For this month’s Healthy Actions topic on diets, my expert is Dr. Janice Camino, a primary care physician with Unity Health Network.
Q: What do you advise when someone wants to lose weight?
A: I ask them “What’s your motivation?” Whether it’s for health reasons or you want to get into your swimsuit, you need to know why and what's realistic.
Let’s not forget the role of counseling in weight loss endeavor. Behavior modification or behavior therapy is one cornerstone in the treatment for obesity. Behavioral therapy can help patients make long-term changes in eating behavior by modifying and monitoring food intake, modifying physical activity, and controlling cues and stimuli in the environment that trigger eating. These concepts are usually included in programs conducted by trained personnel as well as many self-help groups.
Q: What about exercise?
A: Find the right time for you. For me, it has to be in the morning. Find 10 minutes to do something, like finding aerobic exercise videos on YouTube for free or walk on a treadmill. It takes 21 to 28 days to develop a habit. Set a goal that sets you up for success.
Q: Do people try too much too soon?
A: A lot of times, people will say “Dr. Camino, I’m going to be on the treadmill for an hour.” That sounds great, but start with 10 minutes and work your way up. Then you can start venturing into structured exercise.
Q: What’s the ideal amount of exercise?
A: Interval training for 150 minutes a week to get your heart rate up. Different people have different abilities. If you have knee problems, go out for a brisk walk. There appears to be a dose effect for physical activity and weight loss and the more you exercise, the more you lose weight.
Q: Is there still a formula for losing weight and calories?
A: We used to say assuming you’re on a 2,000 calorie-a-day diet, if you reduced your calorie consumption by 500 calories a day, you would lose one pound a week. But now we’re finding out in three to six months, people are gaining back what they lost with a vengeance. Their body was realizing “You’re not feeding me enough” and the basal metabolic rate decreases so this would not work if they are not supplementing this with exercise. The body appears to have a "set point" of fat tissue mass, and after weight loss, counter-regulatory hormones are secreted to re-establish the higher body weight.
Q: So should you not watch your scale?
A: Weight loss of more than 5% can reduce risk factors for cardiovascular disease, such as hypertension (high blood pressure) and diabetes so we need an objective way to track weight loss. After this is achieved or close to it, the focus should really be how a person feels: if their clothes are fitting better, not the number on the scale. There are other benefits of weight loss such as reduced blood pressure medication, insulin, cholesterol medication, improving anxiety, depression, mobility, sex function, and the list goes on.
Q: Do men and women lose weight at different rates?
A: Yes. Men lose more weight than women of similar height and weight because men generally have more lean body mass (which burns more calories than body fat, even during rest), less percent body fat, and, therefore, higher energy expenditure so wives should not focus on the fact that their husbands are losing more weight.
Also, older individuals of both genders have a lower energy expenditure and lose weight slower than younger individuals. Metabolic rate declines by approximately 2% per decade.
Q: What are some other popular diets that work?
A: The Keto diet. Your body lives off of two main energy sources: ketones and sugar. Sugar is an immediate source of energy. After a while, when you’re depriving your body of the sugar, your body starts to look for other ways to find energy by breaking down fat in the body, or ketones. When this happens, your body becomes incredibly efficient at burning fat for energy. It also turns fat into ketones in the liver, which can supply energy for the brain. You are mostly eating meat and fatty sources like avocados, nuts, eggs, broccoli and berries and you stay away from starchy vegetables and fruits.
People are successful with the Keto diet, but it's a lifestyle and it’s hard. I’ve also had people say they can do the Keto diet and eat only bacon and heavy cream. Unhealthy fat consumption is not the point and is not recommended.
Q: What about fasting diets?
A: People fast for a variety of reasons, including religious reasons. The most popular fasting diet now is the 16:8 fasting. You don’t eat for 16 hours and then eat during the following eight-hour window. For instance, you don’t eat anything at all until 12 p.m. so no breakfast and stop eating by 7 p.m. The theory is that while your body is not getting energy from food during the 16-hour fasting period, it uses fat stores for energy. Even though you’re asleep, your body still requires energy.
Some people do intermittent fasting and even for 30 days. I've done the 16:8 and the first three to four days are hardest. During my fasting window, I would drink black coffee with MCT oil (medium chain triglyceride) to keep me full in the morning.
Q: Are there any diets to stay away from?
A: Any diet that sounds too good to be true likely is, especially if there's no exercise involved.
Beacon Journal consumer columnist and medical reporter Betty Lin-Fisher can be reached at 330-996-3724 or firstname.lastname@example.org. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ and see all her stories at www.ohio.com/topics/linfisher