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For June 20, 2018

  • 12 Ways to Restart Stalled Weight Loss
    12 Ways to Restart Stalled Weight Loss

    What to do When the Scale is Stuck

    (From Prevention, Nov 1997; 49(11), By Marisa Fox)

    Reaching a plateau in weight loss when dieting is common but it can be overcome. The problem is caused when the diet is no longer burning enough calories for the new lower weight. Tips include: monitoring portion size, eating more whole foods, drinking more water, and burning more calories.

    So you're still doing the same things that peeled off the first 5, 10, or 50 pounds. You've kept up the daily walk, and you're a role model for low-fat eating. So why does it seem that your scale is stuck?

    You're on a plateau. Join the club. It happens to people losing weight all the time. "Plateaus can happen when you're doing the same thing as you always were, diet and exercisewise," says Terri Brownlee, R.D., dietitian at the Duke University Diet & Fitness Center in Durham, NC.

    What's changed is you.

    The smaller you are, the fewer calories you require. So the diet and exercise program that helped you get from 190 pounds down to 160 may not be burning enough calories to get you to your goal of 145. This doesn't mean you have to swear off satisfying meals or walk to the other side of the state and back to get rid of more pounds. You just need to stop for a minute and grab a pencil.

    Keep a Positive Attitude

    "Instead of getting down on yourself, try to understand what's not working and rethink your strategy," is the advice for dieters given by Cathy Nonas, R.D., administrative director of the Theodore B. VanItallie Center for Nutrition and Weight Management at St. Luke's-Roosevelt Hospital in New York City.

    That's what Cathy Upchurch did when she hit a two-month plateau after losing 70 pounds. "I kept on giving myself pep talks and refused to give up," says this 45-year-old Colorado work-at-home woman. "I kept telling myself that I was an athletic person underneath it all and that there were all these fun things I wanted to do." Cathy eventually lost another 70 pounds and has kept it all off for eight years. Like Cathy, thousands of people have come up against plateaus and been victorious. You can too! As important as a positive attitude is, you need specific and careful evaluation as well. "Once you see what the problems are, you can get back on track," says Pamela Walker, Ph.D., a clinical psychologist at the Cooper Aerobics Center in Dallas. "It shifts the focus from 'something is wrong with me' to problem solving."

    The first thing you want to take a look at is what you've been eating and doing:

    • Have your portions expanded as your waistline has shrunk? "Many people who experience success start getting overconfident and complacent," Dr. Walker says. "Portions start creeping up, and sweets are slowly added again."
    • Has your exercise routine taken a backseat to less strenuous activity? Exercise is always one of the first things to go. Walks get shorter or get skipped.

    Careful examination of eating and exercise logs can pinpoint areas where your guard may be down. Skipping your evening workout in favor of drinks with friends or indulging your sweet tooth more frequently? No time to pack a healthy lunch, so you're resorting to the vending machines?

    "It makes you accountable to yourself, and frequently you're shocked to see that you did start eating more and exercising less," Dr. Walker says.

    Get Calories Under Control

    No matter how you got on the plateau, the answer to blasting off it is to shake things up. You need to start burning more calories than you're taking in. But don't despair. That's not as hard as it sounds. Here's how to get going:

    1. Measure your portions. Arm yourself with measuring devices like scales or cups, so you don't have to rely on your eyes (or your stomach), says Nonas. Once you're familiar with what your portion sizes should be, you need only measure from time to time to make sure you're still on track. Keep portions reasonable. (But don't put limits on plain veggies -- raw or cooked. And try for three to five servings of fruit a day.)

    2. Shortcut portion control. Stock up on prepackaged low-fat meals. Food labels make it easy to know exactly what you're getting -- and you save yourself the job of measuring portions.

    3. Try a meal substitute. Liquid meals can be helpful, especially when you're on the run. This shouldn't become a long-term strategy, but it can help break a plateau.

    4. Fill up on whole foods. Bananas, carrots, and air-popped popcorn pack more fiber and fewer calories than reduced-fat cakes or cookies. Result: You feel full on less food.

    5. Postpone dinner. Eating half an hour or even an hour later than usual may be just what you need to take the edge off late-night munchies.

    6. Drink up. "Put a liter of water on your desk, and make sure you drink it by the end of the day," says Nonas. Filling up on water during the day can help make portion control easier at meals.

    7. Limit mealtimes. So you stuck to your portion, but then you ate your kids' leftovers, and before you knew it, you were noshing ad infinitum. "It's important to do things that signal the end of the meal, like brushing your teeth," says Nonas. "Or set a timer when you sit down to dinner, and when it goes off, you're out of the kitchen or dining room."

    Burn More Calories

    1. Add a minute. "Gradually extend the length of your workouts," says J.P. Slovak, fitness director at the Cooper Fitness Center in Dallas. A few extra minutes here and there can go along way toward producing real results.

    2. Lift some weights. To combat the decrease in metabolism that often comes with weight loss, increase your muscle mass. Muscles burn more calories than fat, even when you're sleeping. And they take up less space, so you look slimmer.

    3. Try something new. You're not the only one who gets bored on the stationary bike -- your muscles do too. If you always work the same muscles in the same way, they become very efficient and then won't burn as many calories as when you first started doing the activity, explains Tedd Mitchell, M.D., medical director at the Cooper Wellness Program in Dallas. If you want to shake up your metabolism, work your muscles in new ways by cross-training. If you're walking, try swimming. If you're running, try boxing. No one activity should ever get to be too easy.

    4. Add some intervals. Invigorate your routine with short blasts of very intense exercise. "Try not to mosey along at the same pace," says Dr. Mitchell. "Sprint for an interval if you're running. Pedal really fast on the bike if you're cycling." Intervals not only make working out more exciting and challenging, they help burn extra calories.

    5. Go the long way. "You don't need to have gym clothes on to get exercise," says Kyle McInnis, Ph.D., a professor in the department of human performance and fitness at the University of Massachusetts in Boston. Use the second-floor bathroom or the copier down the hall. "Accumulating physical activity throughout the day, such as walking more and taking the stairs, adds up," he says.

    A Veteran's Advice

    "The important thing is to realize how far you've come and to remind yourself of your goals," says weight-loss success Cathy Upchurch.

    And that's exactly what Cathy did. She celebrated her victories, didn't dwell on what the scale said, and reevaluated her exercise regime. When she added biking to her daily 1-hour walk and water walking in the pool, the weight started to come off. Today Cathy climbs mountains, mountain bikes, and even snowboards. She's every inch the athlete she always wanted to be.

    Is it really a plateau -- or your ideal weight?

    If you're still 70 pounds more than what most weight tables recommend for your height, chances are you're just on a plateau. If you're merely 10 pounds more, then it might be time to accept your weight. In between? That's a gray area.

    Ideal weight varies among individuals. But the term has become a statistical figure generated by insurance people who are telling you what to weight to live the longest based on averages. "That's something very different," says David Levitsky, Ph.D., professor of nutrition and psychology at Cornell University in Ithaca, NY.

    So if you're in that gray area, here are some things to consider when deciding if you should lose more weight:

    • Are you weight training? Muscle weighs more than fat but looks a heck of a lot better.
    • Where's the weight? If those stubborn pounds are around your middle, they could be increasing your risk of heart disease, diabetes, and even some types of cancer. Waist measurements greater than 39 inches for men and premenopausal women younger than 40, greater than 35 inches for men and women 40 or older, and greater than 33 inches for postmenopausal women pose greater health risks.
    • Do you have any signs of high cholesterol, high blood pressure, or high blood glucose? These may be the first clues that your weight is affecting your health.
    • Is it realistic to eat any less or exercise any more?

    "You can't diet forever," Dr. Levitsky says. "It's better to choose a lifestyle that encourages healthy weight -- in which exercise and healthy eating are a regular part of the program -- than to obsess over a few pounds.

    Balancing Act

    The slimmer you get, the less effective your current weight-loss plan will be. Here's why:

    If you were 190 pounds and sedentary when you started, you burned 2,280 calories a day to maintain that weight. (Men burn slightly more.) If you ate 2,280 calories and burned 344 calories in a 1-hour walk, you burned 344 calories more than your body needed to maintain that weight -- so you lost weight.

    Say you reach 160 pounds. Now, you need only 1,920 calories to stay at your current weight. But you're still eating 2,280 calories and going for a 1-hour walk. Since you're lighter, your walk burns 292 calories. Now you're eating more -- 68 calories -- than you're burning. Keep it up, and the scale will start moving in the wrong direction. Here's how it adds up:

    If you weigh 190 and:

    • You eat: +2,280 calories
    • You burn*: -2,280 calories
    • You exercise: - 344 calories

    Result: -344 calories a day and weight loss

    If you weigh 160 and:

    • You eat: +2,280 calories
    • You burn*: -1,920 calories
    • You exercise: - 292 calories

    Result: +68 calories a day

    This means a plateau, even though your eating and exercising habits haven't changed. Over time, you'll regain some weight unless you shift the balance.

    *to maintain your current weight if you're sedentary

  • How to Avoid Gaining Weight as You Age
    How to Avoid Gaining Weight as You Age

    Tips to Battle the Bulge

    (PHYS, September 1999) � You're smart, healthy, young. You eat sensibly and work out regularly. And in 10 years, if you stay faithful to your current diet and exercise program, you'll probably be about 10 pounds heavier than you are today. That unwelcome prediction reflects a basic physiological fact: At approximately age 30, your metabolism starts a gradual slowdown. Diet and exercise as you will, experts declare, it's just not possible to preserve a perfectly lean, youthful body composition into middle age and beyond. That's the bad news. The good news is that new evidence suggests that if you start out lean and fit in your twenties, gaining a couple of pounds in your thirties and forties might increase your odds of surviving to a healthy old age.

    Although there are no quick and easy solutions to the pound-a-year problem, the following are some good strategies for keeping weight gain to a minimum.

    Reduce Your Caloric Intake
    Clearly, you can reduce the effects of your slowing metabolism by cutting down on calorie intake and stepping up on exercise. "Even for the person who is exercising religiously, her food intake is not going to be able to remain the same," says Leslie Bonci, R.D., assistant director for nutrition at the Center for Digestive Health at Allegheny General Hospital in Pittsburgh and nutritionist for the Pittsburgh Steelers. Change doesn't have to be drastic. Bonci says it's relatively easy to trim your daily calorie intake by 100 calories every decade after age 20: "It's just a little bit of a cut-down � light beer instead of regular, one-quarter cup less cereal in the morning. A very subtle change is enough to keep the body in balance."

    Eat a Low-Fat, Vegetable-Rich Diet
    Sticking to a low-fat diet may help to keep your metabolism from slowing down even further. Obviously, eating lots of high-fat foods increases your daily calorie intake. In addition, because high-fat foods cram calories into a small volume, you wind up eating a lot in order to feel full. High-fat diets are also thought to have a subtly nefarious effect on metabolism, Bonci says, turning down the body's metabolic thermostat slightly, so you burn up fewer calories per day even as caloric intake climbs.

    Eating a vegetable-rich diet appears to help avoid spreading middles as well. American Cancer Society scientists who tracked 79,000 men and women for 10 years found that those who ate 19 or more servings of vegetables each week were less liable to add pounds to their waists. On the other hand, those who gobbled up more than three servings of meat per week were more likely to gain at the waist. Why the veggie diet may be so protective isn't yet clear.

    Increase Your Gym Time
    If you plan to lessen weight gain as you age you'll definitely need to increase the time you spend at the gym. "Our data suggest that you can probably compensate for some middle-age weight gain by becoming more active," says Paul T. Williams, Ph.D., an epidemiologist at the Life Sciences Division of Lawrence Berkeley National Laboratory in Berkeley, California. But expect to put in far more than the half hour of moderate physical activity five or more days a week currently recommended for American adults by the Centers for Disease Control and Prevention. "I've always felt that the government exercise recommendations are excellent for the comatose," avers Williams.

    Keep in mind that the amount of fat you burn with exercise seems to decrease with age. In a study comparing moderately fit adults in their twenties with those in their seventies, Samuel Klein, M.D., director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis, found that older subjects burned up to 30 percent less fat during exercise than did younger ones, even when they did the same amount of work. Older exercisers burned up more carbohydrates. Klein found that elderly subjects began to burn more fat after 16 weeks of intensive exercise. "If older people train, they have more normal patterns of fat oxidation," Klein says. "It goes back to where it is in younger adults."

    All in all, working out regularly will help keep you strong and fit as you go through middle age and beyond. "There's a lot of Scandinavian data that suggests that individuals in their sixties, seventies and eighties who are very physically active tend to live healthier, happier lives," says Metter.

    The real indicator of healthy aging isn't a number on a scale or a measurement on a tape. "On my checklist, the question is how much vitality do I have," Bonci says. "I may be 40, but if I can still run and lift, and if I feel strong and fit and have a lot of energy, I know I'm doing something that's good for my body and good for me."

  • Interval training.
    Interval training.

    Interval training is a special training technique that involves periods of higher intensity exercise interspersed with periods of rest or light activity. These intervals, which can be used to enhance competitive performance in a specific sport or to improve general fitness can vary in the following ways:

    1. Intensity and duration of the exercise period.
    2. Intensity and duration of the rest period.

    Depending on how the workout varies an athlete can train the specific energy system necessary to develop his or her specific fitness goal.

  • Calories Burned During Physical Activities
    Calories Burned During Physical Activities

    When you perform a physical activity, your basal metabolic rate will increase, burning more calories. The good news is that your BMR will stay high even after you stop the activity, continuing to burn calories. In addition, the ideal exercise or activity for losing weight is not one where you are "out of breath". It is better to perform an aerobic exercise, where you can continue to hold a conversation while performing the activity. This helps your body to actually burn fat, instead of sugar. The chart below shows the calories burned for one hour of activity for various exercises for both 140 lb and 195 lb people:

    Activity (1 hour)140 lbs195 lbs
    Aerobics, general381 531
    Aerobics, high impact 445 620
    Backpacking 445 620
    Basketball, game 508 708
    Basketball, shooting baskets 286 398
    Bicycling, <10 mph, leisure 254 354
    Bicycling, 10-11.9 mph, light effort 381 531
    Bicycling, 12-13.9 mph, moderate effort 508 708
    Bicycling, 14-15.9 mph, vigorous effort 636 885
    Bicycling, 16-19 mph, very fast, racing 763 1062
    Bicycling, Mountain or BMX 540 753
    Boxing, punching bag 381 531
    Boxing, sparring 572 797
    Canoeing, rowing, moderate effort 445 620
    Dancing, aerobic, swing, ballet or modern, twist 381 531
    Football, touch, flag 508 708
    Golf, carrying clubs 350 487
    Golf, pulling clubs 318 443
    Golf, using power cart 222 310
    Hiking, cross country 381 531
    Hockey, ice 508 708
    Jogging 445 620
    Judo, karate, kick boxing, tae kwon do 636 885
    Mowing lawn 350 487
    Racquetball, casual 445 620
    Rock climbing, ascending rock 699 974
    Rope jumping, moderate 636 885
    Rowing, stationary, moderate effort 604 841
    Running, 5 mph (12 minute mile) 508 708
    Running, 5.2 mph (11.5 minute mile) 572 797
    Running, 6 mph (10 minute mile) 636 885
    Running, 6.7 mph (9 minute mile) 699 974
    Running, 7 mph (8.5 minute mile) 731 1018
    Running, 7.5 mph (8 minute mile) 795 1107
    Running, 8 mph (7.5 minute mile) 858 1195
    Running, 8.6 mph (7 minute mile) 890 1239
    Running, 9 mph (6.5 minute mile) 953 1328
    Running, 10 mph (6 minute mile) 1017 1416
    Running, 10.9 mph (5.5 minute mile) 1144 1594
    Running, stairs, up 953 1328
    Shoveling snow 381 531
    Skateboarding 318 443
    Skating, ice 445 620
    Skating, roller 445 620
    Skiing, cross-country, moderate effort 508 708
    Skiing, snow, downhill, moderate effort 381 531
    Skiing, water 381 531
    Snowmobiling 222 310
    Soccer, casual 445 620
    Softball or baseball 318 443
    Swimming laps, freestyle, light/moderate effort 508 708
    Tennis, singles 508 708
    Tennis, doubles 381 531
    Volleyball, competitive 254 354
    Walking, 3.0 mph, moderate pace 222 310
    Weight lifting, light or moderate effort 191 266
    Weight lifting or bodybuilding, vigorous effort 381 531

    Numbers are from the "Official Journal of the American College of Sports Medicine."

  • New Drug Fights Osteoporosis
    New Drug Fights Osteoporosis

    Raloxifene regrows thinning bone

    (MSNBC News, Aug. 17 1999) � It is dramatically good news for the 22 million American women at risk for fractures from the bone-thinning disease osteoporosis � a drug that actually regrows bone.

    "WOMEN WHO ALREADY have osteoporosis can take a treatment that will markedly reduce their risk of fractures � reduce that fracture risk by 40 percent," said Dr. Bruce Ettinger of Kaiser Permanente's Division of Research in Oakland, Calif. "So even women in their late 60s who already have fractures can get a tremendous benefit for their health." The findings in the largest study to date of the drug raloxifene were published in Wednesday's Journal of the American Medical Association. The research was funded by Eli Lilly and Co. of Indianapolis, which sells the drug as Evista.

    The news comes only a month after data from the same women revealed that raloxifene appears to lower breast cancer risk by 70 percent. That is a major advantage for postmenopausal women who fear using estrogen for its bone-strengthening benefits because it slightly increases breast-cancer risk with long-term use.

    The drug is already on the market to prevent osteoporosis and it will now join the three other drugs that can treat the disease. Ettinger said the four approved osteoporosis drugs should not be considered competitors, because their benefits and limitations are so different. Doctors say each drug carries risks and benefits, but with the growing number of treatments, almost everyone should get help.

    "We can approach the patient with many choices," explained Dr. Joseph Lane of New York's Hospital for Special Surgery, "There is usually one drug or more than one drug that we can use."

    The four approved osteoporosis drugs are:

    • Alendronate, marketed as Fosamax, is the strongest bone builder and the only drug shown to protect against hip fractures. But it offers no other health benefits and causes many women stomach upsets severe enough to discourage them from taking it.
    • Estrogen, which is almost equal to alendronate as a bone-builder, and research suggests it also protects against heart disease and even mental decline for women past menopause. It relieves menopause's hot flashes and night sweats, but it commonly causes breast tenderness and a resumption of menstrual bleeding, unacceptable to many women.
    • Raloxifene, which has about two-thirds the bone-building power of alendronate but does not relieve menopausal symptoms and may worsen some, such as leg swelling. But it seems to lower "bad" cholesterol levels in the blood and is well tolerated.
    • Calcitonin, marketed as Calcimar, which is the least powerful of the bone-boosters but is offered in an easy-to-take nasal spray.

    Osteoporosis strikes women four times as often as men, usually after menopause. Women with thinning bones can suffer compression fractures in the spine that make them shorter and hunched over � and they are at great risk for debilitating hip fractures if they fall. "One in 20 women in the hospital are recovering from a hip fracture," said Lane. "It leads to profound loss of function."

    As important as treatment is, doctors say it is crucial for women in their 30s, 40s and 50s to start thinking about getting lots of calcium in their diets and taking other steps to prevent osteoporosis. "I think it is actually critical to start as soon as possible," said Lane. "Once you start losing bone we can replace it, but when we replace it we never rebuild the architecture the way God gave it to you and it is always weaker."

    A $150 test called a bone scan is an important way to make sure your bones are not getting weaker. If it shows a woman's bones are weakening, doctors can start her on one of the drug regimens. Four months ago when a bone scan revealed that Anna Borruso, a patient at the Hospital for Special Surgery, was starting to get osteoporosis, her doctor put her on Evista. When she suffered a bad fall, it was not nearly as bad as it could have been. "I was elated that I did not break my arm or my hip or my ribs," Borruso said.

    Doctors say the new drugs could give similar protection to millions of women � sharply reducing one of the worst dangers of aging.

    The Associated Press contributed to this report.

  • Need Help for Hurting Joints?
    Need Help for Hurting Joints?

    (From "Ask Dr. Weil, August 13 1999)

    Question: I am a 54-year-old yoga teacher and vegetarian. I'm having lots of hip pain, especially at night. I haven't found a movement that relieves it. Any suggestions?

    Answer: I would recommend getting a diagnosis based on a physical exam and X-ray. One possibility is osteoarthritis, a common cause of age-related aches and pains. You're a yoga teacher, so it could also be bursitis.

    Bursitis is usually caused by repetitive overuse or injury to a joint which irritates the bursae, cushioning sacs between the bones. The result can be chronic aching in the outer area of your hip which can radiate down into the buttocks or the outside of your leg.

    Standard medical treatment calls for a steroid injection to relieve the inflammation, but I suggest you try other measures first. The following strategies should help:

    • Take niacinamide. Start with 500 mg twice a day, increasing the dose by 500 mg every three weeks to a maximum daily dose of 2,000 mg.
    • Take one to two grams of powdered ginger per day in capsules.
    • Try boswellia, an Ayurvedic herb. Follow instructions on the package.
    • Soak in hot water as often as possible, and use ice packs if the pain is acute.

    You may also want to follow the advice in "The Arthritis Cure" by Jason Theodosakis, M.D. (St.Martin's Press, 1998) regarding glucosamine sulfate and chondroitin sulfate. Massage, acupuncture, osteopathic manipulation, and visualization may also offer relief.

    Finally, you could try DMSO (dimethyl sulfoxide), a solvent (found in most health food stores) that penetrates the skin and helps heal inflammation. Paint a 70 percent solution over the painful area with absorbent cotton. You may feel some warmth or stinging and may get an odd, garlicky taste in your mouth. Apply three times a day for three days. If your hip feels better, cut down to twice a day for three more days, then once a day for a final three days. If it doesn't help after three days, discontinue use.

    You might also want to take a break from yoga. Simple rest, to keep pressure off your hip, may turn out to be the best treatment of all.

    Copyright 1999 Asklepios Enterprises, Inc.


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