring its citizens to get regular aerobic exercise. Its citizens take their obligation seriously. When I have been in Boulder during a snowstorm, my brother pointed out that plowing the roads was scattershot. However, the bike trails, which are numerous, were plowed. The residents of Boulder have their priorities and snow removal on roads is second to removing snow from its biking trails. They do not seem to mind biking in freezing weather or even in the snow. Instead, they put studs on their bike tires and peddle to their destination. Or they may snow ski. Or run. They do not seem worried about twisting an ankle by running through the snow, even on the mountain trails where a slip could be fatal. Whole families can be seen walking around neighborhoods at night just for the exercise.

My latest trip to Boulder in March suggested to me that a certain percent of Boulder residents are, well, insane. I should mention that this does not apply to my wonderful brother, his wonderful wife and her adorable daughter. They work in exercise, daily if possible and particularly on the weekends. Fifty or sixty mile weekend bike excursions are par for their course. It could be that, or snow shoeing, or hiking, or long walks or most likely of all, some combination of all of these. Frankly, I admire their healthy attitude and wish some of it would rub off on other members of my immediate family here in traffic clogged Northern Virginia.

Nevertheless, there are significant numbers of Boulderites who exercise the way addicts mainline crack. I saw some of them on the last Sunday in March when my brother drove me up to Fort Collins. I thought it was strange when in thirty-degree weather we kept passing packs of bicyclists traveling on the shoulders of major thoroughfares, at times even crowding out the vehicular traffic. We passed dozen of packs on the way to Fort Collins; some of these packs consisted of a hundred or more bicyclists. My brother told me that many were biking to Fort Collins and back, which is a nice little jaunt of a hundred miles or so.

He also told me of a neighbor who after returning from one of these marathon hundred mile plus rides quickly rushed off to the swimming pool. Why? Because he was competing in a triathlon so now he had to swim a few miles too. This probably meant he also had to run a dozen miles or so too.

Doubtless, he was but one of many Boulder residents also planning to compete in a triathlon, so I expect the swimming lanes at the local pools were congested. Good luck to them but isn’t doing this level of exercise consistently maybe just a wee bit insane? It is to me. Granted there is nothing wrong with it, if your body can handle it, and it is certainly magnitudes healthier than eating grease at the plentiful fast food joints in Tallahassee. My last trip to Boulder though convinced me that it is possible to overdo exercise. Some small but sizeable number of Boulderites have gone off the deep end.

I am considering Boulder as a place to retire. I suspect it would not take too many weeks of living in Boulder before hundred mile bike jaunts would become second nature to me too. I would hardly be unique, just one of the crowd. I do know one thing: despite some folks in Boulder who may be exercise obsessed, it is a great place to live, if you can afford its real estate prices. I would definitely rather retire to Boulder than to Tallahassee, although on my pension I could live like a king in Tallahassee. In Tallahassee, I am convinced I could gain weight just by breathing its air.

Solving the obesity crisis

I read two items in the news that are guaranteed to make obese people and the parents who raise them feel guilty. First, obese people are contributing disproportionately to global warming. Apparently, because obese people are larger, they need more calories to sustain their weight. This also translates into the need for more fuel to move them around on cars and public transportation. According to the London School of Hygiene and Tropical Medicine, obese people on average require eighteen percent more calories than people of the same height and age of normal weight.

The second story (and to me the more frightening one) is the lead story in today’s Washington Post, Obesity Threatens a Generation. Apparently, the youth of today who are obese or even overweight have a much higher likelihood of developing chronic diseases earlier in life.

Doctors are seeing confirmation of this daily: boys and girls in elementary school suffering from high blood pressure, high cholesterol and painful joint conditions; a soaring incidence of type 2 diabetes, once a rarity in pediatricians’ offices; even a spike in child gallstones, also once a singularly adult affliction. Minority youth are most severely affected, because so many are pushing the scales into the most dangerous territory.

I am worried not only for the children out there who are overweight but also for my own daughter. She had times in her childhood when she was technically obese. For a few years, we enrolled her in Taekwondo. During that time, she had a normal weight and was in great physical condition. Eventually chose to give up the sport to concentrate on her academics. We encouraged her to exercise but she got out of the habit.

Now that she is eighteen and is earning her own money, she has the freedom to buy whatever she wants. Apparently, our choice of junk foods is very modest, so she has begun to buy her own food. Her food choices have been discouraging. She eats what most in her generation eat: a preponderance of junk food. My wife and I have of course registered of concern, but are being careful not to overdo it. As a young adult, she has the right to make her own choices and too much nagging is likely to be counterproductive. Fortunately, her job at a bookstore provides exercise simply because associates are so often on their feet. That helps.

Obesity runs in my wife’s side of the family. I am hoping my daughter did not pick up that particular gene. Given that my wife is one of many Americans struggling with obesity, I cannot help but wonder if ten or twenty years down the line, or perhaps even sooner, my daughter will be struggling with the same issues. I hope of course that she will emulate me and eat better, and exercise regularly. Like most teenagers, she thinks she is immortal. She realizes she may have to eat better and exercise regularly someday, but for now, she chooses to ignore the issue.

As do a preponderance of our youth, apparently. I am skeptical that today’s youth will find the wherewithal to address the problem as adults. I think without some major societal intervention that it is much more likely that they will stick with their current eating and exercise choices, because it has the feeling of familiarity and thus provides the illusion of comfort in a confusing world.

The consequences for these latest generations are truly dire. Yet there is little in the way of planned action to address these chronic problems. It appalls me to think that I may live to an older age than my daughter, primarily because my mother fed us healthy and nutritious food. Single parent families or dual income families are disproportionately raising today’s generation. That was true for our daughter. We both had full time jobs when our daughter was growing up. Living on one income, however modestly, was out of the question until the last few years. Our daughter ate most of her lunches in the school cafeteria, where she could safely consume the foods she wanted, like pizza, rather than the foods she needed. She fit right in. Her friends largely did the same thing.

I think dual income parenting contributed a lot toward the obesity epidemic. With family time so squeezed, it is not surprising that parents often rustled up meals from of a box or out of a fast food bag. It was also not surprising that our children tended to prefer these meals too. Food vendors do not stay in business by making uninteresting food. In order to attract more business, food had to be jazzed up. In that sense, American capitalism succeeded very well. Over time, we developed strong preferences for this unhealthy kind of food.

Congress may have inadvertently done our kids in too. Our agricultural subsidies, most of which went to subsidizing grains that could rarely turn a profit, made grain incredibly cheap. When certain types of food are cheap to purchase, many of us feel inclined to consume more of them than we used to. It used to be that we would rotate through seasonal foods over the course of a year. With grain cheap all year round, we added more and more grain to our diets. With sugar also artificially cheap, we had a deadly combination: cereals and breads laced with sugars. Cheap grain also encouraged us to give it to our livestock, making the price of meat cost less too. Most foods served in America were relative bargains throughout the latter half of the 20th century. There was little reason for restaurants not to super-size our portions when the ingredients were so cheap.

Our additional eating was one part of the equation. Lack of exercise was the other part. When I was a youth, we were free to roam neighborhoods at will as long as our homework was done and we returned home in time for dinner. Neighborhoods were assumed safe. My parents gave little thought to where we were as long as we were in the neighborhood. We also lacked modern indoor distractions like computers and videogames. Going outside and playing with the kids on the block was a compelling alternative to the drudgery of being home. Modern parents perceive that if they give the same freedom to their children that their children are at risk from child molesters. Parents believe it is safer to keep children at home rather than let them roam the neighborhood. To make this unfortunate reality easier to swallow, we provided indoor amusements for them. The combination of a poor diet and reduced exercise appears to be toxic.

Few of our children are likely to end up in professions where exercise will be built into the jobs. Most are likely to spend their lives much as we do: in offices living sedentary work lives much like Dilbert’s. Perhaps in their off hours they will be able to grab some exercise. That seems unlikely, for they will likely have children of their own at home, and these children will have to be fed and protected.

Our society desperately needs a culture shift. We may need to reduce our workweeks to 35 hours a week simply to allow adults to have time for physical fitness and parenting. An hour-long workout may not be enough, but it is a start. Employers may need to be required to offer exercise facilities to their employees to use at work. Just as you cannot keep horses in the stables for days on end, neither should humans be trapped in cubicles, cars and their homes for days on end. We are built to move, not to sit.

Exercise needs to be seen as a necessary and critical part of being a human being. What has changed over the last generation or two is that most Americans must now dedicate time for exercise. It should be encouraged by our leaders and our employers. Health insurance premiums should be substantially discounted for people who participate in monitored exercise programs. Our children need more than recess and occasional PE classes. They need regular and more vigorous exercise at school, extending the school day if needed, as well as more healthful food in school cafeterias. Since they are children, their weekly exercise should be monitored and tracked by school officials. It may seem offensive to some to require our children to be regularly weighed and tested for their physical fitness at school. However, these prosaic activities also encourage children toward a lifelong appreciation toward the necessity of exercise and healthy eating.

My suspicion is that these are the sorts of steps that must be taken to keep future generations of Americans from being obese, dying prematurely and the obscene health care costs that are associated with obesity. They may seem Big Brotherish, but for the sake of our children, we need to do it.