Wednesday, February 3, 2016

How Do I Lose Weight - and KEEP it Off? What the Research Says About Weight Maintenance

"It's one thing to lose weight - another thing to keep it off." There is a lot of truth to that statement. The good news is that extensive research has been done to determine what it takes to lose excess weight - in a healthy and sustainable way.

Many of us have heard the depressing old wive's tale that only 5% of people who try to lose weight can keep it off. The good news is that rumor is not true! The number is a little better than that - around 20% succeed - and even better news is that we have studied those successful "super losers/super-maintainers" to find out what strategies they have in common. While individuals vary in details, there are in fact common "patterns" of behavior that the successful "elite losers" employ. Learning from their experiences can help more people be successful! The National Weight Control Registry is a great source of this information, and other studies have also provided us with key clues and tactics.  

Our goal at Physicians Healthy Weight Center is to show you the research, and then customize that research to fit the successful strategies into YOUR lifestyle - with your unique challenges, circumstances, preferences. We show people the "why", then work with them on the "how" of long term weight success. We also help them get back on track when they inevitably slip off the wagon. (In fact, learning how to avoid falling off the wagon, AND how to get back on track, is a key part of long term success.)

While the best results of course are going to be achieved with individual counseling, treatment, and support, we would like to share some of the research so you can start thinking about what works.
Here are excerpts from an excellent article from the American Academy of Family Physicians about weight loss maintenance, along with some of our "translations into English" in italics:





http://www.aafp.org/afp/2010/0915/p637.html


Excerpts from the AAFP article Weight Loss Maintenance:

Weight Loss Maintenance

SAMUEL N. GRIEF, MD, University of Illinois at Chicago, Chicago, Illinois
ROSITA L.F. MIRANDA, MD, MS, Clay County Hospital, Flora, Illinois
Am Fam Physician. 2010 Sep 15;82(6):630-634.
“... Approximately 65 percent of adults in the United States are overweight or obese. Almost one half of the adult population is trying to lose weight at any given time. Although losing weight can be very difficult, the real challenge often is maintaining the weight loss...Research has shown that approximately 20 percent of overweight or obese persons are successful at long-term weight loss...Successful approaches to weight loss maintenance include consulting with a physician, (ideally with a physician who is board certified in Obesity Medicine), nutritionist, or another support source; adhering to a stable diet with a limited variety of food (keeping things simple and choosing "easy favorites" helps with success); monitoring weight (at home or at physician's office for extra accountability); eating breakfast (higher protein breakfasts help weight loss maintenance in research); and exercising regularly (exercise must be tailored to the individual)

Long-term pharmacologic treatments ("weight loss medications") for weight loss maintenance have been studied and were found to have modest success (weight loss medications can help certain people get on track more quickly while they establish new eating and lifestyle patterns, and can help later if people face new challenging life circumstances which may put them at risk of relapse)...

(How success is defined, and by whom): Successful weight loss maintenance is defined as losing at least 10 percent of one's initial body weight and maintaining the loss for at least one year. The 10 percent threshold was initially suggested because weight loss of this magnitude can lead to (health benefits)...in lipid ratios (cholesterol numbers), blood glucose homeostasis (blood sugar control), and risk of heart disease, all of which have been well-documented...the definition of successful weight loss maintenance was selected based on criteria from the Institute of Medicine.

Long-term adherence to a diet and exercise program is the key to success (it is important to create long-term, livable strategies, rather than short-term gimmicks or extreme diets)...The National Weight Control Registry (NWCR) is the longest prospective compilation of data and information from persons who have successfully lost weight and maintained their weight loss..(a majority) of registry participants reported receiving some type of help with weight loss (e.g., commercial weight loss program, physician, dietitian or nutritionist)...

The most common dietary strategies for weight loss were to restrict certain foods (*“trigger foods”*) (87.6 percent), limit food quantities (44 percent), and count calories (43 percent). Regardless of the diet employed, the strategy for successful weight loss maintenance usually entailed dietary modification plus physical activity... Research has determined that certain strategies, such as weighing oneself, planning meals, tracking fat and calories, exercising at least 30 minutes daily, and adding physical activity into one's daily routine, are important in successful weight loss maintenance. Barriers to exercise (e.g., being too tired, having no time or no one with whom to exercise, finding it too hard to maintain an exercise routine) were associated with being unsuccessful at losing weight (barriers need to be identified and addressed) ... time pressure and lack of social support seem to be important hindrances in achieving exercise-related goals (successful people need strategies to simplify their routines to save time, and they also need to have a support team.) Reducing consumption of fast foods can also assist persons in keeping weight off (cutting out junk food/addictive food improved success.)
Persons who maintain a stable day-to-day diet and do not appreciably change their diet on weekends, holidays, or special occasions tend to experience less weight regain over the subsequent year and are 1.5 times more likely to maintain their weight loss (don't turn weekends into a free-for-all, and you'll be more successful long term.)
Brief, monthly personal contact between patient and physician or patient and educator has been shown to be more effective in accomplishing weight loss maintenance than other methods of interaction, including Web-based technology (face to face support and accountability is a key to success.)  

Physicians can assist their patients with maintaining weight loss by reinforcing healthy dietary and exercise habits; regularly monitoring weight, body mass index (BMI), and waist circumference; encouraging additional support from nutrition counseling and cognitive behavior therapy, when indicated; and addressing other risk factors for weight regain (a comprehensive approach works best, including counseling/life-coaching by a trained physician.)  

Social support, better coping strategies, and the ability to handle life stressors are factors associated with successful weight loss maintenance (it's not just about food and exercise, life challenges also need to be addressed.)

Food journaling is an additional proven strategy for short-term weight loss and successful weight loss maintenance (journaling is not fun, but it works. It can be a 'detective tool' to identify problems, so they can be fixed.)
Pharmacologic treatment may be considered as an adjunct to lifestyle changes (weight loss medications are not meant to replace healthy lifestyle, they are supposed to facilitate healthy lifestyle.)...Indications for pharmacotherapy (criteria to quallfy for weight loss medication) are a BMI of at least 30, or a BMI of at least 27 with weight-related comorbidities (anyone with a BMI of 30 and above may be considered for weight loss medication, and anyone with a BMI of 27 or above who has a health problem related to excess weight, such as high blood pressure or diabetes, may be considered for weight loss medication.)
A recent prospective case-control comparison of surgical and nonsurgical methods in NWCR participants demonstrated no statistical difference between either method in achieving weight loss maintenance.  (Bariatric surgery does not result in better weight loss maintenance than nonsurgical treatments.) This suggests that behavioral changes can achieve the same results as surgical interventions when patients are sufficiently motivated and supported."  (This actually comes as a surprise to many patients, and even to many physicians who are not weight loss specialists - that weight loss surgery is no more successful than nonsurgical treatment, when the nonsurgical approach is comprehensive, and the patients are given support and motivation.)

We can help you with all phases of the process - setting up a healthy weight loss lifestyle strategy, supporting you while the new lifestyle becomes "second nature", and then we can help you stay on track during maintenance. It is our job to translate the science into real-life strategies that fit your unique needs and health/medical challenges. We are glad to help! Read more about our program at healthyweightcenter.com .
Call any time at (6030 379-6500.

References:
1. http://www.aafp.org/afp/2010/0915/p637.html
2. The National Weight Control Registry http://www.nwcr.ws/
3. Unites States Preventive Services Task Force: "The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. " http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/obesity-in-adults-screening-and-management#Pod2
4. New US Obesity Guidelines:  Treat the Weight First; January 16, 2015 http://www.medscape.com/viewarticle/838285

Tuesday, February 2, 2016

Protein and Calorie Chart: How do I get enough protein?

“Doctor, how do I get 30 grams of protein at breakfast?!” A patient asked me this today, after reading about the latest research which shows that higher protein diets can help with weight loss, appetite control, and blood sugar levels.  The patient realized, after a quick examination of her own breakfast, that she was getting nowhere near the recommended 30 grams of protein, and when she thought about adding protein, her calorie count was going too high... she came to the right place for help.  This is what we do every day - helping people achieve healthy eating patterns that are realistic, tasty, and meet their needs for nutrition and calories.


Research has indeed shown that diets higher in protein can help with weight loss, appetite, and can even help control blood glucose (important for anyone with symptoms of hypoglycemia, prediabetes, diabetes, or  excess “belly fat”, known as the “apple” weight pattern).  Eating 30 grams of protein at breakfast can give benefits all day long - improvements in blood glucose, appetite, and calorie control. Here is my recent blog post on the research:  


Additional research demonstrates that higher protein diets can help us burn more calories  - up to 350 more burned off per day - by increasing our metabolic rate (our body actually “burns” more calories when digesting protein).  My previous blog posts about this research:




More on Dr. Ludwig's Research - or Why It's So Hard to Lose Weight!”



Even more research on the benefits of protein show that starting EVERY meal and snack with protein can help control appetite and blood sugar:  



Now that we can see the research, how do we make this happen in “real life”?  How can we get our protein, while controlling our calories?


Below we have created a chart which shows how many calories come with 30 grams of protein, by food type.  As you can see, some protein sources are a “calorie bargain” when it comes to packing a protein punch, while others end up providing too many calories if you tried to rely on them as the sole source of protein.


You can mix and match different protein sources.  Most of our patients try to keep their breakfast under 350 calories, and it can be far too easy to go over that goal, without preplanning, intentionally, with the facts.  We can help, if you are finding it challenging to set up on your own.  The good news is that once you set up a simple plan, it becomes pretty easy to stay on track!


Quick tip - for convenience, many patients use a protein powder base for smoothies, or add a boost of protein with an easy packet of protein hot chocolate - to get 15 extra protein grams for 80 calories, just by stirring in hot water. We have some simple and tasty options at Seacoastnutrition.com



PROTEIN CHART
                                    Goal: at least 30 grams of protein for breakfast


Dairy (Goal: Nonfat or 1%)
Food
Protein (g)
Calories
Egg whites (1 ½ c)
30
150
5 whole eggs
31.4
360
4 cups of nonfat milk
32
330
1 ⅓  c nonfat Greek yogurt
(example: Fage)
30
173
24 oz regular nonfat plain yogurt  
32
320
¾ c. fat-free cheese (ex.: Kraft shredded mozzarella)
27
135
1% fat cheeses (ex: Cabot 75% fat free, 3.3 oz)
30
200
4 Low fat/light mozzarella cheese sticks
28
200
1 c nonfat cottage cheese
28
160


Protein Powder
Food
Protein(g)
Calories
VHP easy complete meal replacements, just add water
(1 packet)
35
250
3 scoops Nectar Whey Protein
30
120
2 Protein Hot Chocolates
30 (15g per packet)
160 (80 per packet )
2 Vanilla Cappuccinos
30 (15g per packet)


160 (80 per packet)
2 Healthwise Chocolate Drinks
30 (15g per bottle)
160 (80 per bottle)
Physicians Protein Smoothies (1 packet)
(50:50 mix of whey and caseinate, with fiber)
20
110
Thorne VegaLite Vegan Protein (1 scoop, vanilla)
1 ½ scoops: 36
1 ½ scoops: 180


 Poultry (choose white meat, and remove the skin)
Food
Protein (g)
Calories
6 oz white meat turkey breast nitrate-free deli meat  
30
180
3.5 oz roasted turkey breast
30
130
3.5 oz chicken breast
30
164
97% lean ground turkey (1 cup cooked)
34
140
2 Alfresco Chicken Sausages
32
280
2 medium chicken thighs with skin
30
300


                  
 Fish and Seafood (see separate list for more clean/sustainable)
Food
Protein (g)
Calories
Varies by type - 4 oz
28
                 150
Tuna, light, canned in water or tuna or salmon in foil packet (better, no BPA!)(5 oz)

40

                 190
4.6 oz pink salmon (AK)
30
                138
6 oz tilapia (US,  Ecuador)
30
                150
6.6 oz catfish (US)
30
                 260
6 oz scallops (farmed)
30
                 370
4.4 oz shrimp (US farmed)
30
                 190
4.5 oz mussels
30
                 218
5.8 oz crab (King, Snow)
30
                 135



 Meat  (lowest calories in lean cuts)
Food
Protein (g)
Calories
5.3 oz 90% lean ground beef
30
270
5 oz lean bison (“buffalo”)
30
152
6.6 oz rib eye steak
30
416
4.6 oz bison steak (“buffalo”)
30
149
5 ½  slices Canadian bacon
30
245
4.75  oz lean ham (watch sodium)
30
200
5.2 oz pork tenderloin
30
201
4.9 oz ostrich tenderloin
30
169


Beans, Soy, Seitan
Food
Protein (g)
Calories
3 cup Light soy milk
18-30
180-300
11.25 oz firm  tofu
30
262
11.25 oz LITE firm tofu (Nasoya)
30
169
5.8 oz cooked tempeh
30
290
½ c seitan
30
170
1 cup soy beans/edamame
28
220
1 ½  cup beans (varies)
21-30
420
2 cup cooked split peas
32
460
2 cup chickpeas
28
440
 
                     




Nuts and Seeds (Caution: very high in calories to get enough protein!)
Food
Protein (g)
Calories
7 1/2 Tbs peanut butter
30
712
12 Tbs  PB2
30
270
0.9 cup almonds
30
787
0.8 (over ¾) cup peanuts
30
716
1 ½  cup cashews
30
1128
1 ½  cup pecans
30
1140
1 ¼  cup sunflower seeds
30
825
1 cup pumpkin seeds
30
672
0.9 cup flax seeds
30
1050
30 cups Pure Almond Milk (Silk Original)
30
1800
(not a mistake - almond milk has almost NO protein!)



For help designing your healthy meal plan, and healthy lifestyle plan  - including healthy activity, sleep, tactics and strategies to get on track, and back on track, and help with medical conditions tied to excess weight - call us at (603) 379-6500.  Read more about our program at healthyweightcenter.com

For easy, simple protein supplements to make planning easier, you may look here:  seacoastnutrition.com
                                                
References:

1.Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels, Alpana P Shukla, Radu G. Iliescu, Catherine E. Thomas, and Louis J. Aronne: http://care.diabetesjournals.org/content/38/7/e98.full

2. Nutr Metab Cardiovasc Dis. 2014 Mar;24(3):224-35. doi: 10.1016/j.numecd.2013.11.006. Epub 2013 Dec 20. Long term weight maintenance after advice to consume low carbohydrate, higher protein diets--a systematic review and meta analysis. Clifton PM1, Condo D2, Keogh JB3. http://www.ncbi.nlm.nih.gov/pubmed/24472635

3.http://www.sciencedaily.com/releases/2012/06/120626163801.htm Children's Hospital Boston; The study finds diets that reduce the surge in blood sugar after a meal -- either low-glycemic index or very-low carbohydrate -- may be preferable to a low-fat diet for those trying to achieve lasting weight loss.
4.http://jama.jamanetwork.com/article.aspx?articleid=1199154 Effects of Dietary Composition on Energy Expenditure During Weight-Loss Maintenance. JAMA, June 27, 2012 DOI: 10.1001/jama.2012.6607
5. .Nutr J. 2015; 14: 17.Published online 2015 Feb 10. doi:  10.1186/s12937-015-0002-7 PMCID: PMC4334852  Breakfast protein effect on adult women
6. http://ajcn.nutrition.org/content/97/4/677.fullAm J Clin Nutr
vol. 97 no. 4 677-688 Breakfast protein effect on late adolescent girls
7. NRDC Sustainable Seafood Guide: http://www.nrdc.org/oceans/seafoodguide/page4.asp
9. Monterey Bay Aquarium Seafood Watch: http://www.seafoodwatch.org/