Graphic designer
29 years old, married
Six months
16-18 to 6
Cooking more from scratch; eating plenty of whole grains, especially bulghur wheat in place of rice; packing her own lunch instead of buying it.
Sweets, especially cookies and granola bars
Running and signing up for races; sewing, crocheting and knitting at night so as not to eat.
Running and ice cream.
Trader Joe's Fat Free Caramel Corn; buys large bag but measures into single servings to control portions.
Learning to eat only when hungry, not out of boredom.
Struggled with weight most of life; joined Weight Watchers three times. "Third time was the charm," she says.
Better appearance. "I hated how I looked."
Flowers for every five pounds lost and no deprivation. "There's no food that I don't eat," she says. But she is very careful about portion sizes.
Being able to run half marathons, she's run four since October.
More about nutrition, especially the importance of whole grains, calcium and sodium. From the Web chats: food finds, healthy recipes including baked oatmeal and mindful eating.
ScienceDaily (July 8, 2008) — Keeping a food diary can double a person's weight loss according to a study from Kaiser Permanente's Center for Health Research. The findings, from one of the largest and longest running weight loss maintenance trials ever conducted, will be published in the August issue of the American Journal of Preventive Medicine.
Funded by the National Heart, Lung and Blood Institute at the National Institutes of Health, the study is one of the few studies to recruit a large percentage of African Americans as study participants (44 percent). African Americans have a higher risk of conditions that are aggravated by being overweight, including diabetes and heart disease. In this study, the majority of African American participants lost at least nine pounds of weight, which is higher than in previous studies.
"The more food records people kept, the more weight they lost," said lead author Jack Hollis Ph.D., a researcher at Kaiser Permanente's Center for Health Research in Portland, Ore. "Those who kept daily food records lost twice as much weight as those who kept no records. It seems that the simple act of writing down what you eat encourages people to consume fewer calories."
In addition to keeping food diaries and turning them in at weekly support group meetings, participants were asked to follow a heart-healthy DASH (a Dietary Approaches to Stop Hypertension) diet rich in fruits and vegetables and low-fat or non-fat dairy, attend weekly group sessions and exercise at moderate intensity levels for at least 30 minutes a day. After six months, the average weight loss among the nearly 1,700 participants was approximately 13 pounds. More than two-thirds of the participants (69 percent) lost at least nine pounds, enough to reduce their health risks and qualify for the second phase of the study, which lasted 30 months and tested strategies for maintaining the weight loss.
"More than two-thirds of Americans are overweight or obese. If we all lost just nine pounds, like the majority of people in this study did, our nation would see vast decreases in hypertension, high cholesterol, diabetes, heart disease and stroke," said study co-author Victor Stevens, Ph.D., a Kaiser Permanente researcher. For example, in an earlier study Stevens found that losing as little as five pounds can reduce the risk of developing high blood pressure by 20 percent.
The Kaiser Permanente Care Management Institute's Weight Management Initiative has recommended food journaling as a strategy for losing weight since 2002. The Weight Management Initiative unites clinicians, researchers, insurers, and policymakers to identify practical, effective, non-surgical approaches for the prevention and treatment of overweight and obesity.
"Keeping a food diary doesn't have to be a formal thing. Just the act of scribbling down what you eat on a Post-It note, sending yourself e-mails tallying each meal, or sending yourself a text message will suffice. It's the process of reflecting on what you eat that helps us become aware of our habits, and hopefully change our behavior," says Keith Bachman, MD, a Weight Management Initiative member. "Every day I hear patients say they can't lose weight. This study shows that most people can lose weight if they have the right tools and support. And food journaling in conjunction with a weight management program or class is the ideal combination of tools and support."
The study, coordinated by the Kaiser Permanente Center for Health Research in Portland, also was conducted at Duke University Medical Center, Pennington Biomedical Research Center, and Johns Hopkins University. In addition to Hollis and Stevens, the Kaiser Permanente research team included William M. Vollmer, Ph.D.; Cristina M. Gullion, Ph.D.; Kristine Funk, M.S.; and Daniel Laferriere, MR. Other study co-authors included Phillip J. Brantley, Ph.D. and Catherine M. Champagne, Ph.D. at Pennington; Jamy D. Ard, MD, at the University of Alabama at Birmingham; Thomas P. Erlinger, MD, MPH, at the University of Texas; Lawrence J. Appel, M.D., and Arlene Dalcin at Johns Hopkins; Pao-Hwa Lin, Ph.D., and Laura P. Svetkey, MD, at Duke University; Carmen Samuel-Hodge, Ph.D. from the University of North Carolina at Chapel Hill; and Catherine M. Loria, Ph.D., at the National Heart, Lung, and Blood Institute and National Institutes of Health.
The winners at weight control do not have more willpower than those who fail - they have more strategies. These are the strategies that I have learned from the winners
If you just think calorically, you will probably fail. It's not just how many calories in a cookie or a candy, but how many or how much of this food do you typically eat. Always ask yourself, not just about the calories, but what is my history with this food? and you will not find yourself among the millions of dieters who gain back the same weight again and again with the same foods.
Certain foods affect the neurochemistry of the brain and actually trigger cravings and appetite especially in those who are genetically sensitive to such foods. Knowing this scientific fact helps you to understand. It may not be your lack of willpower or character, but your hypersensitivity to the taste or texture of a certain food which is actually creating losses of control and excess eating. Remember the potato chip commercial - "we bet you can't have just one"?
The structure of 3 meals and 2 to 3 snacks a day promotes metabolic efficiency and helps with cravings and going longer than 3-4 hours without a healthy snack or meal promotes cravings, hunger and failure.
Sometimes eating is not about food. You can lose all the weight in the world but, if the next time you get upset you turn to food, your success at weight control will be temporary.
To succeed at a diet does not mean you have to give up your favorite foods but, if you have a long history of overeating them, you need new strategies to take control of them rather than letting them continue to control you.
Thin is a life-management skill. It is not about being "good" or "bad" It is about learning what works. Part of any learning process involves making mistakes. This Commandment teaches you how to learn from those mistakes and never again to make the greatest mistake of all - saying "I blew it" and giving up.
Dieting has always been associated with deprivation. This commandment teaches you how to overcome that feeling and to fully appreciate that in the end it is not about deprivation but about liberation.
The greatest deprivation of all is to spend a lifetime of being heavy when you could have easily succeeded with strategies that could have worked for you
This commandment deals with the truth that our bodies have a budget like our checkbook. It teaches us the insider tips and foods that allow you to stretch your calorie budget so you can eat more and weigh less.
Keeping it off is the other half. If you're 30 or 40 or 50 or 60 and lose weight today how do you keep this weight off for the decades to come? This concerns maintenance and the strategies that work best to keep it off for a lifetime without cravings or deprivation. It's about living in the world of food as a thin person.
While it is clear that humans cannot survive for longer than several days without water, very little research has assessed how average individuals' health is affected by drinking extra fluids. Experts have claimed that ingesting water is helpful for everything from clearing toxins and keeping organs healthy to warding off weight gain and improving skin tone.
To investigate the true benefits of drinking water, Dan Negoianu, MD, and Stanley Goldfarb, MD, of the Renal, Electrolyte, and Hypertension Division at the University of Pennsylvania, in Philadelphia, PA, reviewed the published clinical studies on the topic. They found solid evidence that individuals in hot, dry climates, as well as athletes, have an increased need for water. In addition, people with certain diseases benefit from increased fluid intake. But no such data exist for average, healthy individuals. In addition, no single study indicates that people need to drink the recommended "8x8" amount of water each day. Indeed, it is unclear where this recommendation came from.
This scan of the literature included a look at studies related to the notion that increased water intake improves kidney function and helps to clear toxins. A variety of studies reveal that drinking water does have an impact on clearance of various substances by the kidney, including sodium and urea. However, these studies do not indicate any sort of clinical benefit that might result.
Other studies have tested water's effects on the functioning of organs. They indicate that water retention in the body is variable and depends on the speed with which water is ingested-if it is gulped quickly, water is more likely to be excreted, while if it is sipped slowly, it is retained in the body. However, no studies have documented any sort of benefit to organs based on increased water intake, regardless of speed.
Drs. Negoianu and Goldfarb also investigated the theory that drinking more water will make people feel full and curb their appetite. Proponents say this may help people maintain their weight and even help fight obesity. But studies remain inconclusive. No carefully designed clinical trials have measured the effects of water intake on weight maintenance.
Headaches also are often attributed to water deprivation, but there are few data to back this up. Only one small trial has addressed the question, and while trial participants who increased their water intake experienced fewer headaches than those who did not, the results were not statistically significant.
In addition, water has been touted as an elixir for improved skin tone. While dehydration can decrease skin turgor, no studies have shown any clinical benefit to skin tone as a result of increased water intake.
The literature review by Drs. Negoianu and Goldfarb reveals that there is no clear evidence of benefit to increasing water intake. On the other hand, no clear evidence exists of a lack of benefit. "There is simply a lack of evidence in general," they explain.
The study entitled, "Just Add Water" will be available online at http://jasn.asnjournals.org/ beginning on Wednesday, April 2, 2008 and in print in the June issue of JASN.
The American Society of Nephrology (ASN) is a not-for-profit organization of 11,000 physicians and scientists dedicated to the study of nephrology and committed to providing a forum for the promulgation of information regarding the latest research and clinical findings on kidney diseases.
In 1988, the surgeon general, C. Everett Koop, proclaimed ice cream to a be public-health menace right up there with cigarettes. Alluding to his office's famous 1964 report on the perils of smoking, Dr. Koop announced that the American diet was a problem of "comparable" magnitude, chiefly because of the high-fat foods that were causing coronary heart disease and other deadly ailments.
He introduced his report with these words: "The depth of the science base underlying its findings is even more impressive than that for tobacco and health in 1964."
That was a ludicrous statement, as Gary Taubes demonstrates in his new book meticulously debunking diet myths, "Good Calories, Bad Calories" (Knopf, 2007). The notion that fatty foods shorten your life began as a hypothesis based on dubious assumptions and data; when scientists tried to confirm it they failed repeatedly. The evidence against Häagen-Dazs was nothing like the evidence against Marlboros.
It may seem bizarre that a surgeon general could go so wrong. After all, wasn't it his job to express the scientific consensus? But that was the problem. Dr. Koop was expressing the consensus. He, like the architects of the federal "food pyramid" telling Americans what to eat, went wrong by listening to everyone else. He was caught in what social scientists call a cascade.
We like to think that people improve their judgment by putting their minds together, and sometimes they do. The studio audience at "Who Wants to Be a Millionaire" usually votes for the right answer. But suppose, instead of the audience members voting silently in unison, they voted out loud one after another. And suppose the first person gets it wrong.
If the second person isn't sure of the answer, he's liable to go along with the first person's guess. By then, even if the third person suspects another answer is right, she's more liable to go along just because she assumes the first two together know more than she does. Thus begins an "informational cascade" as one person after another assumes that the rest can't all be wrong.
Because of this effect, groups are surprisingly prone to reach mistaken conclusions even when most of the people started out knowing better, according to the economists Sushil Bikhchandani, David Hirshleifer and Ivo Welch. If, say, 60 percent of a group's members have been given information pointing them to the right answer (while the rest have information pointing to the wrong answer), there is still about a one-in-three chance that the group will cascade to a mistaken consensus.
Cascades are especially common in medicine as doctors take their cues from others, leading them to overdiagnose some faddish ailments (called bandwagon diseases) and overprescribe certain treatments (like the tonsillectomies once popular for children). Unable to keep up with the volume of research, doctors look for guidance from an expert — or at least someone who sounds confident.
In the case of fatty foods, that confident voice belonged to Ancel Keys, a prominent diet researcher a half-century ago (the K-rations in World War II were said to be named after him). He became convinced in the 1950s that Americans were suffering from a new epidemic of heart disease because they were eating more fat than their ancestors.
There were two glaring problems with this theory, as Mr. Taubes, a correspondent for Science magazine, explains in his book. First, it wasn't clear that traditional diets were especially lean. Nineteenth-century Americans consumed huge amounts of meat; the percentage of fat in the diet of ancient hunter-gatherers, according to the best estimate today, was as high or higher than the ratio in the modern Western diet.
Second, there wasn't really a new epidemic of heart disease. Yes, more cases were being reported, but not because people were in worse health. It was mainly because they were living longer and were more likely to see a doctor who diagnosed the symptoms.
To bolster his theory, Dr. Keys in 1953 compared diets and heart disease rates in the United States, Japan and four other countries. Sure enough, more fat correlated with more disease (America topped the list). But critics at the time noted that if Dr. Keys had analyzed all 22 countries for which data were available, he would not have found a correlation. (And, as Mr. Taubes notes, no one would have puzzled over the so-called French Paradox of foie-gras connoisseurs with healthy hearts.)
The evidence that dietary fat correlates with heart disease "does not stand up to critical examination," the American Heart Association concluded in 1957. But three years later the association changed position — not because of new data, Mr. Taubes writes, but because Dr. Keys and an ally were on the committee issuing the new report. It asserted that "the best scientific evidence of the time" warranted a lower-fat diet for people at high risk of heart disease.
The association's report was big news and put Dr. Keys, who died in 2004, on the cover of Time magazine. The magazine devoted four pages to the topic — and just one paragraph noting that Dr. Keys's diet advice was "still questioned by some researchers." That set the tone for decades of news media coverage. Journalists and their audiences were looking for clear guidance, not scientific ambiguity.
After the fat-is-bad theory became popular wisdom, the cascade accelerated in the 1970s when a committee led by Senator George McGovern issued a report advising Americans to lower their risk of heart disease by eating less fat. "McGovern's staff were virtually unaware of the existence of any scientific controversy," Mr. Taubes writes, and the committee's report was written by a nonscientist "relying almost exclusively on a single Harvard nutritionist, Mark Hegsted."
That report impressed another nonscientist, Carol Tucker Foreman, an assistant agriculture secretary, who hired Dr. Hegsted to draw up a set of national dietary guidelines. The Department of Agriculture's advice against eating too much fat was issued in 1980 and would later be incorporated in its "food pyramid."
Meanwhile, there still wasn't good evidence to warrant recommending a low-fat diet for all Americans, as the National Academy of Sciences noted in a report shortly after the U.S.D.A. guidelines were issued. But the report's authors were promptly excoriated on Capitol Hill and in the news media for denying a danger that had already been proclaimed by the American Heart Association, the McGovern committee and the U.S.D.A.
The scientists, despite their impressive credentials, were accused of bias because some of them had done research financed by the food industry. And so the informational cascade morphed into what the economist Timur Kuran calls a reputational cascade, in which it becomes a career risk for dissidents to question the popular wisdom.
With skeptical scientists ostracized, the public debate and research agenda became dominated by the fat-is-bad school. Later the National Institutes of Health would hold a "consensus conference" that concluded there was "no doubt" that low-fat diets "will afford significant protection against coronary heart disease" for every American over the age of 2. The American Cancer Society and the surgeon general recommended a low-fat diet to prevent cancer.
But when the theories were tested in clinical trials, the evidence kept turning up negative. As Mr. Taubes notes, the most rigorous meta-analysis of the clinical trials of low-fat diets, published in 2001 by the Cochrane Collaboration, concluded that they had no significant effect on mortality.
Mr. Taubes argues that the low-fat recommendations, besides being unjustified, may well have harmed Americans by encouraging them to switch to carbohydrates, which he believes cause obesity and disease. He acknowledges that that hypothesis is unproved, and that the low-carb diet fad could turn out to be another mistaken cascade. The problem, he says, is that the low-carb hypothesis hasn't been seriously studied because it couldn't be reconciled with the low-fat dogma.
Mr. Taubes told me he especially admired the iconoclasm of Dr. Edward H. Ahrens Jr., a lipids researcher who spoke out against the McGovern committee's report. Mr. McGovern subsequently asked him at a hearing to reconcile his skepticism with a survey showing that the low-fat recommendations were endorsed by 92 percent of "the world's leading doctors."
"Senator McGovern, I recognize the disadvantage of being in the minority," Dr. Ahrens replied. Then he pointed out that most of the doctors in the survey were relying on secondhand knowledge because they didn't work in this field themselves.
"This is a matter," he continued, "of such enormous social, economic and medical importance that it must be evaluated with our eyes completely open. Thus I would hate to see this issue settled by anything that smacks of a Gallup poll." Or a cascade.
