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Making weight loss stick

A year ago, Debbie Belle found herself in the same unhealthy situation as one-third of American adults. At 5 feet 6 inches and 221 pounds, she had a body-mass index above 30 and was officially obese, according to weight criteria set by the Centers for Disease Control and Prevention.

Belle, 54, had tried several of the best-known programs on the multibillion-dollar weight-loss market. She enjoyed early success with one or two. But each turned out to be too pricey, too stress-inducing or too unwieldy to keep her committed for the long haul.

Then, she says, she tried the cheapest, lowest-pressure, most self-effacing program she’d ever run across, and the decision transformed her quest for better health.

Belle joined Taking Off Pounds Sensibly, or TOPS, a national nonprofit that promotes peer support and personal determination to encourage members to avoid crash diets and instead adopt healthy lifestyle changes. Its goal is to help the average person lose weight moderately and manageably — and to keep it off.

Belle’s experience with TOPS, a nationwide nonprofit with 63 chapters in Maryland (including 18 in the Baltimore area), is in some ways a model of what weight-management scientists — as opposed to those who market weight-loss programs — have been arguing for years: that when it comes to losing weight, participants’ long-term health is more important than their appearance; that a slow and steady approach is healthier than a quick and splashy one; and that it’s just as important to maintain weight loss as to achieve it in the first place.

Dr. Kimberly Gudzune, an assistant professor of medicine at the Johns Hopkins University and a leading researcher in weight-management science, said a study of 32 popular weight-loss regimens she led in 2015 suggested that the TOPS approach is effective. But what interests her more than any single program is exploring and explaining the tenets that lie behind any program that works.

Research has long shown that obesity increases the incidence of diabetes, heart disease, hypertension and a host of other dangerous medical conditions.

Gudzune said those who wish to lose weight would do well to look at what TOPS and a few other organizations emphasize — in contrast to most programs in the $40 billion- to $60 billion-per-year weight-loss industry.

“If you look at the market of proprietary weight-loss programs, you’ll generally see two main camps,” she says. “One spotlights dramatic losses by using ads with models holding up these very large pants, then tiny ones in the next photo: ‘Lose 100 pounds in three months!'”

Others “advocate a more regimented change in lifestyle, changes you can actually keep up for the rest of your life,” Gudzune said. “I usually prefer a steadier, more purposeful change.”

Given her weight loss, Belle might appear to exemplify the quick-fix camp, but what originally attracted her to TOPS was the gently supportive, user-friendly approach it has promoted for 70 years, always without paying for advertising.

Trying a better-known national program for more than a year, Belle said, helped her shed 100 pounds, but she regained it within few months.

In retrospect, she said, that program called for such rigorous calculation of weight-loss points it was hard to keep up. What’s more, its monthly membership fee, which added up to $540 per year, was too high. She also felt the company representatives who ran the meetings were often judgmental, and the program reduced its accountability requirements once participants hit their target weight.

“They only asked you to come back once a month after you make your goal weight, and I need it once a week,” Belle said. “I can be disciplined, but when it becomes too hard to keep up, it’s easy to fall back into bad habits.”

She then checked out TOPS. She’d heard the program operates in self-organized chapters in churches and senior centers.

At her first meeting with the Fallston chapter she felt as though she had met 30-plus soul mates.

They encouraged her that night —and welcomed her developmentally disabled adult son, David, into their midst.

After two meetings, she said, she began getting motivational cards from the group and realized they felt like family.

Taking advantage of TOPS literature on exercise and nutrition, she began taking what felt like manageable steps, swimming at a local community college, doing morning walks with David, and maintaining a regimen of “calorie cycling” — 1,800 calories on high-exercise days, 1,200 on the rest.

The positivity of the feedback — and weekly weigh-ins — motivated her not to quit, she said, and to add gradually to her chosen exercise regimen. She now swims 30 laps a day three times a week, walks for an hour at a rapid clip four times a week, and rarely goes back for seconds at meals.

Perhaps most important, she said, TOPS doesn’t let up after members hit their target weight; it places them in its coveted “KOPS” (Keeping Weight Off Sensibly) category, and the positive feedback and weekly expectations continue.

Like most programs in an industry regulated more by the Federal Trade Commission than by federal health agencies, TOPS has never been subjected to the randomized clinical trials that would measure its effectiveness against that of its rivals.

But one weight-management researcher, Dr. Nia S. Mitchell of Duke University, became interested in TOPS while seeking weight-loss alternatives for her lower-income clinical patients 14 years ago.

She found in longitudinal studies that members who stayed enrolled year to year generally lost between 5.9 percent and 7.1 percent of their original body weight over three years, easily eclipsing the 5 percent considered a benchmark for significantly improving one’s overall health.

And most of those who stayed with TOPS for seven straight years kept the weight off.

“I see continuous engagement as a key to the weight-loss maintenance success of TOPS,” Mitchell said.

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To lose weight, practice these 6 habits before bed

When you’re dieting, you may start the day with good intentions, only to have your willpower trail off during the night. But there are actually certain nightly habits that can keep you on track with your weight loss and health goals.

Fox News spoke to Sheah Rarback, a registered dietitian at the University of Miami Miller School of Medicine, and dietitian Jennifer Christman, a clinical nutrition manager at Medifast, for their tips on the best nightly habits for weight loss:

1. Eat a well-balanced meal for dinner.
If you have a well-balanced meal full of carbs, protein, and fat, you’ll feel full longer and won’t go to bed hungry, Christman told Fox News. And high-quality lean protein, such as fish, chicken, chickpeas or lentils, can help boost your metabolism and stimulate muscle growth and repair, she said, so you can keep burning calories all night long.


2. Have a hot cup of herbal tea.
Both dietitians recommended having a cup of herbal tea—which is naturally caffeine-free — before bed. You can even make a nightly, relaxing ritual out of it, Rarback said. Try hot chamomile tea to unwind before bed.

3. Stay busy.
Often, people overeat at night because they’re bored, Rarback said. As an alternative, try reading a book, taking your dog for a walk, or engaging in some other activity that will keep you from hitting the fridge, she recommended.


4. Turn off your smartphone.
Try not to check your phone or go on your iPad right before bed, Christman said. She explained that doing so can disrupt your sleep, which in turn can increase the amount of the hormone ghrelin in your body, making you hungrier.

5. Find ways to relax.
Anxiety is another reason that people turn to food late at night, Rarback said. Try practicing breathing exercises or meditation — in her nutrition counseling, Rarback often recommends the app Calm, which can lead you through a guided meditation.


6. Floss and brush your teeth.
When your teeth feel clean and minty fresh, you might think twice before mindlessly snacking, and instead ask yourself if you’re actually hungry, Rarback said. So wash up and brush early on in the night to help reduce any snacking temptations.

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How to get hidden sugars out of your child’s diet — from the start

Tabatha Griffith is a conscientious mom. When her older daughter Bellamy, now 2, was 6 months old and moving on to solids, Griffith even made some of her own baby food. In the supermarket aisles, the new parent found a wealth of products aimed at toddler palates: toy-shaped crackers, rainbow-hued yogurts, fruity drinks. Kid-friendly foods.

That is, until Griffith looked closer.

“A lot of the stuff that was geared toward kids had so much sugar,” said Griffith, a middle school teacher and Gloucester County resident. “Somebody who’s not a label reader wouldn’t know. I was surprised. It was definitely disappointing.”

Parents, do not go gently into the juice box aisle. Or, for that matter, to many of the cereals, toddler snacks, and a whole lot of other stuff that claims to be healthy.

Added sugars abound in the edibles and drinks sold in the United States, including food products routinely fed to and marketed for young children. These sugars, added during processing or preparation, go by many names: fructose, high fructose corn syrup, glucose, cane sugar, even so-called natural ingredients such as honey, to name just a few. By July 2018, added sugars — as opposed to those that naturally occur in a food — will be required by the U.S. Food and Drug Administration to be noted on the labels of most foods sold.

Last year, the American Heart Association issued guidelines that children ages 2 to 18 should consume no more than 25 grams, or six teaspoons, of added sugars a day, and children under 2 should have no added sugars. Diets high in added sugars have been linked to obesity, diabetes, high blood pressure, and unhealthy cholesterol levels, not to mention dental problems.

How does 25 grams of sugar translate into food? A 12-ounce serving of a popular brand of cranberry juice cocktail has more than twice that much. Many doctors advise limiting fruit juice to six ounces a day — and in a cup, never in a baby’s bottle.

Added sugar can be a problem from the very day a child is born.

A recent study by researchers with the University of Southern California’s Keck School of Medicine made the startling discovery of fructose in the breast milk of nursing mothers. Because  fructose isn’t a naturally occurring sugar in breast milk — long considered the gold standard for newborn nutrition — the researchers theorized that “secondhand sugar” may have come from foods that were high in added sugar, such as processed foods or juice drinks, although they do say that more study is warranted. Fruit contains less fructose and the body metabolizes it differently.

Moreover, the researchers found that although the amounts of fructose in the breast milk varied among the women in the study, higher levels of fructose, although still small, were related to greater infant weight.

“Early life is a period of rapid development and early-life nutrition is strongly linked with long-term health outcomes,” said Tanya Alderete, study co-author.

“Results from this work suggest that the composition of breast milk may be another important factor to consider in regards to infant health and perhaps future risk for overweight or obesity,” Alderete said. “For this reason, mothers should try to consume a healthy diet that is low in added sugar.”

As sneaky as sugars are, you can keep ahead of the game, nutrition experts say.

“Eyeball the labels,” said Lore Noyes, director of clinical nutrition for Nemours/Alfred I. duPont Hospital for Children.

Know that ingredients are listed in order of amount. That includes sugars. Noyes suggested paying particular attention to “watch-out foods”: flavored yogurt, cereals, crackers, peanut butter, even bread and condiments such as ketchup, which can all contain lots of sugars. Pasta sauces and applesauce also can harbor lots of the sweet stuff.

Beth Leonberg, who teaches nutrition at Drexel University, sees little reason to feed prepared baby foods, generally, but, she noted, the desserts can be real sugar havens.

“The manufacturers make baby food desserts because people buy them and kids like them,” Leonberg said.

Which isn’t to say you must eschew all sugars.

“The naturally occurring sugars in milk and fruit I don’t worry about at all,” said Megan Robinson, clinical dietitian with the Children’s Hospital of Philadelphia. Fruit also contains fiber and valuable nutrients, and milk is full of the stuff needed for strong bones.

Robinson has her own go-easy list.

“Granola bars,” the nutritionist said. “I call them glorified candy bars.”

Again, read the labels. Some of the newer offerings are much lower on the sugar scale, she said. Look at the sugar content on those packets of instant oatmeal, too.

“I never recommend families purchase low-fat foods,” Robinson added, referring to foods with reduced fat, as opposed to naturally low in fats. Often, reduced fat products will have added sugars to improve flavor lost when fat is removed. Natural peanut butter is often a better choice than low-fat or regular, she said, when it comes to sugars.

Starting a child out right can be the best defense. Robinson suggested serving plain yogurt sweetened solely with fresh fruit, or unsweetened cereal flavored with nuts and cinnamon.

Tyree Winters, a Rowan University pediatrics professor and doctor who counsels families on obesity and weight problems, is also a believer in getting children off to a healthy start when it comes to food.

Some tips: Choose fresh or frozen fruit without sugar added; provide a wide variety of fruits and vegetables and don’t give up on a food until you’ve offered it 20 times; encourage kids to enjoy food but don’t use it as a reward. And even when they are little, let them help you in the kitchen.

“I can’t stress enough having your kids help you prepare food,” Winters said. “They start to understand the relationship with food. They begin to voice their likes and dislikes. I’m a firm believer in letting kids have a voice. It develops this relationship of trust.”

Over at the Griffith family home in Clarksboro, Bellamy has a while to go before she gets to heavy kitchen lifting, but she does enjoy mixing it up with the measuring cups and bowls while her mother, Tabatha, cooks.

Baby sister Riley is still on a liquid diet, but Bellamy has been branching out. Lunch is often dinner leftovers, cut up to toddler size. Her mother has been sticking with whole foods with recognizable ingredients, rather than the processed stuff full of unpronounceable chemicals.

“You’re told to tell your kids about strangers on the playground, and then there’s all this crap in the food,” she said.

For now, Bellamy is content with her chicken and veggies lunches. She does enjoy the occasional Goldfish cracker snack. And she does like sweets.

“She’ll ask for multiple bananas a day,” her mother said. “She also likes apples.”

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Diet Doc Examines Troubling Trend of Illness-Based ‘Flu Diet …

LAS VEGAS, NV–(Marketwired – April 21, 2017) – Given how difficult the average weight loss journey can be, it’s no wonder that many people go to extreme measures to lose weight fast. Normally such trends manifest themselves in fad dieting, very low-calorie consumption, meal replacements, juicing, fasting, etc. All these ‘diets’ have their own set of rules and you’d assume that if they actually worked, the industry wouldn’t be producing so many versions of them over time. In fact, most of them trigger temporary, unsustainable weight loss, along with a multitude of additional side-effects such as hunger, binge eating, mood swings, heart palpitations, low-energy, nutritional deficiencies and a host of others.

However, as damaging as fad dieting can be, there’s been a disturbing recent trend of celebrities and/or journalists who are promoting illness as a way to lose weight quickly. Just last week, a popular magazine faced criticism when it seemed to promote cancer as a diet plan due to the weight loss experienced while on chemotherapy. This week, a major celebrity tweeted that her six-pound weight loss under the “flu diet” was amazing. Joke or not, very few pop culture experts understand what is involved in making healthy dieting and lifestyle choices.

Diet Doc strongly recommends that any new dieting regimen be supervised by a licensed doctor or certified nutritionist who can take into account all dietary needs and specifications. This is particularly critical for those who suffer from obesity, heart disease, diabetes or any other medical condition as not to create unnecessary complications. Diet Doc is troubled by the fact that an increasing number of consumers are getting their weight loss advice from celebrities and trendy magazines rather than consulting with experienced weight loss professionals. While consumers are certainly intelligent enough not to take much of the advice seriously, it still points to an overwhelming cultural desire to discover quick ways to lose weight, rather than make investments in one’s health. Diet Doc’s offers customized weight loss strategies based on your unique needs rather than an unsafe, ineffective cookie-cutter template.

New Diet Doc patients can call or easily and effortlessly visit https://www.dietdoc.com to complete an initial comprehensive, yet simple, health questionnaire and schedule an immediate personal, no-cost consultation. Diet Doc Physicians all received specialized training in nutritional science and fast weight loss. Diet Doc reviews each patient’s health history to create a personalized diet plan geared for fast weight loss, or that addresses life-long issues causing weight loss to slow down or stop. Nutritionists work personally with each patient and use their own algorithm to craft meal and snack plans that are compatible with each patient’s age, gender, activity level, food preferences, nutritional needs and medical conditions. They combine these state of the art diet plans with pure, prescription diet products that enable their patients to resist the temptation to reach for sugary snacks, eliminate fatigue and curb the appetite. Over 97% of Diet Doc patients report incredible weight loss results with the majority losing 20 or more pounds per month.

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Ask the Doctors: Multivitamins can’t replace healthy diet – Star-Gazette – Elmira Star

Dear Doctor:

Do I really need to take a multivitamin? My sisters are convinced that you can’t get all the nutrients that you need without one, but it seems to me that as long you’re eating right, you’re covered.

Dear Reader: Multivitamins are the most widely used supplements in the United States. It is estimated that between one-third and one-half of all Americans take a multivitamin each day. As a result, your question is one that comes up often in our practices.

And while we can’t offer specific advice, we can share and explain the information we give to our patients.

The short answer is that for most patients, we believe that if you’re eating a balanced diet, one that includes whole grains, a variety of vegetables and fruits, adequate lean protein and dairy products, there is no need for a multivitamin.

However, when a patient’s diet isn’t ideal, then a multivitamin can offer insurance for the deficient vitamins and/or minerals.

Of course, there are exceptions. Pregnant women and women who are trying to become pregnant need at least 400 micrograms of folate per day, a B vitamin that helps to prevent neural tube defects. For these women, a prenatal vitamin or a daily folic acid supplement is recommended. Nursing women have unique nutritional needs that may call for supplementation.

Some elderly adults whose appetites have diminished and who therefore don’t eat a balanced diet may benefit from adding a multivitamin. Someone on a restricted diet, such as a vegan, typically needs a B12 supplement.

A strict vegetarian may require additional zinc, iron or calcium. And for individuals with chronic conditions such as iron deficiency anemia, B12 deficiency or malabsorption, or a history of gastric bypass surgery, then supplemental vitamins and minerals are necessary to maintaining good health.

So what are vitamins, exactly?

They’re nutrients that we need in small quantities to maintain various metabolic functions that, when taken in total, add up to good health. Vitamins help the body to produce energy, ward off cell damage, facilitate in the absorption and utilization of minerals, and play varying roles in the regulation of cell and tissue growth.

Vitamins must be taken in food because the body either doesn’t produce them in adequate quantities, or doesn’t produce them at all.

Vitamin D is a bit of an outlier. It’s an essential nutrient that does not naturally appear in food in adequate quantities, but is produced when our skin is exposed to the ultraviolet B rays in sunlight. It is also available in fortified foods like milk, fish and mushrooms.

Take an honest look at your diet. If you find some nutritional holes, our advice is to adjust and improve your eating habits. If you do decide to make a multivitamin part of your daily regimen, keep in mind that it cannot take the place of a balanced and healthy diet.

Not only do fruits, vegetables, whole grains and leafy greens contain vitamins, they also provide fiber, which is important to good health. Whole foods also contain trace nutrients and other useful compounds that no pill or supplement can re-create.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to [email protected]

Food for thought: reconstructing the diet of Napoleon’s Grand Army

Understanding the historic past can be incredibly challenging. Written records are only as accurate as the knowledge of the author, and historical narratives can be influenced by political orientations and specific agendas. Even accurate depictions of historical events may not reveal the whole truth; how some people may have experienced a particular event may differ radically from how the majority of people experienced it. The version of history that makes its way into history books can be incomplete.

That’s why archaeology is necessary to corroborate written documents of historical events. Physical evidence is a powerful check on speculation, deceit, and inaccuracy.

But archaeology and its related discipline, biological anthropology, can do more than just confirm or falsify historical narratives; it can reveal details of people’s lives (and deaths) unobtainable through other means. Paleopathology can tell us exactly how young men died on a July afternoon in 1863 in a Pennsylvania peach orchard, or how an older man spent the last few hours of his life 5,000 years ago. Anthropological genetics can tell us that an anonymous skeleton found under a parking lot belonged to a famous king whose family tree was not quite what recorded history claims.

And stable isotope analysis can tell us about diet in ancient times: what a person eats is literally archived in his or her bones. If your diet consists mainly of C4 plants (like corn, sorghum, and millet) which undergo a particular photosynthetic pathway, you likely have a different ratio of isotopic elements 13C and 12C (carbon atoms with different numbers of neutrons in their nuclei) than if you eat mostly C3 plants (temperate crops like barley, wheat, and potatoes), which undergo a different photosynthetic pathway.

Live near the coast and eat seafood? You likely have more 13C relative to 12C than inland dwellers because your carbon derives mainly from the ocean rather than the atmosphere. The ratio of nitrogen isotopes 15N and 14N will be similarly dependent on what kinds of food you eat. Finally, your isotopic ratios will also reflect how much of your diet is derived from animal vs. plant sources (your “trophic level”).

Together, and in the context of region-wide studies of isotopic ratios from different historical periods, the analysis of multiple stable isotopes can give a good indication of the diet of different individuals in the past.

I was thinking of how this kind of study can tell us such personal stories of history while reading a recent study in the American Journal of Physical Anthropology by Sammantha Holder and colleagues: Reconstructing diet in Napoleon’s Grand Army using stable carbon and nitrogen isotope analysis.

Napoleon’s Russian campaign of 1812 was marked by terrible logistical disaster and resulted in profound loss of life within his own army. Although his forces reached Moscow, they found the city abandoned and burning—a deliberate tactic on the part of the Russian army to prevent the French soldiers from finding provisions.

Forced to retreat to find supplies, the French encountered terrible winter conditions and further disruptions to their supply lines. Total estimates of casualties vary, but hundreds of thousands of soldiers died in the campaign, many due to the combination of starvation, disease, and exposure while the army retreated.

The practice of requiring soldiers to “live off the land” to supplement their rations likely contributed a great deal to this loss of life. This rendered them extremely vulnerable to the Russians’ scorched earth tactics which left them little to forage or steal. But Napoleon’s Grande Armée was ethnically and socially heterogeneous. Were their origins, social status, and access to food during this time of deprivation reflected in their diet? This is one of the questions that Holder et al. set out to address in their research.

They analysed stable carbon and nitrogen isotopes from the remains of 78 individuals excavated from a Napoleonic-era mass grave in Vilnius, Lithuania where the army had retreated in December of 1812. The presence of uniform buttons from multiple Napoleonic regiments in the grave confirmed that most of these individuals were members of the army. However, it is unlikely that everyone in the grave was necessarily a soldier; many male and female civilians were associated with the military in various capacities, and female remains were found in the mass grave.

Skeletons of soldiers of the great army of Napoleon are uncovered after they were discovered at a building site in Frankfurt, western Germany, on September 17, 2015. The remains of some 200 dead soldiers in total of the Napoleonic Army of 1813, on the way back after the defeat of Napoleon during his Russian campaign, are expected to be found. Photograph: Daniel Roland/AFP/Getty Images

Holder et al. found surprising variation in isotopic ratios among the individuals excavated from the mass grave. For example, one group of individuals had primarily C4-based diets, suggesting that they may have originated from Italy or Poland where similar isotopic ratios have been found in remains from this period. This interpretation was bolstered by the presence of buttons from the uniforms of Italian and Polish regiments in the mass grave.

However, the majority of individuals from the grave ate C3 plant-based diets—characteristic of many Northern European countries–but individuals differed significantly in the amount of terrestrial animal protein they consumed.

One group, which ate limited animal protein, may have been regular soldiers or conscripts. Another cluster of individuals, which included three women, ate a diet containing a significantly higher amount of terrestrial animal protein. The authors interpret this result to indicate they were high-ranking officers (and perhaps their family members).

Holder et al. concluded that the strikingly wide range of isotopic ratios found in the remains from the mass grave was “indicative of dietary variation associated with a multiethnic and socially stratified military population.”

These results are perhaps not all that surprising. Napoleon’s Grande Armée is known to have been composed of soldiers from multiple populations, including French, Polish, Austrians, Italians, and Spanish. C3 plants (wheat and barley) are known to have been the most commonly consumed plants in Northern European diets. C4 plants (such as millet) were often consumed in southern Europe, and thus the isotopic ratios of the soldiers may have reflected their geographic origins. In addition, the amount of meat in a diet was directly related to social status. Class differences between officers, regular soldiers, conscripts, and camp followers would have likely meant that there was unequal access to certain kinds of foods (such as meat) most of the campaign. Limited supplies during the winter retreat from Russia would have likely driven this inequality of access to even more extremes.

Interestingly, when compared to other European military forces (such as members of Britain’s Royal Navy buried in a cemetery at Gosport), the dietary variation in the French army was significantly higher. As more studies of this type are conducted, it will be interesting to see if other countries’ armies were similarly diverse in their diet. I would be particularly curious to see how Napoleon’s Russian opponents ate during the same period of time.

As we said in the introductory post to our new blog, archaeological inference is based on complex, multi-layered evidence, and takes a holistic approach to understanding the past. Holder et al.’s study is a good example of how even the large scale events of history can be illuminated through an archaeological study of the tiniest details of individual people’s lives.

Further reading

Holder S. et al. 2017. Reconstructing diet in Napoleon’s Grand Army using stable carbon and nitrogen isotope analysis. American Journal of Physical Anthropology DOI: 10.1002/ajpa.23184

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