http://www.adn.com/life/story/9215317p-9131460c.html
Weight loss is simple: Eat less and be more active
OBESITY: Anchorage doctor says the key is to have a plan and stick to it.
By ROSEMARY SHINOHARA
Published: August 12, 2007
3:37 PM 8/12/2007
It's simple, but nobody wants to hear it.
To lose weight, you need to use up more calories than you eat.
In most cases, that means eating less, says Dr. Jeffrey Lawrence, director of the Providence Alaska Medical Center weight loss clinic.
"There really is no other way," he said.
And exercise is key to maintaining weight loss, Lawrence says.
Nobody wants to hear that, either, but Americans better face up to it.
As a country, we're getting fatter and fatter, the federal Centers for Disease Control and Prevention reports. Only 15 percent of adults aged 20 to 74 were considered obese in a survey from 1976 to 1980. By 2003-04, the number had more than doubled to nearly 33 percent, the CDC reports.
Alaska is right up there, with more than a quarter of the adults weighing in as obese.
Lawrence was an ob-gyn in private practice here for 20 years, then shifted to weight management. He is board-certified in the field.
And he lost 50 pounds himself 10 years ago. "I let myself drift up," he said. But it felt wrong to be sitting across from people admonishing them about being overweight when he was too.
His trick? There was none. "I cut my portion size and did exercise."
OK, it can't be that easy, or everyone would do it.
Here's what else Lawrence had to say in written responses to Daily News questions. The questions and answers were edited for length and clarity.
Q. Why is it so hard to lose weight?
A. It really isn't hard to lose weight IF you really want to. The problem is commitment. You must be willing to change. Americans are addicted to food. They associate the pleasure and enjoyment of food with quantity, not quality. Even our best Anchorage restaurants have started serving larger-than-normal portions to satisfy this change.
True long-term weight loss is the result of learning new eating habits and sticking with them until those new habits become the norm. Time and knowledge are the keys to sustained weight loss.
Q. What makes success more likely?
A. Use a nutritionally sound program. Learn about what you eat. Read and understand labels. Reduce portions, listen to your body's signals and increase activity. Notice I did not say exercise. Exercise is something formal. An increase in activity is increasing the usual daily activities: walking, using stairs, reducing sedentary activities.
Q. How can people break out of the lose-a-little, gain-it-back, lose-it-again cycle?
A. Simple things like cutting portion size in half, reducing high-calorie, nutritionally poor junk and convenience foods. Start keeping a record of what you eat and the activity you do. This results in accountability. It forces you to see what you are doing. You see that the ... burger at Carl's Jr. is 1,000 calories and mostly fat.
Have a plan and stick to it. Get help, support. Obesity is a chronic disease. It has remissions and relapses. Accept it as such.
Q. How much of whether you're fat or thin depends on genes?
A. Genes are about 40 percent and the environment is about 60 percent. George Bray (obesity expert at Louisiana State University) has said, "Your genes load the gun but the environment pulls the trigger."
Q. A recent Stanford University study of four diet approaches says Atkins (a low-carbohydrate plan) is the best. Your views?
A. I have not seen the Stanford study. ... Atkins is a very good program if you are fully committed to it. You cannot do it halfway. If you continue eating your carbohydrates the program will not work. If you continue eating 3,000 calories a day, you will not lose weight.
Remember the Native Alaskan diet was an 80 percent-fat diet. There were very few carbohydrates available. They were very healthy. It was only when the "white man" introduced high-carbohydrate junk foods to their diet that diabetes and obesity became a problem.
To answer the question, any (program) that is well balanced and a person will stay with as a lifetime change will work.
Q. There's a new pill, Alli, the first government-approved, over-the-counter weight-loss drug. What's your opinion of it?
A. Alli, formally Xenacal, will be over the counter soon. It will teach the folks who use it a new definition of "oil slick." It prevents the absorption of 33 percent or more of dietary fat. ... If you do not absorb the fat, where do you think it goes? (Note: Diarrhea and oily stools are reported side effects.) It is aversion therapy. The problem may be fat-soluble vitamin deficiency. It has never been shown to cause a great deal of weight loss.
Q. I've read that a small amount of weight loss can have a powerful effect on health. How small? What does it do that's so wonderful?
A. Yes! Yes! Yes! A 10 percent weight loss can mean up to a 50 percent decrease in risk of diabetes, hypertension, heart disease, etc. It can make a person a better surgical risk. A reduction in sleep apnea.
Q. If you just cut calories, what happens? At what point is there a danger that your body will adapt to the new calorie amount and you won't lose? How does this work?
A. Basically the body has a very strong anti-starvation system. Our ancestors, hunter-gatherers, had a starvation problem, not obesity. Our genes are set to prevent starvation. If you drop your daily intake too far, the body ... reduces energy expenditure to conserve energy. This is why missing breakfast is such a bad idea. By mid-morning there is little energy for the body.
Where that calorie level is for any person, I cannot say. It is probably less than 800 calories per day.
The second part of the answer is: We each have a weight set-point. It is your usual weight. Your body will try to maintain that weight. That is why we have a tendency to jump right back up after weight loss.
Q. How do you feel about gastric-bypass operations?
A. For some folks bypass surgery is a lifesaver. For others it is just another failed quick fix. Obesity is a food addiction problem. Unless that gets under control, the surgery, like everything else, will fail. Just because you have a small stomach and/or your intestine has been rerouted does not mean you cannot eat 3,000 calories a day.
Q. Do you have any thoughts about the typical programs that people turn to for help, such as Weight Watchers, TOPS (Take Off Pounds Sensibly) and Overeaters Anonymous?
A. Weight Watchers and TOPS have long records of success for some people. They are a support system. My feeling is they are best for small weight loss and, most important, for maintenance.
Overeaters Anonymous, if you are a FULL participant and do the 12-step program, can change your life in many ways, not just weight loss.
Weight loss is simple: Eat less and be more active
)
Linear Mode
