Tag Archive for: weight

Finding Your Health Partners

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I finished Thursday’s Memo by saying there may be hope for physicians when dealing with overweight patients. It was another viewpoint written by two clinicians. They say learning about diet and nutrition and how to interact with patients were not priorities in medical school; I’ve confirmed that with physicians I know. The authors put together ABCs of steps to treat obesity in patients. The very first one was the most important.

A stands for Ask for Permission: permission to speak to an overweight patient about his or her weight before discussing ways for the patient to begin to address excess weight. I’ll take that any day as the best first step. If physicians will do that, it shows respect for the patient. They further recommend addressing the purpose of the visit first and then asking if they could address excess body weight. That’s the way it should be. You can read the full article at the link below.

Paula, my family, and I have been blessed with some pretty special physicians and healthcare professionals who always listen to us and work with us to reach our health goals. Based on the feedback from the Thursday Memo, so have some of you. Too many haven’t, but there’s hope based on recognizing that it’s a problem in medical training as expressed in the article I cited.

If your doctor isn’t a partner to you, find a different one; that goes for specialists, dentists, physical therapists, and others. (Maybe not surgeons—I don’t care if he’s a jerk, I want the best I can find.) Ask friends and family for recommendations and check reviews online; as with anything online, take it with a grain of salt and read as many reviews as you can. If you’re staying in the same practice, find a graceful way to explain your desire to switch; you’d feel more comfortable with someone older (or younger), someone male (or female), and so on. Don’t be rude and demanding, but you’re the customer and if your optimal health isn’t the goal of the practice, maybe it’s time to start over.


The Bottom Line

I’ve spent the past two weeks addressing a different way to look at our health based on the books of Jane Austen and learning to love and respect ourselves. I’ve talked about healthcare professionals changing how they treat obese patients. But make no mistake about it: part of learning how to love yourself the way you are is to gain the confidence to address the issue to improve your health—not with the idea of being rail thin or running marathons, but by becoming the best version of yourself you can be, because that’s also a part of loving yourself.

What I envision is finding the physician or healthcare professional who will be your partner in the journey toward better health. You both have the responsibility to put forth your best efforts to try to do that. In every audio I record, I always say your physician should be your partner in reaching better health. I mean just that. So when you find that doctor, do your part; keep an open mind, do what you say you’ll do, and don’t make promises you know you won’t keep.

It all comes down to one question: what are you prepared to do today?

        Dr. Chet

Reference: JAMA Online. doi:10.1001/jama.2019.2352

Too Fat to Get Sick?

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Once in a while, a health news story makes you do a double-take and say, “Did I just read what I thought I read?”

The legislature in West Virginia passed a bill to delay the implementation of water safety guidelines from the Environmental Protection Agency for two years. They’re allowing delays in the restriction of 60 pollutants, including some known carcinogens, dumped into streams and rivers by chemical manufacturers. How did this happen? A lobbying group for the chemical manufacturers lobbied the legislature to delay the implementation so that more state-specific data could be gathered. Sounds reasonable, doesn’t it?

No. The lobbying group’s justification for the delay is that West Virginians are fatter and thus can handle more pollutants. They also drink less water and eat less fish as well; therefore additional amounts of pollutants are just fine in drinking water.

I understand that we’re now in an era of turning back EPA regulations, and maybe some are even justified. But a legislature that accepts this BS argument by a group representing chemical companies doesn’t seem to have the health of their populace in mind. The facts are that many pollutants are stored in fat, so being heavy may make people more vulnerable, not less.

Too fat to get sick? Unbelievable. Maybe it’s time to see what’s happening to the water in your area.

What are you prepared to do today?

        Dr. Chet

My Weight Loss Experience and Goals for 2019

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As the author of the Optimal Performance program, I want to tell you about my experience with the Weight Loss Cycle. I had used the Basic Program to train my body to use fat as a fuel. I use the strategy in Energy on Demand when I need to be at my best whether for a time of day, an entire day, or for an event that lasts a week. I’ve used the approach in the Fat-Burning Plan for years. Here’s my experience on the Weight Loss Cycle.

My goal was to lose 16 pounds in six weeks; normally I recommend no more than two pounds a week. I determined my caloric intake based on my exercise program and activity level. When I didn’t meet my weekly weight loss goal, I decreased calories for the next week. In those six weeks, I lost 12 pounds and almost three inches off my waist. I missed my overall goal, but because I began after already losing over 30 pounds and maintaining it for a couple of years, it was unrealistic to lose the remaining weight in that short a time; don’t make the same mistake if you choose to use the Weight Loss Cycle.

The Weight Loss Cycle explains how to maintain the lost weight and what to do until you decide to do another cycle. I chose to ignore it and went back to my typical caloric intake just to see what would happen. It took eight months to gain back the 12 pounds. The reason I did that was to show that if you’re going to lose weight and maintain it, you have to defend the weight you lose by adjusting your calories to maintain that weight.

The Optimal Performance program isn’t based only on my personal experience. In addition to keeping up on the science on weight, metabolism, and physical training, I have over 30 years experience in the field of weight loss and physical performance. This isn’t one of those “do as I say but not as I do” situations; I’ve lived it, I know it’s possible, and you can do it, too.

My Goals for 2019

I’m going to limit my goals to physical changes; my blood pressure, blood lipids, and other metrics have stayed in the excellent range.

My goal is to lose 18 pounds by April 15th—15 weeks. I’m going to break it into two six-week cycles with three weeks of maintenance between cycles. The reason for that weight loss goal is that it will put my BMI into the normal-weight category. I’ve never been there in my entire adult life.

At that point, I’m going to spend the next six months adding seven pounds of muscle while losing the remaining fat around my waist to get it to an actual 34 inches. I’ll use the Fat Burning Plan in a three-day cycle every week. That takes me to October 15th.

If I can accomplish those goals, I’m going to maintain the weight, muscularity, and body fat to the end of the year.

Those are my goals and I’ll write about my progress. But while this Memo was about me, the real question is what are your weight loss or weight gain goals and how are you going to achieve them? Remember, you can use any diet you want with the Weight Loss Cycle. It’s the process that will make you successful to get to the weight you always wanted and to maintain it.

Join me for the journey.

What are you prepared to do today?

        Dr. Chet

The Truth Behind the Obesity Paradox

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In my opinion, the short answer to the obesity paradox is that it doesn’t really exist. But what fun would that be? That doesn’t teach you anything. Let’s take a look at the problems with the research that contributed to this paradox.
 

Study One: Dialysis, BMI, and Mortality

A study of dialysis patients led to the first observation that people with higher BMIs lived longer (1). After tracking over 1,300 subjects on dialysis for a year, researchers found that those who were overweight had a decreased risk of dying and had fewer hospital stays when compared to those who were underweight. This may have been the study that yielded the name The Obesity Paradox. The problem? The study lasted only one year. Trying to generalize what will happen to all overweight and obese people on dialysis from a study that lasted only one year and at only a single location isn’t realistic. It raises an intriguing question, but we’ll need a much more extensive study to really make a solid prediction.
 

Study Two: The Rotterdam Study

I described this study on Thursday (2). While the study appeared to show a protective benefit from being overweight or obese, the subjects were elderly with an average age of 77 at the study’s beginning. One risk factor that you cannot change is age: the older you are, the more likely you are to die. But that’s not the whole story. We can probably say that older people may live longer with a little extra weight, but to extend that prediction to all age groups isn’t valid.
 

Study Three: BMI and Mortality

While this study claimed to analyze the data on over two million people, it was still a meta-analysis (3), which doesn’t yield cause and effect, just a statistical association. Further, they used studies of varying lengths without necessarily knowing exact causes of deaths. They also did not have precise BMIs on everyone; some studies included metrics such as BMI under 27.5 and over 27.5. They tried to include the highest number of subjects, but the quality of data varied and that made it a mess. Researchers chose too many different types of studies in the meta-analysis, and it just doesn’t work. I wouldn’t bet my life on it.
 

Study Four: A Broader Look

The real problem with every approach is the lack of acknowledgement that people with advanced disease may have lost weight before they were included in the study; diseases such as heart failure, diabetes, or renal disease will often lead to weight loss. Those who were heavier when disease hit had the benefit of extra energy stored as fat to deal with the disease, and that could explain the outcomes of those studies. It had nothing to do with being obese; it was a matter of timing.

A study published last month appears to confirm that (4). Researchers in the Cardiovascular Disease Lifetime Risk Pooling Project obtained data from 10 different longitudinal studies, including individual-level data and accurate mortality data. They found that as BMI increased, the death rate from all forms of CVD increased. For those who carried extra weight while younger, CVD occurred earlier, making it more likely they would die before their time.
 

The Bottom Line

As I said, there really is no obesity paradox. Being overweight or obese carries with it risks of degenerative disease. Some people may have better genes and may gain protection for a few years. But in the end, being overweight or obese carries a higher risk of various diseases than the limited protection from an advanced disease you may gain by carrying extra weight. So my advice is the same as it always was: if you’re overweight, your best bet for a long, healthy life is to lose it.

What are you prepared to do today?

Dr. Chet

 

References:
1. Kidney International, Vol. 55 (1999), pp. 1560–1567.
2. European Heart Journal (2001) 22, 1318–1327.
3. JAMA. 2013; 309(1): 71–82.
4. JAMA Cardiol. doi:10.1001/jamacardio.2018.0022.

 

Does a Little Extra Weight Keep You Alive?

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The Rotterdam Study was begun in 1991 to investigate the risk factors of cardiovascular, neurological, ophthalmological, and endocrine diseases in people 55 and older (1). The study is still ongoing, but periodically subsets of subjects are examined to find out which characteristics are associated with these diseases. In a study published in 2001, researchers reported on a group of subjects who were diagnosed with heart failure at the beginning of the study and followed for an average of six years—181 out of over 5,000 subjects. By the end of five years, 85 subjects had died. One of the observations that researchers noted was that a higher BMI was associated with reduced mortality; in plain terms, the heavier people were more likely to stay alive.

It didn’t stop there. In 2013, a study was published that directly examined the relationship between BMI and mortality (2). This meta-analysis included 97 studies and examined more than 2.88 million participants and more than 270,000 deaths. They reported that while grades 2 and 3 obesity (grade 2: BMI of 35-39.9; grade 3: BMI more than 40) were associated with increased mortality, grade 1 (BMI of 30-34.9) was not, and the overweight category (BMI of 25-29.9) actually showed a reduced risk of dying. (How do you rate? Check your BMI here.)

Is this true? Is body weight not associated with an increased risk of death? Have we been trying to lose weight for no reason? I’ll finish this on Saturday.

What are you prepared to do today?

Dr. Chet

 

References:
1. European Heart Journal (2001) 22, 1318–1327.
2. JAMA. 2013 January 2; 309(1): 71–82.

 

What Is the Obesity Paradox?

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Did you ever hear something that didn’t seem to make sense? That seemed to go against everything you thought to be true? One example of this is something called “The Obesity Paradox.” I’ve seen a few headlines this week that have talked about it, so it’s time to address it in the Memo.

One of the variables that we would think is related to the development of cardiovascular disease would be body weight. It seems logical: as weight increases, so does the strain on pumping the blood through the additional blood vessels required to feed the extra fat and muscle. People who are overweight may eat the wrong foods, consume too much food, and move too little.

But since the early 2000s, several studies have been published seeming to show that body weight wasn’t necessarily a risk factor for CVD or an early death. They showed that those who were overweight, a BMI between 25.0 and 29.9, had lower mortality rates than those who were normal weight. Some showed that stage-one obesity, a BMI between 30.0 and 34.9, was also not related to mortality. Thus the term “The Obesity Paradox” was coined. But is it true? We’ll take a look at the research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

Sleep More and Quit Eating Sooner

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Sleep more, eat the same, and lose weight. Seriously? That’s what researchers are going to try to find out. At this point, there’s little question that for most people, lack of sleep messes with the circadian rhythms and negatively impacts glucose metabolism.

But a different research team is looking at another element: how long you eat every day can impact your ability to lose weight. Researchers have done a pilot study looking at eating intervals: the time you eat your first meal until you stop eating for the day. For people devoted to their evening snacks, it can be 16 to 18 hours per day.

In the pilot study, subjects restricted their eating to a period of 10 to 12 hours per day. Over 16 weeks, subjects lost an average of seven pounds. One more thing: they didn’t have to restrict their eating. They ate what they wanted, just in a shorter time interval every day.

This was a pilot study using an app that the researchers developed; they’re recruiting 10,000 subjects to see if the idea will work on a greater scale while collecting additional data. Such as what? Well, maybe you actually eat fewer calories when you eat in smaller time frame even if you eat the same foods. By the way, if you want to be a subject, check out www.mycircadianclock.org to see if you qualify.

Back to the sleep portion. The part that interests me the most is the messed up carbohydrate metabolism by eating when your clock says it’s time to sleep. Getting more sleep is not easy these days, but it just might be worth it.

We’ve all heard people say they cannot lose weight no matter what they do. Well, maybe getting a little more sleep and eating over fewer hours may help. Of course, if you’re a diabetic or hypoglycemic, talk with your doctor. But here’s something simple and cheap you could do: sleep more and eat the same over fewer hours. Will you lose weight? We don’t know, but it’s worth a try.

What are you prepared to do today?

Dr. Chet

 

Reference: doi:10.1001/jama.2017.0653

 

Can You Lose Weight by Sleeping More?

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That doesn’t seem to make any sense; you’re not going to be as active because you’re sleeping, so how can that help you lose weight? Well, if you’re sleeping you’re not eating, but there must be more to it than that. Let’s go back to the SCN, the pacemaker of rhythms.

Researchers have found that cortisol and melatonin aren’t the only hormones and organs tied to the light-dark cycles. Hundreds if not thousands of genes also respond to light-dark cycles. Glucose metabolism, the processing of sugars, is tied to these cycles; we seem to process sugars better during the light hours than at night. For some reason, eating carbohydrates in the dark hours results in slow processing of carbohydrates. Typically carbohydrate metabolism is a fairly high-energy process using 15 to 20% of the calories in digestion and absorption, but eating in the evening seems to decrease metabolism enough that it could theoretically result in gaining 12.5 pounds in a year.

Theory and life are two different things. Research on rodents shows that if researchers flip their cycle by feeding them in opposition to their rhythms—they’re day-sleepers, so they’re the opposite of us—they gain more weight when fed the same diet than mice fed during their normal cycle.

What about humans? Is there a solution? Skinny rats are fine, but what’s in it for us? We’ll wrap this up on Saturday.

What are you prepared to do today?

Dr. Chet

 

Reference: doi:10.1001/jama.2017.0653

 

Could Your Rhythms Be Keeping You Fat?

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You eat well and you exercise, but you still can’t lose any weight. What if the answer was in the natural rhythms of your body? I’m not talking about dance moves; I’m talking about circadian rhythms, the natural 24-hour cycles based on day and night. Since we can pretty much control the amount of light indoors 24-hours per day, our natural rhythms can be in disarray.

I’ve talked about the pacemaker of the heart several times over the years. It turns out that there’s an area in the brain called the superchiasmatic nucleus (SCN) that acts as the central pacemaker for circadian rhythms. It’s found in the hypothalamus and for a small group of cells, it seems to do a lot.

In the mornings in response to daylight, the SCN sends signals to raise body temperature and produce hormones such as cortisol. Time to get up! The SCN also responds to light by delaying the release of other hormones such as melatonin that help us sleep. When it gets dark the eyes signal the SCN that it’s night. Melatonin levels rise in the evening and stay elevated throughout the night, promoting sleep.

What does this have to do with being fat and not being able to lose weight? Now that we know how this pacemaker works, it turns out it could be an important factor. I’ll cover recent research the rest of the week.

What are you prepared to do today?

Dr. Chet

 

Reference: www.sleepfoundation.org.

 

Obesity: A Global Problem

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The overwhelming conclusion by the Global BMI Mortality Collaboration is that the rate of mortality linked with the degree of obesity follows the same pattern in the entire world with one exception: South Asia. If you look at the graphs of the mortality rate per BMI category, they’re virtually identical in North America, Europe, Australia, New Zealand, and East Asia. One of the reasons that South Asia might be different was that only three studies were included in the analysis.

We are not alone in our fight to lose weight and get healthier. Actually, that’s a completely different . . .

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