Archive for Wednesday, January 4, 2006

Elizabeth Stewart chats about weight management

January 4, 2006

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Welcome to our online chat with Elizabeth Stewart about weight management.

The chat took place on Wednesday, January 4, at 1:30 PM and is now closed, but you can read the full transcript on this page.

Moderator: Welcome to our chat today with Elizabeth Stewart, a post-doctoral researcher of the Energy Balance Laboratory at Kansas University.

The laboratory has several projects funded by the National Institutes of Health to investigate issues regarding exercise, nutrition prevention of obesity and weight loss. It also has four weight-loss clinics. The center, which opened in 2000, occupies 8,000 square feet in the Robinson Center at KU.

I'm Dave Toplikar, online editor, and I'll be moderating today's chat.

Elizabeth, thanks for being here today with us.

We've already received some questions, so we'll get started with those.

Deb, Lawrence: I want to start losing weight, and was wondering if I constantly drink water as a start, will that in turn help as well as the diet and exercise?

Elizabeth Stewart: There is no evidence that drinking water will jumpstart your weight loss in any way. Many people find that they will spontaneously lose weight when they switch from sodas and juices to water because they then create a deficit in calories. However, water is not a magic elixir that will help you burn more calories. Furthermore, studies have shown that drinking water before or during a meal will not cause you to eat less. I would suggest going the conventional "eat less, move more" route and drink water as your thirst dictates. Drinking water instead of caloric beverages may help your weight loss because of that aforesaid deficit in calories.

Elizabeth Stewart, a post-doctoral researcher of the Energy Balance Laboratory at Kansas University, responds to reader's questions about weight management.

Elizabeth Stewart, a post-doctoral researcher of the Energy Balance Laboratory at Kansas University, responds to reader's questions about weight management.

Mary, Lawrence: 10 years ago I stopped eating dairy products due to allergies. When I quit eating cheese, suddenly my weight dropped from 220 to 170. My doctor says my cholesterol and BP are now also at very healthy levels. Is good eating just giving up the cow? Why are M.D.'s only required to have a 1/2 credit in med school for nutrition? Does the meat/dairy industries really have that much control over our lives? Thank you!

Elizabeth Stewart: It is very likely that you dropped some weight because not eating cheese created a calorie deficit. Cheese is very dense - therefore, quite high in both calories and fat. Most people do not realize a serving size of cheese is very small (about the size of a couple of dices). So when you stopped eating cheese, you cut out a lot of calories with that single step. That being said, there is some evidence that consuming low-fat dairy products (such as skim milk and non-fat yogurt) may AID in weight loss. Even cheese can be consumed in a well-balanced diet - just watch the portion sizes. So much of eating healthy and weight management is not WHAT you eat, but HOW much.

Sam/Lawrence: Do you have any suggestions for women around 50 years old, for better weight loss results, other than the typical responses to exercise and watch what you eat? I've heard how much sleep you get per night actually affects this also, is this true?

Elizabeth Stewart: Women in their 40's and 50's have a difficult time with their weight due to the hormonal changes that occur during menopause and peri-menopause. Not only is weight loss more difficult, but the fat deposits shift toward a more "male" pattern (around the belly vs. around the hips and thighs). I am sorry to say that no magic solution exists except the same "exercise and watch what you eat." You are correct in that the amount of sleep may play a role in weight loss. Both human and animal studies have shown that lack of sleep increases levels of cortisol which appears to help trigger cravings for high fat or high sugar foods. In addition, when we are tired, we tend to reach toward energy-dense foods in the hopes that it will "pick us up." Getting adequate sleep during menopause is especially important as it appears those food cravings intensify during that time. And finally, let's face it: if you are sleeping - you can't be eating! The old adage of 7 to 9 hours a night still holds true. Good luck.

Desperate, Lawrence, KS: I am obese now and have tried so many methods of losing weight. My doctor suggest the Lap-Band surgery but my wonderful insurance won't cover anything for obesity. What do you suggest? Please help!!!!!!

Elizabeth Stewart: Bariatric surgery can be a great solution for some people at their wits end with their weight. However, the same results CAN be achieved with ifestyle change. In our studies and programs, we have seen weight losses similar to surgery when people drop down to a 1200 calorie diet. What seems to really help is the use of "meal replacements." Meal replacements are nothing more than pre-packaged entrees like Lean Cruisine and certain high-volume, low-calorie shakes. Meal replacements work because they automatically limit portion and calorie control with no thought on the part of the busy dieter. Another trick is increasing the volume of meals by using fruits and vegetables to fill up your stomach. The reason why bariatric surgery works is because it limits the amount of food (and therefore calories) that your stomach can tolerate. That's it. You can do that on your own. I know it's not easy but neither is recovery from surgery. Again, we achieve similar results in our programs just by using meal replacements in a reduced calorie diet.

Nick, Lawrence: I'm concerned about weight because my dad is diabetic and I have been told that I am pre-diabetic. I have a problem with portion sizes. I've always been a big eater. I haven't been to a fast food chain in years, but I do eat at buffets. Even when I eat at home I tend to need big portions to feel full.

I don't mind exercise, but I don't see where it makes much difference anymore. For instance, I have been jogging every day for 45 minutes for over a week now, and I don't see any change. I'm middle aged, so its just jogging -- no sprinting.

My questions are:

1) This is probably my most important question if you are pressed for time: What programs/help/etc. do you have that are available for someone who needs to loose weight (to avoid diabetes)?

2) I get such mixed signals. I need to watch my fat intake to keep my cholesterol down, yet I am supposed to keep my carbs down for diabetes. What is left? I don't know anything that is ONLY protein. It seams every label if it is low/no fat, it is high carbs. If it is low carbs it is high fat. It is confusing what to do.

3) I don't mind exercise, but why does it seem to make such little difference? When I was young it seams as though exercise kept it off. It doesn't seem to be the case anymore.

Elizabeth Stewart: 1. To find out more about programs, please contact Rachel Martin at 785-331-4681 or visit our website at www.ebl.ku.edu or contact Rachel through email at wcrp@ku.ed. She will be happy to give you information on our different studies and programs. Since we run externally funded research studies, we often have strict parameters of who qualifies based on age, weight, medications, etc. However, we do also run a non-research program for folks who don't qualify for research. It uses the same protocols and structure of the research program. That being said, I will be honest and say nothing we do is magic. In fact often folks are disappointed because it all comes down to eating less and moving more. What we really stress, and I think what makes the difference, is the ACCOUNTABILITY. Food and exercise plans must be written down. Food logs and exercise logs are turned in. We teach people to be mindful of their lifestyle habits. Weight management doesn't just happen - it must be practiced EVERY DAy.

Good question about the fat and carbohydrates. Such mixed signals in the media these days. And you are right - almost all food contains a mix of nutrients. I can tell you that more and more evidence points to its the AMOUNT of food/calories that people eat rather than any specific make-up (of fat or carbs) that makes a difference. Most Americans do eat too many simple carbohydrates. If you focus on getting the majority of your carbs from fruits, vegetables, and whole grains rather than crackers, cookies, white flour, etc - you really can't go wrong. Remember - it really comes back to portion size.

I think I can answer your last question in a question coming up about exercise.

Tom, Eudora: If I had to choose between focusing on eating well or exercising to lose weight, which would be more effective?

Elizabeth Stewart: The "exercise to lose weight" theme seems to be appearing quite a bit so hopefully I can address all those questions with this answer.

Exercise is good. However, exercise alone will most likely NOT help you lose weight. It just takes too long to create a calorie deficit. Imagine you eat a bag of M 'n' M's for 300 calories, then decide to "burn it off" through exercise. Depending on your size, you're looking at at least a 45 to 60 minute walk. You can see how over the course of the day, 100 extra calories here and 400 extra calories there - you would have to train like an Olympic athlete 10 hours a day to "burn" it all off. Studies at our lab indicate that exercise alone can help prevent weight gain (in healthy young college students) but not facilitate a great weight loss. Yes, this is a great disappointment to a chocoholic and runner like myself.

So the solution: to LOSE weight, you MUST create a calorie deficit through diet. Trade in the 1000 calorie plate of pasta for a 300 calorie plate. You've saved yourself 2 hours of walking there.

However, exercise is critical during weight MAINTENANCE. After weight loss, it is imperative to keep exercising in order to maintain that loss. In fact, we tell people before they begin our program: if you're not willing to exercise for the rest of your life, this is probably not the program for you. You may lose a little weight, but it will come right back.

So in a long-winded answer to your question - do both. Calorie deficit for maximum weight loss, exercise for long-term maintenance.

Matt....Lawrence: What is your overall opinion about the Atkins diet?

Elizabeth Stewart: The Atkins diet, as we know it, is neither magical nor evil. It is just one of the many eating methods that works very well for weight loss in some people - not so well in others. Interesting research in the past few years has shown that a low-carbohydrate diet may actually improve blood chemistry in some individuals with a certain "metabolic profile" (for example, someone who is insulin resistant). Other research, including our own from the Energy Balance Lab, has shown that people who follow a low-carbohydrate diet for a year experience no adverse events. However, no long-term (over a year) studies on the long-term outcomes of Atkins exists right now, so I can't speak completely for their long-term effectiveness or safety. At this point, it appears that the diet works very well and is safe for individuals who can comply to it. Compliance, however, is the issue. If you personally do well on a lower-carbohydrate diet, go for it. What we say at the lab is: "Any diet works if YOU work the diet."

Bob, Lawrence: I've heard people should consult a physician before starting a weight-loss plan. Is that really true? Why would that be?

Elizabeth Stewart: Depends on the person who wants to lose the weight. If someone is on a variety of medications, these medications will need to be adjusted as the person loses body mass. This is especially important for blood pressure medications. However, if the person is relatively healthy and medication-free, there is really no reason to see the doctor before reducing calories and starting a walking program. If the person drops to a calorie level LESS than 1200 cal/day, medical supervision is recommended. However, people don't need to drop that low to see weight loss. A 1200 or 1500 calorie diet is safe, can easily include all nutrients, and can be tolerated without constant hunger. To be on the safe side, I should probably repeat the warning to "see your doctor" before trying to eat less and move more. However, I have seen this becomes a major deterrent for many people and they continue perpetuating a sedentary, high-calorie lifestyle that puts them even MORE at risk for health problems. So again - if you're on medications, good idea to check with the doctor about adjusting dosage as weigh loss occurs. If you're healthy and med-free, reducing portion sizes and walking 30 minutes a day can be done without a physician's note.

Snowgurl, Lawrence: Is there a way to calculate your personal daily calorie intake?

Elizabeth Stewart: There are a variety of expensive, complicated ways to calculate your exact calorie needs but there is also a very simple way that gives you a pretty darn good estimation. Females: take your body weight and multiply by 9 or 10 (depending on how physically active you are).

Males: take your body weight and multiply by 1.1 or 1.2 (again - depending on exercise levels).

For example, a 200lb woman will need between 1800 and 2000 cal/day. Males need more calories because they have more muscle mass and muscle is more metabolically active.

And herein lies the horrible hidden secret of weight loss: once you LOSE weight, you must eat fewer calories to sustain your new lower body mass. If the 200lb woman loses 30 calories, she now only needs about 1700 calories a day to maintain her weight. Once you lose weight, you cannot go back to eating as much as you once did. That's one of the reasons the weight seems to come back on so easily. Your newer, smaller body doesn't need as many calories.

That being said, this is where exercise helps so much. You can make up for some of this new "lower metabolism" by regular exercise that helps you burn a few extra hundred calories a day.

Jill, Oskaloosa: Hello. What are some of the most common foods people think are healthy, but really are not good for you? In other words, what do people eat thinking they're being good to their body when, in fact, they're doing more harm than good?

Elizabeth Stewart: It's hard to answer your question in one statement because food advertising has become so smart! Almost any food these days can advertise some positive benefit like "no added sugar" etc and yet be high in calories. That's why reading labels - and being aware of PORTION SIZES - is so important. For example, stonewheat crackers may claim to contain whole grains, which we're all told to eat more of. But if 1 serving has 110 calories, and the box contains 12 servings, and you just ate half the box... that's almost 700 calories. Doesn't matter if the crackers contain whole wheat - 700 calories is at least a third of most individuals' daily caloric needs! I know the theme is reoccurring, but it really comes back to the calories.

Now, some specifics to your questions. These are foods that are not inherently bad but just very easy to over-eat:

- Pasta and rice (too much of it)

- Bagels and other breads (too much of them)

- Juices - ANY KIND (no fiber, all sugar)

- Dried fruit (very calorie dense)

- Many dry cereals - look for kinds that contain 3 or more grams of fiber per serving and less than 5 gram of sugar

- Granola and energy bars (high in calories, no t satisfying)

- Any type of sweetened coffee drink (very high in calories)

Again - always look the calories. Sometimes you will be pleasantly surprised. For example, reduced fat cool whip has the same amount of calories as the fat free cool whip (and tastes a whole lot better)

Bill, Topeka: I tend to always gravitate to 175 pounds. No matter how much I gain or lose, if I wait a few weeks, I'll end up back at 175. Is there a scientific reason for that? What can I do to get over the hump?

Elizabeth Stewart: Good question. There does seem to be some evidence that people gain and lose weight at different weights AND seem to maintain weight at different levels and differing levels of difficulty. For example, in the famous "Twins Studies" it was found that different sets of twins gained or lost different amounts of weight even though they were all on the SAME diet. Even more interesting, the twin pairs (within-pairs) gained or lost about the SAME amount, thus providing more evidence that genetics does play a role in weight fluctuation.

Rather than using this as an excuse to not lose weight, people be more forgiving of themselves and congratulate themselves for what they CAN do and what their bodies WILL respond to. A weight loss as little as 5 to 10% of initial body weight (a 200lb person losing just 10 to 20lb) can result in tremendous health benefits. And that is really the bottom line. If your blood pressure, blood lipids, energy levels, etc all improve at 175lb, and you can stay at that weight without killing yourself, than that's probably the weight your body wants to be at.

Leigh, Lawrence: I've been reading some critiques recently of the USDA's newer "My Pyramid" food guide (e.g. Harvard School of Public Health, Mayo Clinic, etc.). What's your take on the guide? Is there a "pyramid" you think is better conceived?

Elizabeth Stewart: The different pyramids are like the different diet plans: they all "work" depending on which one works for you. I'm sorry to repeat myself, but it all comes back to portion sizes which ultimately comes back to calories. The USDA pyramid has received much criticism for its emphasis on grains. But people forget that one bagel contains 4 to 6 grain servings!!! That's more than half of most folks' daily allotment. Weight management is all about making choices: I would rather eat this, and "spend" my calories on this, rather than on that. For example, many would prefer the Mediterranean pyramid's emphasis on olive oil over the USDA's pyramid on grains. Both are OK, as long as you stay within your calorie allotment for the day. That being said, you are right in that lots of behind-the-scenes politics go into constructing all these pyramids, as well as anguish about finding a message that resonates to the greatest amount of people. I think the best answer to your question is: NONE of the pyramids contain junk food, fast food, or soda.

James, Lawrence: My wife says that I'm too skinny. Do you have any suggestions for putting on weight, while still keeping my body in good shape?

Elizabeth Stewart: Two parts to this answer:

1) A lot of people don't realize that GAINING weight can be just as difficult as losing it, partly due to the genetic influences mentioned in a previous question. But skinny people don't get much sympathy, do they? The best thing you can do is try to increase your calorie level by 500 to 1000 cal/day choosing high-calorie but nutrient dense foods. Examples: dried fruit, fruit juice, nuts and nut butters of all types, smoothies, dense cereals like granola, and easy-to-eat grain products. You will notice this is exactly opposite of the foods I recommended folks avoid for weight loss. What you want are foods that pack a LOT of calories into a small amount, such as nuts or energy drinks like "Ensure." Ironically, Slim-Fast and other such shakes are great for weight gain - just drink them alongside a regular meal for added calories.

2. Second part of the question - are you really underweight? Go to our website www.ebl.ku.edu and use the Body Mass Index calculator to determine your BMI. Chances are, you are probably on the slim side but still in the healthy range. If this is the case, I wouldn't worry about gaining weight. Focus on eating for health and enjoyment and exercise for the same reasons. As I said about weight loss - it's really about health. If you are healthy at your weight, that's all that matters.

Moderator: This next question will be our last one for today.

Ashley, Lawrence: Are there any weight-loss supplements, pills, etc. on the market that are still considered safe to take? Are any of them reputable?

Elizabeth Stewart: Two parts to your question as well:

The prescription drugs for weight loss (Meridia, Xenical, etc) are safe enough to pass through millions of dollars worth of clinical research trials. However, do they work? Yes, they do... but not necessarily better than just lifestyle changes. Studies from our lab comparing Xenical to a diet using meal replacements found no difference between the two. And often the drugs carry unpleasant side effects, ranging from increased heart rate to unpredictable bowel movements. So the drugs are safe - but don't produce astounding weight loss compared to lifestyle changes - and do carry some side effects that may not be dangerous but still unpleasant.

As far as over-the-counter drugs - yes, many of them work in the same way that metamphetamine works. They artificially stimulate your system/metabolism which in turn produces weight loss. These pills probably carry different levels of risk and much depends on the health status of the person taking them and what medications they might already be on. The bottom line is: once you stop taking the drugs, the artificial stimulation stops. Weight gain is almost inevitable. Furthermore, you will notice that many of those pills always advice you to take the pill in the context of "reduced calorie diet and exercise plan." Hmmm, that's usually what we do to promote weight loss in the first place.

In closing, I have enjoyed all your questions and appreciate very much your interest in this topic. I apologize for not getting to every question.

Moderator: Elizabeth, thanks for taking all of our questions today.

I learned quite a bit, and I'm sure our readers did too.

I'd also like to thank all of our reader for participating today. And we're sorry if we couldn't get to your question today. We had quite a few.

Elizabeth Stewart: I think the most important thing to remember is (as grim as this is):

It all comes back to calories.

It's also important to realize that weight management is a lifelong task. Everyone who works at the lab has the same struggle as everyone else: no time to exercise, someone brought in cookies, etc etc. It is up to each one of us to make the personal decision to take personal responsibility for our health and realize that constant vigilance is the price we pay for living in the civilized society dominated by technology. Thank you again for the chance to speak today!

Comments

hckleberry 9 years, 6 months ago

my wife and i would like information about weight loss studies at KU, thnx

Hong_Kong_Phooey 9 years, 6 months ago

hckleberry: I would go to the website that Ms. Stewart mentioned. www.ebl.ku.edu

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