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Daniel

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The Truth About How To Lose Weight
by Alex Lickerman, MD
Psychology Today blog: Happiness in this World
October 15, 2009

from the second page of the blog post:

  1. First, recognize there's no way to lose weight and keep it off that's easy. Completely discontinuing an addictive behavior is far easier than moderating one—and obviously you can't ever stop eating. People whose brains seem to want them to be obese must accept that, in order to achieve and maintain a healthy weight (which need not be perfectly thin), they will likely have to work at it for the rest of their lives. As science and technology advance, this may eventually not be the case, but for today it is simply the truth.
  2. It's extremely difficult to lose weight without regular exercise. Not impossible. Just much more difficult. Exactly what exercise routine is best, however, remains debatable. Evidence exists that if you exercise past a certain level of intensity ("intensity" being variably defined in the medical literature) you'll actually induce an increase in your resting metabolic rate that lasts up to 11-14 hours after you've finished exercising. Some think this shift may counteract the tendency of brains with higher weight set points to lower resting metabolic rates when weight loss begins. In other words, jogging for 30 minutes may only burn 400 calories or so, but by raising your resting metabolic rate for 11-14 hours afterward, you may burn up to as much as an extra 1000 calories! Interestingly, anaerobic exercise (like weight lifting) may actually be more effective than aerobic exercise (like jogging or aerobics) in producing this effect. On the other hand, studies of people who walked on treadmills (a low intensity exercise) while actually at their desk jobs (instead of sitting at their computers they walked at their computers!) also lost significant amounts of weight over the long-term. Unfortunately, while many people attempt to lose weight with low intensity exercise, most don't do nearly enough of it to be effective. Finally, the key to maintaining a good exercise program is to think creatively about how to fit it into your busy daily schedule. The glass is always half-full: any amount of exercise you manage to do is worth it. Even just 15 minutes a day.
  3. Get adequate sleep. Through complex mechanisms only partly understood, inadequate sleep is now known to make it more difficult to lose weight. In addition, it's hard to exercise regularly or intensely if you're chronically tired.
  4. To cut calories reducing carbohydrates may be better than reducing fat, and is certainly better than reducing protein. Though I'm not endorsing any one particular diet over another, one thing from the medical literature seems clear: when you reduce your calories, don't do it by reducing protein.
  5. Make all lifestyle changes gradually. Don't expect to be able to run a marathon on your first day of exercise. Don't expect to cut your calorie intake in half the first week. Pick an exercise you like (or at least don't hate), begin it slowly, and build up intensity gradually. Consult your physician if you have health problems that may make exercising dangerous. Alter your diet gradually and make choices you can tolerate and maintain in the long-term.
  6. Keeping a food diary may help. Studies have shown most people tend to underestimate the amount of calories they eat (Mrs. Withers turned out to be a case in point). Studies have also shown keeping a food diary itself tends to cause people to reduce their calories spontaneously. How long that effect lasts, however, may be limited.
  7. Figure out if you're overeating for secondary gain. In other words, does eating fulfill some other purpose for you besides satisfying hunger? Many people overeat to deal with unpleasant feelings such as anxiety or depression. This actually works because pleasure of any kind is extremely distracting. If you find yourself eating for comfort, think creatively about substituting another pleasurable activity besides eating that can distract you from whatever unpleasant feelings you're trying to avoid. And take steps to challenge those unpleasant feelings directly.
  8. In general, avoid diet pills. I advise this for three reasons. First, the diet pills that work (and many do) typically only yield an additional 10% weight loss (despite this modest benefit, some of my patients still want them—to date, however, no one to whom I've given them has chosen to stick with them). Secondly, once you stop the pills, that 10% of weight you lost will come back. Thirdly, some diet pills aren't safe (does anyone remember fen-phen?). Millions of dollars are being spent every year on research to find effective, safe diet pills so I suspect eventually we'll have some good ones—but I see none now. As a side note, beware exaggerated claims made by manufacturers of over-the-counter diet pills. None of them that have actually been studied have lived up to their claims.
  9. Gastric bypass may be a good option. You have to meet strict criteria to qualify as a possible candidate (BMI>40 or BMI>35 associated with a serious weight-related health problem) and all surgery carries risk. However, with a BMI>30 you're also at risk for a premature death. Also, this surgery cures diabetes and hypertension in 90% of patients who also have those diseases! No medication we have can do anything like that. If this path seems like it might be right for you, ask your doctor for a referral to a beriatric surgeon.
As I told Mrs. Withers the last time I saw her, losing weight and keeping it off is incredibly hard, but hard is easy compared to impossible. And though she hasn't yet managed to lose a significant amount of weight, she yet may. As may you.

Alex Lickerman is a general internist and former Director of Primary Care at the University of Chicago.

If you enjoyed this post, please feel free to explore Dr. Lickerman's home page, Happiness in this World.
 

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I see it's the third-most popular fiber supplement sold at Amazon:

Amazon.com: Natural Factors - Wellbetx Pgx Soluble Fiber, 180 capsules: Health & Personal Care

Of course, most Americans / Canadians don't eat enough fiber, but, personally, I don't think much of it because I get lots of fiber as a vegetarian. And natural sources of soluble fiber like broccoli not only have fiber but stomach-filling volume with their water content.

Regarding fiber:

YouTube - Dr. James Anderson as a guest on Graham Kerr
 

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Diet alone will not likely lead to significant weight loss

Newly-published research by scientists at Oregon Health & Science University demonstrates that simply reducing caloric intake is not enough to promote significant weight loss. This appears to be due to a natural compensatory mechanism that reduces a person's physical activity in response to a reduction in calories. The research is published in the April edition of the American Journal of Physiology ? Regulatory, Integrative and Comparative Physiology. "In the midst of America's obesity epidemic, physicians frequently advise their patients to reduce the number of calories they are consuming on a daily basis. This research shows that simply dieting will not likely cause substantial weight loss. Instead, diet and exercise must be combined to achieve this goal," explained Judy Cameron Ph.D., a senior scientist at OHSU's Oregon National Primate Research Center, and a professor of behavioral neuroscience and obstetrics & gynecology in the OHSU School of Medicine, as well as a professor of psychiatry at the University of Pittsburgh.

To conduct the research, Cameron and OHSU post-doctoral fellow Elinor Sullivan, Ph.D., studied 18 female rhesus macaque monkeys at the Oregon National Primate Research Center. The monkeys were placed on a high-fat diet for several years. They were then returned to a lower-fat diet (standard monkey food) with a 30 percent reduction in calories. For a one-month period, the monkeys' weight and activity levels were closely tracked. Activity was tracked through the use of an activity monitor worn on a collar.

"Surprisingly, there was no significant weight loss at the end of the month," explained Sullivan. "However, there was a significant change in the activity levels for these monkeys. Naturally occurring levels of physical activity for the animals began to diminish soon after the reduced-calorie diet began. When caloric intake was further reduced in a second month, physical activity in the monkeys diminished even further."

A comparison group of three monkeys was fed a normal monkey diet and was trained to exercise for one hour daily on a treadmill. This comparison group did lose weight.

"This study demonstrates that there is a natural body mechanism which conserves energy in response to a reduction in calories. Food is not always plentiful for humans and animals and the body seems to have developed a strategy for responding to these fluctuations," added Cameron. "These findings will assist medical professionals in advising their patients. It may also impact the development of community interventions to battle the childhood obesity epidemic and lead to programs that emphasize both diet and exercise."

Reference:
Sullivan et al. A rapidly occurring compensatory decrease in physical activity counteracts diet-induced weight loss in female monkeys. AJP Regulatory Integrative and Comparative Physiology, 2010; 298 (4): R1068 DOI: 10.1152/ajpregu.00617.2009

Related article:
10 Reasons You're not Losing Weight

http://exercise.about.com/cs/weightloss/a/lastfewpounds.htm
 

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15 Best Diet Tips Ever
By Kathleen M. Zelman, MPH, RD, LD, WebMD.com

Everyone knows the keys to losing weight: Eat less and exercise more. Sounds simple enough, but in the context of real life and its demands, it can be anything but simple. So how do successful losers do it? To find out, Top Diet Secrets asked experts across the country for their best diet tips. Here’s what they said:

Best Diet Tip No. 1: Drink plenty of water or other calorie-free beverages.
People sometimes confuse thirst with hunger. So you can end up eating extra calories when an ice-cold glass of water is really what you need.

"If you don't like plain water, try adding citrus or a splash of juice, or brew infused teas like mango or peach, which have lots of flavor but no calories," says Cynthia Sass, RD, a spokeswoman for the American Dietetic Association.

Best Diet Tip No. 2: Think about what you can add to your diet, not what you should take away.
Start by focusing on getting the recommended 5-9 servings of fruits and vegetables each day.

"It sounds like a lot, but it is well worth it, because at the same time you are meeting your fiber goals and feeling more satisfied from the volume of food," says chef Laura Pansiero, RD.

You're also less likely to overeat because fruits and vegetables displace fat in the diet. And that's not to mention the health benefits of fruits and vegetables. More than 200 studies have documented the disease-preventing qualities of phytochemicals found in produce, says Pansiero.

Her suggestion for getting more: Work vegetables into meals instead of just serving them as sides on a plate.

"I love to take seasonal vegetables and make stir-fries, frittatas, risotto, pilafs, soups, or layer on sandwiches," Pansiero says. "It is so easy to buy a variety of vegetables and incorporate them into dishes."

Best Diet Tip No. 3: Consider whether you're really hungry.
Whenever you feel like eating, look for physical signs of hunger, suggests Michelle May, MD, author of Am I Hungry?

"Hunger is your body's way of telling you that you need fuel, so when a craving doesn't come from hunger, eating will never satisfy it," she says.

When you're done eating, you should feel better -- not stuffed, bloated, or tired.

"Your stomach is only the size of your fist, so it takes just a handful of food to fill it comfortably," says May.

Keeping your portions reasonable will help you get more in touch with your feelings of hunger and fullness.

Best Diet Tip No. 4: Be choosy about nighttime snacks.
Mindless eating occurs most frequently after dinner, when you finally sit down and relax.

"Sitting down with a bag of chips or cookies in front of the television is an example of eating amnesia, where you mindlessly eat without being hungry, but out of habit," says American Dietetic Association spokesperson Malena Perdomo, RD.

Either close down the kitchen after a certain hour, or allow yourself a low-calorie snack, like a 100-calorie pack of cookies or a half-cup scoop of low-fat ice cream. Once you find that you're usually satisfied with the low-cal snack, try a cup of zero-calorie tea, suggests Perdomo.

Best Diet Tip No. 5: Enjoy your favorite foods.
"I think putting your favorite foods off limits leads to weight gain because it triggers 'rebound' overeating," says Sass.

Instead of cutting out your favorite foods altogether, be a slim shopper. Buy one fresh bakery cookie instead of a box, or a small portion of candy from the bulk bins instead of a whole bag.

"You can enjoy your favorite foods, but you must do so in moderation," says Sass.

Best Diet Tip No. 6: Enjoy your treats away from home.
When you need a treat, Ellie Krieger, RD, host of Food Network's Healthy Appetite, suggests taking a walk to your local ice cream parlor or planning a family outing.

"By making it into an adventure, you don't have to worry about the temptation of having treats in the house, and it is a fun and pleasurable way to make it work when you are trying to lose weight," says Krieger.

And for those times you just can't get out? Krieger stocks her kitchen with fresh fruit, which she thinks can be every bit as delicious as any other dessert.

Best Diet Tip No. 7: Eat several mini-meals during the day.
If you eat fewer calories than you burn, you will lose weight. But when you're hungry all the time, eating fewer calories can be challenging.

"Studies show people who eat 4-5 meals or snacks per day are better able to control their appetite and weight," says obesity researcher Rebecca Reeves, DrPH, RD. She recommends dividing your daily calories into smaller meals or snacks and enjoying as many of them as you can early in the day -- dinner should be the last time you eat.

Best Diet Tip No. 8: Eat protein at every meal.
Protein is more satisfying than carbohydrates or fats, and thus may be the new secret weapon in weight control.

"Diets higher in protein [and] moderate in carbs, along with a lifestyle of regular exercise, have an excellent potential to help weight loss," says University of Illinois protein researcher Donald Layman, PhD.

Getting enough protein helps preserve muscle mass and encourages fat burning while keeping you feeling full. So be sure to include healthy protein sources, like yogurt, cheese, nuts, or beans, at meals and snacks.

Best Diet Tip No. 9: Spice it up.
Add spices or chilis to your food for a flavor boost that can help you feel satisfied.

"Food that is loaded with flavor will stimulate your taste buds and be more satisfying so you won't eat as much," says Perdomo.

When you need something sweet, suck on a red-hot fireball candy for a long-lasting burst of sweetness with just a few calories.

Best Diet Tip No. 10: Stock your kitchen with healthy convenience foods.
Having ready-to-eat snacks and meals-in-minutes staples on hand sets you up for success. You'll be less likely to hit the drive-through or call in a pizza order if you can make a healthy meal in 5 or 10 minutes.

Sass stocks her kitchen with:
  • 94% fat-free microwave popcorn (20-25 calories per cup, and you can make it in two minutes or less)
  • Frozen vegetables
  • Bags of pre-washed greens
  • Canned diced tomatoes
  • Canned beans
  • Whole-grain wraps or pitas
  • Pre-cooked grilled chicken breasts
  • A few containers of pre-cooked brown rice
Within minutes, she can toss together a healthy medley.

Best Diet Tip No. 11: Order children's portions at restaurants.
"When you are eating out, order a child's pizza or a small sandwich as an easy way to trim calories and get your portions under control," suggest Perdomo.

Another trick is to use smaller plates. This helps the portions look like more, and if your mind is satisfied, your stomach likely will be, too.

Best Diet Tip No. 12: Eat foods in season.
"If you don't love certain fruits or vegetables, it could be because you ate them out of season when they have little taste or flavor," says Pensiero. "When you eat seasonally, fruits and vegetables are more flavorful, at their best, and I promise you won't be disappointed."

At GiGi's Trattoria, her restaurant in Rhinebeck, N.Y., she serves simple fruit desserts, like naturally sweet strawberries topped with aged balsamic vinegar, or low-fat yogurt or fresh berries in a compote.

Best Diet Tip No. 13: Swap a cup of pasta for a cup of vegetables.
Simply by eating less pasta or bread and more veggies, you could lose a dress or pants size in a year.

"You can save from 100-200 calories if you reduce the portion of starch on your plate and increase the amount of vegetables," says Sass.

Best Diet Tip No. 14: Use non-food alternatives to cope with stress.
Sooner or later, you're going to be faced with a stressful situation. Instead of turning to food for comfort, be prepared with some non-food tactics that work for you. Sass suggests reading a few chapters in a novel, listening to music, writing in a journal, practicing meditative deep breathing, or looking at a photo album of loved ones.

Best Diet Tip No. 15: Be physically active.
Although it may seem counterintuitive, don't use exercise either to punish yourself for eating or to "earn" the right to eat more.

"When you do, it sets up a negative thought pattern, which is why so many people say they hate to exercise," says May.

Instead, focus on how great you feel, how much better you sleep and how much more energy you have when you exercise. Physical activity is good for you whether you are trying to lose weight or not, so keep it positive and build a lifelong habit.
 

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The book Calm Energy makes the argument that exercise decreases appetite partly by improving mood and energy levels, making one less likely to use food as a pick-me-up:

Many people aren't aware of the importance of this low-energy state as a cause of overeating, but this is often the case. The so-called crises of these dieters all occurred in the afternoon and evening, times when energy begins to decline for most people. The average relapse crisis for these subjects occurred at 4:34 P.M...[They] ate something and felt energized and less anxious.

Calm Energy: How People Regulate Mood with Food and Exercise
This may be similar to the more-established findings that getting enough rest/sleep helps prevent overeating and helps with sports performance.
 

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Keeping a food diary may help. Studies have shown most people tend to underestimate the amount of calories they eat. Studies have also shown keeping a food diary itself tends to cause people to reduce their calories spontaneously. How long that effect lasts, however, may be limited.
Regarding food diaries:

When you track calories closely, you lose more weight, said Dr. Lawrence Cheskin, associate professor of health, behavior and society at Johns Hopkins Bloomberg School of Public Health. But dieters who simply write down their intake at the end of each day tend to underestimate the calories they have consumed (call it wishful thinking).

The beauty of mobile apps is that they work in real time. You eat lunch and immediately log in your meal on your phone. The apps rely on databases to record the calorie counts of thousands of foods, whether a single item like an apple or a prepared meal like a sub sandwich, which takes the guesswork out of totaling calories...

If you’re looking at a menu wondering whether to order pasta primavera or a Caesar salad, an app can tell you on the spot which option has fewer calories...

With mobile apps, dieters also can better visualize the relationship between exercise and eating. A 30-minute walk burns about 100 calories, they learn, while jogging for the same time at 6 miles per hour burns four times that amount.

Losing Weight the Smartphone Way, With a Nutritionist in Your Pocket - NYTimes.com
 

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If you’ve ever found yourself surprisingly unhungry after a strenuous workout, a team of researchers at multiple institutions may have the molecular explanation. The peptide N-lactoyl-phenylalanine (Lac-Phe), which is produced during exercise from the enzymatic condensation of lactate and phenylalanine, seems to suppress appetite, at least in mice (Nature2022, DOI: 10.1038/s41586-022-04828-5).
 

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