Refuse To Regain

Barbara's "Dr. Oz" Interview To Air at 7 a.m., 11 a.m. and 4 p.m. EDT Tomorrow

We just learned the air times for Barbara's interview on the Dr. Oz radio show. It will air at 7 a.m., 11 a.m. and 4 p.m. tomorrow (Wednesday, April 1) on Sirius/XM.

The Oprah Network can be heard on XM 156 or on Sirius 195 if you have the Sirius/XM package. If not, for those who would like to listen, the best bet is to go to the XM website. They offer a free 30-day trial. Once you sign in, you can hear the channel via your computer. The interview won't be available by podcast, but the Dr. Oz show airs several times during one day.

We look forward to your feedback after hearing Barbara's interview!

Salt, Meat and The Blindfolded Man

By Barbara Berkeley

You are probably getting tired of my ranting on about the value of ancient diet, but the evidence to support this simple, intuitive approach to eating keeps mounting. In fact, there is something almost farcical about the intense search for the perfect diet when we keep coming up with single pieces of the original diet, shouting “eureka!” and completely ignoring the rest of the parts.

This week, I wrote a response to a blog in the “Well” section of the NY Times. (Click here to read it; my comment is #59). This particular blog focused on meat eating and a study that suggested that meat eaters may have a slightly higher risk of dying than non-meat eaters. Many of the comments focus on the health aspects of meatless or almost meatless diets. None address the larger issue of diet “gestalt” (totality).

Now, a large study from rural China reveals that salt has quite a magnified effect on the blood pressure of people who tend toward metabolic syndrome (weight in the middle and its frequent companions: blood pressure, sugar problems, cholesterol issues). When given salt, these overweight people had very significant jumps in blood pressure. When the salt was removed, blood pressure fell markedly. If you believe that we were constructed with the ancient diet in mind, this all fits perfectly. Our original diet had far more potassium than sodium. We don’t do well when we reverse this ratio.

A strong sensitivity to salt is a phenomenon that I frequently observe clinically. When patients have been “good” on their diet but haven’t lost weight, it is often because of salt. Take the salt out, and their weight declines. This is an interesting point for maintainers. You may well notice that taking better care of your salt intake makes it easier for you to stay at goal weight. Salt is often buried in prepared foods and restaurant foods. Being careful to avoid it is a healthy habit.

Indicting salt is all well and good, but Chinese researchers who commented on the salt study went on and on about reducing salt intakes in their country without placing the salt issue into its larger context. Salt intakes were low for hundreds of thousands of years and these low intakes were part of a very different dietary pattern than the one we currently consume. Metabolic syndrome results from multiple elements that depart from this original human diet….not one. While controlling salt intake is a good idea, it will not do much if a diet is still high in foods that turn into blood sugar, saturated fats or tons of inflammatory omega six fatty acids.

Another example of this singular focus is our reliance on vitamins. Vitamins are part of healthy food so we assume they must be good for us. Before long we all rush to buy more and more advanced vitamins. The prices go up as the formulations become fancier and more complex. Then we start reading the studies. With a few exceptions, virtually none of them show any benefit to taking vitamins. Once again, we’ve focused on one element of a larger picture and that element alone is meaningless. It turns out that vitamins need to be cradled in the original foods from which they came if they are to be effective. Isolating them and putting them into pills leaves them shorn of all strength and potency.

I believe that we are making diet a lot more complicated than it really is. As soon as one element jumps to the fore, we all rush to focus on it. We’re like the blindfolded man trying to identify an elephant. First we touch an ear, then a foot, then the tail. What we really need to do is pull off the blindfold. What we would find, standing before us in the bright light of day, would be some version of the diet we ate for hundreds of thousands of years.

A modern day version of this diet can take many forms. It can be vegetarian (assuming that starches and sugars don’t overly dominate it) . It can be a raw food diet. It can be a Primarian diet. It can be a Mediterranean diet. Inevitably though it will be mostly original and only minimally modern. The degree to which we can control those modern elements will dictate our weight and the state of our health.

Questions From Readers To Readers: Do You Still Have Food Demons?

By Lynn Haraldson-Bering

My Maintaining Diva friend Sondra will be featured in next month’s Weight Watcher’s magazine. Her story is online now. Click here to read how she went from an inactive 242 pounds to a sleek 129-pound marathon runner.

Sondra's story prompted an email question from reader B.B. that I wanted to throw out to all of you. Sondra's answer is below, but we'd love for you to offer your insights to B.B., too, all you wise, wise RTR readers!

Here's B.B.'s question: "You know I've maintained my weight lost for 8 years now, but I still have the demons that send me to the pint of ice cream or cookies or whatever every once in awhile. I'm curious. Do you? Does Sondra? If not, how did you finally release these devils; you know those devils called feelings, memories, insecurities, etc?"

Sondra's reply: "What a great question and I think it is one that every person on this journey has. I can honestly say that I do still eat foods that some would consider taboo…including my good friend, Lynn. (NOTE FROM LYNN: This is probably true. Ya'll know what a militant I am. However, in my defense, I do eat chocolate and stuff I "shouldn't" sometimes...LOL)  I allow these foods at times because I am a firm believer that if you tell yourself that you can never have something again, you will always crave it. Once you allow yourself to have a little you can learn to control it…at least I have. I also find that I have substitutes for many of the foods I felt that I could not live without.

"That said, when I have an urge to eat not because I am truly hungry, but because I am bored, upset, tired, happy, breathing or whatever, I do two things: I grab a healthy snack first - a few (4-9) plain almonds, a piece of fruit, a slice of toast with sf fruit spread or tsp of peanut butter, a cup of tea or coffee, or even a piece of strong flavored gum. If I finish that and still feel the urge to eat, I think about what I am doing and analyze again if I am truly hungry. If it is just that I really want that Entenmanns’s coffee cake (yes, that was my demon last night) then I portion out just a few bites - it might not even be a full serving - and I eat it. 

"There are times that I have cravings that I need to make sure it isn’t just my body asking for more of something - protein, iron, carbs, etc., and that is why I take the time to really think about why I am having 'hugries.'  I have found that if I am wanting something out of frustration or some type of emotion, writing it down helps the most. I am blessed that the Divas are great listeners, but there are times when I just sit and write in my journal. I have also taken up doing jigsaw puzzles again. It has helped with my nighttime snacking a lot. It even has slowed my dinner/meal eating down because we are a 'eat in front of the TV' family and I have been eating while working on the puzzle instead. I don’t find myself rushing through my food anymore.

"Do I still have demons? Heck yeah. The great thing is that we have learned to live together in harmony. They know they will only be placated sometimes. But most of the time I get my way."

What are your thoughts on B.B.'s question? Do you still have your food demons in maintenance? Leave a comment or send an email. As always, we look forward to your replies.

Are You A “Just-In-Time” or a “Just-In-Case” Maintainer?

By Lynn Haraldson-Bering

In the latest issue of O, The Oprah Magazine, Martha Beck writes about the two ways she believes people live their lives: Either we gather everything in sight, just in case; or we trust that we’ll find what we need, just in time.

“Living in an abundant environment but operating on the assumption that good things are scarce leads to a host of dysfunctions that can be summed up in one word: excess. Most of us are living in some kind of excess; we work too much, eat too much, rack up debt buying too much stuff. Yet, driven by the unconscious, just-in-case assumption that ‘everything good is scarce,’ we just keep doing and accumulating more.”

I read this article while huffing and puffing on my exercise bike. Now while that sounds healthy, and physically it was, what was going on in my head was far from healthy, and this article was like a brick to my head.

I am the queen of anticipation and planning. A Ph.D. in “Prep and Prepare.” OK, maybe not a Ph.D., but I definitely subscribe to and live the notion that it is imperative in maintenance to plan meals and make exercise a priority. The problem is, I often anticipate and plan to excess, spurred by my deep-set fear of regain.

For instance, last Tuesday, my calendar was packed with appointments, and Wednesday I was needed in Pittsburgh to watch my granddaughter. The entire week before I worried and fussed over having to take two days off in a row from exercise. I kept thinking, I HAVE to do some kind of exercise. I CAN’T take two days off. I HAVE to find time to at least walk or lift weights or something. Must. Can’t. Have to. Must. Can’t. Have to.

I’ve been living in this regimented, worrisome way for years now, to the point of excess. Part of this thinking has grown out of my fear of advancing arthritis. I HAVE TO exercise today because tomorrow (or next week or next month or next year) I might not be able to. And when I won’t be able to, I’ll gain 170 pounds. Either/or. Black/white.

But unlike milk in the fridge, bodies don’t come with an expiration date. They do what they can in the moment, “just in time.” None of us know when or how our body will slow down or die. We can only do what’s best for it right now, as in today. Anticipating my body’s demise and forcing it to live in the future is probably why my arms ache today. What’s five more pounds and one more set on the barbell? I thought yesterday as I pushed myself past my limit. Challenging ourselves physically is great when we can do it. Going beyond our limit is just stupid. And what I did yesterday was stupid. I’m not calling myself stupid, but my decision was certainly not smart and I’m paying for it today, possibly forever.

The other area I often “prep and prepare” for too far in the future is food. Like milk in the fridge, some foods will expire quickly. I let my eyes do the shopping and buy too far ahead, which is not useful when it comes to fresh fruits and vegetables. I end up throwing away lettuce or cutting off soft spots on zucchini or “using up” tomatoes and once-fresh mushrooms for a sauce when they were meant for a salad. I want to train myself to be a “just-in-time” shopper, someone who is OK with what is available and not someone who hoards perishable items just because they’re there.

Here are the promises I made myself. In regard to exercise, I will strive to be less rigid in my planning and trust that my body will not all of a sudden fail. And if it does, I will trust that I have the tools and resources to deal with it. In regard to food, when I visit Trader Joe’s and Whole Foods next week, I will only buy what I can eat before it goes bad, no matter how good everything in the refrigerated section looks.

Next week, Grammy Lynn is needed on Tuesday and Wednesday. Two days in a row of little or no formal exercise. In “anticipation,” I’m going to meditate on Beck’s words: “The great news is that just one mental shift – focusing on the abundance of your environment – switches your psychological setting so that your life automatically improves in many areas you think are unrelated. This is essentially a leap from fear to faith; it’s not religious faith but the simple belief that we’ll probably be able to get what we need when we need it.”

She suggests three simple exercises to effect this shift:

1. List 10 times you thought that there wouldn’t be enough of something and you survived.
2. List 10 areas where you have too much, not too little.
3. List 20 – or 50 or 1,000 – wonderful things that entered your life just at the right time, with no effort on your part. Start with the little things (oxygen, sunlight, a song on the radio). You’ll soon think of bigger ones.

Claire has a stroller. I can take her for a walk. As long as there’s a floor beneath me, I can do crunches. If there are soup cans handy, I can do bicep curls. Exercise is not beyond my reach no matter where I am or what I’m doing. Leg lifts under my desk. A run up and down the stairs a few times. Eating a few less calories on the days I can’t formally sweat.

I have the tools. I have the resources. Mostly, I have the knowledge. Now it’s time to apply the faith.

Cursed

By Barbara Berkeley

When my husband and I were medical residents in Boston, we often would try to escape from the harsh world of the hospital by going to a place called “1001 Plays,” an early version of today’s video arcade. We’d try to drown out the stresses of the day by shooting things in the form of PacMen or Space Invaders. The silly sound effects and sparkly graphics usually worked, but only up to a point. Inevitably someone right near us would start talking about medicine. Their gallbladder needed fixing, or they were due for a stress test, or they weren’t sure if their thyroid medicine was the right dose. No matter where we fled, we couldn’t avoid being near someone who was talking about illness. We decided that this annoying phenomenon needed a name so, in honor of the father of modern medicine, Sir William Osler, we called it “Osler’s Curse.”

Now, many years later, I find that I am haunted by a curse of similar persistence. Perhaps The Atkins Curse? It seems that everyone around me is constantly bringing up the topic of diet. It doesn’t matter whether they know what I do for a living or not. Give them a minute and they’ll start talking about losing weight. This particular curse drives me crazy. Part of it is that I simply can’t get away from the subject. But for the most part, what truly bothers me is the offhand way people look at their overweight state. Most people complain about being too heavy, but treat it as trivial. They want to lose some pounds and are sure they know how to keep them from coming back. They’ll get to it one of these days. I generally listen politely. What I really want to do is take them by the shoulders and talk some sense into them.

There are two ways to look at fat accumulation. The general perception is that being overweight just means that someone has eaten too much and their body has stored the excess. Kind of like an overstuffed pillow. If you look at it this way, it’s hard to get very excited about being overweight.

But suppose you look at weight in a completely different way? Suppose that weight gain only happens when there is a real problem with how the body is working. In other words, suppose fat is a symptom of something else? If that’s true, gaining weight is an alarm that’s ringing; a flashing red light. It’s your first indication that something is very wrong.

This is the way I look at overweight. It may be caused by the behavior of overeating, but that behavior has led to a disturbance in the body; a disturbance that is showing up as fat accumulation and signals a problem with the way the body uses sugar, controls blood pressure and manufactures artery-clogging cholesterol.

Overweight trivial? What about this little item that appeared in the paper recently?

“In an age when the adult populations of most industrialized nations have grown significantly taller, the average height of black women in the United States has been receding, beginning with those born in the late 1960s…..The main culprit appears to be diet.”

The gap between the height of white women and their black counterparts is:

“Truly phenomenal,” according to John Komlos, an economist and historian who mas made a specialty of studying human heights. “Such a steep decline is practically unprecedented in modern U.S. history….The only reasonable explanation we can come up with is diet and the obesity epidemic among middle and low income black women.”

The article goes on to make the following point:

Over the last three decades, the prevalence of obesity among white Americans has tripled, while among blacks it has increased five-fold. Black females were hardest hit: almost 80 percent of black females are overweight or obese compared with 62 percent of the total female population, according to the CDC.

I found it interesting that this particular finding did not receive the wide publicity accorded to other obesity related news items. Diet and obesity can actually stunt growth! The fate of obese people who are of lower income or belong to a minority group tends to get less press. That’s shameful because we’re all headed in the same direction. Johns Hopkins University published a paper last year that predicted a whopping overweight and obesity rate of 86 percent in the population at large by 2030. The huge burden of disease that will come along with such an increase is expected to raise obesity related health-care spending from the current $100 billion to over $960 billion per year.

And what about this little article in the Internal Medicine News? A study from the NIH has shown that more than 40 percent (40 percent!!!!) of American adults have blood sugar that is too high. And right above that, an article documents a newly discovered connection between a diabetes diagnosis in midlife (common in overweight people) and a doubling of the risk of dementia.

These headlines represent a tiny fraction of the articles I read each day predicting doom and gloom from our modern obesity epidemic. I walk through my everyday world carrying this information like a heavy weight, while all around me, I am subjected to The Atkins Curse – the conversations about the latest diet book, whether a colon cleanse can help you lose weight, the vow to get serious about that belly just as soon as the next cruise is over.

Honestly. It’s time to get serious now.

Two Years and Counting

By Lynn Haraldson-Bering

Two years ago today, I reached my goal weight: 138. It wasn’t a number I really chose, but rather it was the place where my waist measured my personal goal of 31 inches and where my doctor told me, “I think you can stop now.” I went on to lose another 10 pounds, but not consciously. My body did what it needed to do, I guess, and found its equilibrium around 128.

My head, on the other hand, has been on a heckuva ride. 

I spent the first months of maintenance wondering what I was supposed to do. Eat more? Exercise more? Weigh every day? I stumbled through on my own for awhile, and then in the course of a year, two things happened that changed my maintenance footpath into a real road.

First was the formation of The Maintaining Divas. I asked four women from the Weight Watchers discussion boards, who had also lost more than 100 pounds and were maintaining, if they minded if I emailed them once in awhile to ask questions about maintenance. They, too, knew very few people who were maintaining their weight. So we formed a private discussion board to talk about the trials of maintenance. A deep and abiding friendship blossomed, and I have a greater understanding and acceptance of my reduced body.

The Divas met for the first time last September and I wrote a blog about our get-together, “The Maintaining Divas Meet At Last.” We still “chat” every day about anything and everything, and I’m always amazed how the tentacles of maintenance reach into all aspects of our lives. It’s not always conscious. It’s more than we live our lives as women who are maintaining, not as women who’ve lost a lot of weight. There’s a big difference.

The second road-building thing that happened was meeting Barbara, who is a doctor, and who by virtue of being a doctor should have scared the bejeezus out of me. Except for my current family physician, I’ve not had a real good track record with doctors in regard to weight issues. Whether I was 138 pounds, 150 pounds, 200 pounds, whatever, “You have to lose weight!” was basically their message, which is fine if they would have also offered some advice and support. But no, they just said, “You’re fat, go away.”

Granted, Barbara wasn’t my doctor and I didn’t need to lose weight anymore, but I was still a little nervous when she wrote to me and asked if I’d consider working with her. Add to that, she’d written a book about maintenance. What did I know about maintenance? I knew how to lose weight, sure, but I was still quite new to the what-happens-next part.

Then I read the final draft of Refuse to Regain. Barbara’s passion for helping people maintain weight loss was equal to my desire to learn more about maintenance and not screw it up. She wasn’t scary and I’m glad I got past that particular doctorphobia. If I hadn’t, I wouldn’t have this blog. And without this blog, I wouldn’t have all of you, the readers, who through your comments and emails about your views and experiences with maintenance, have been vital to my own maintenance. I’m eternally grateful for your participation.

Yesterday, I reread the foreword I’d written for Barbara’s book before writing my latest Lynn’s Weigh blog and thought I’d share a portion of it with you.

“The Refuse to Regain message is strong and clear: maintenance requires diligence and a plan. It requires adopting a warrior mentality to navigate the real world of modern food consumption and to say no to would-be saboteurs. It requires understanding the body’s response to complex and simple sugars, fat, and protein; developing and sustaining an exercise regimen; and nurturing our emotional health by seeking out others in maintenance for support. Within its pages is concrete guidance to help those who have lost weight and are determined to keep it off to accomplish these goals.

Like a writer needs a pen and a carpenter needs a hammer, POWs (Previously OverWeight) need a fundamental, basic tool to help them navigate the waters of maintenance. We need reliable, no-nonsense information. Refuse to Regain shines a light in the dark void left empty by a world obsessed with weight loss and ignorant to the true challenge that is weight maintenance.”

Would I be celebrating two years at goal without the “light” of the Divas and RTR? Maybe. But the road, with all its  hills, twists and turns, is much easier to navigate and a lot more fun to travel with the support of people who “get it.”

The Food Free Workplace: A Sore Subject Revisited

DR. OZ UPDATE: Barbara will be a guest on the the Dr. Oz radio show this Wednesday, March 11, however, the show will air anywhere from a day or two to as much as a week after taping. The only way to find out when it's on the schedule is to check under Dr. Oz on www.oprah.com/radio. It will air on XM channel 156 or Sirius 195 (if you have the Sirius/XM package). XM offers a free month of listening on their web site. We will keep our eyes on the schedule and let you know the air date.  

By Barbara Berkeley

I think it would be safe to say that I have rarely come up with an idea that has taken as thorough a bashing as the Food Free Workplace. It’s worth repeating that the FFW simply suggests that food at work be confined to areas that are away from desks and work centers, not that people stop eating, eat less or even monitor their choices. Nevertheless, the mere mention of controlling access to food inevitably brings forth a flood of criticism and a lot of talk about preserving rights.

For those of you who have written to say that you dislike the FFW, let me assure you that you are not alone. I have a doctor friend, for example, who had been worried about his office staff as he watched the majority become seriously overweight. He noticed daily food consumption at desks and more and more junk food being brought to work. He felt that there was also a problem being created by big lunches being brought in by drug company representatives. He asked my opinion on what to do. I suggested that he sit down with his employees and sincerely tell them how much he cared about their health. I then suggested that he ask the drug reps to limit lunches to healthy foods and that he set an office policy that eating was fine in the office kitchen, but not elsewhere. These ideas went over like the proverbial lead balloon. The office staff threatened to quit, citing their rights. Under continuing pressure, the doctor relented.

Undeterred, I naively went on to suggest the FFW idea to the CEO of a company that was spending large amounts of money paying for diabetes, hypertension, arthritis and other obesity related issues in its employees. The CEO liked the idea, but said that it would “cause a revolution” in his company so he was afraid of suggesting it. He was probably right. Is the FFW simply a really bad idea?

No one likes the feeling of Big Brother dictating what we can and can’t do. Nevertheless, I continue to find the ferocity of the response to this fairly mild policy both fascinating and baffling. Further discussion leads to some controversial political topics, but I think we all know each other well enough at this point to have this debate. So here goes.

A number of you have pointed to the fact that you simply had to learn how to deal with food being around all the time; that this was a vital skill of maintenance. I admire you for that more than you can know. But the fact is that people who have successfully learned to negotiate the constant presence of food are few and far between. The vast majority of people who would like to lose weight are defeated by the nearness of food, which stimulates powerful responses in the brain and gut. Successful maintainers represent a small minority: the group of people who have figured out how to live a singular life within an overwhelmingly unhealthy food environment. When someone says that people just have to learn how to deal with this environment, I hear a variant of what NOWs (never over weight people) say about those who weigh too much, “They just have to just stop eating.” We all know that this is a vast oversimplification. And it places blame on the overweight person, making them seem both irresponsible and gluttonous.

By the way, I am not running from the issue of personal responsibility. We need to do a better job of encouraging people to take responsibility for their own eating choices. That must be a major part of any plan to get our country well again. But the effort against overweight (the consequences of which effect all of us in terms of health care spending) must have a multilateral front. All I am suggesting is that most obese people in this country are buckling under environmental pressure. There has to be some way to give people a fighting chance.

Invoking rights starts us down a complex path. If you make choices that severely impact your health and lead to hundreds of thousands of dollars of medical bills, and if those bills drive up the cost of everyone else’s health insurance, is that choice your right? It always has been your right in America to make “bad” choices up to a point. We do have helmet laws, seatbelt laws and so on. The question becomes this: with the entire population aging and obesity related illness killing 300,000 people a year is this really still about rights? No one wants intervention from schools, businesses or government, but what happens when certain behaviors start to seriously impact our ability to pay for healthcare? Just as with the banking industry, government may be forced to step in if too many people opt for consumption rather than frugality. If you enjoy bringing doughnuts to your desk, but another person is trying to keep weight off and is bothered by the constant unwanted exposure to food, whose rights are pre-eminent? Whose rights are more important? It could be argued that the rights of the person whose health is being impacted have greater weight.

I always thought that in suggesting ideas that would relieve a bit of the pressure of the food culture, I was on the side of those who were waging the long-term weight battle. What I’ve found, though, is that very few people like the idea of giving up choice, even in so minor a thing as where to eat the food you bring. It remains an interesting question and one that obviously provokes strong responses. I’ve had my say, feel free to let me have it if you disagree.

Trickle-Down Dietetics

By Lynn Haraldson-Bering

It’s clear from the comments and emails we received in response to Barbara’s last post, One Against the Many: Time to Take a Broader Perspective, that maintainers’ opinions vary widely regarding food regulation, education, and availability. Thank you for your impassioned responses that add to the debate all Americans should have: How do we change attitudes about food?

I was particularly saddened by one line in the editorial comment Barbara quoted by Dr. Martijn Katan in the New England Journal: “Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices.”

Powerless. How did we get to be so powerless? And how do we take back our power? I suggest we, as a culture, do it with what I call “Trickle-Down Dietetics.”

My husband was invited to join the secretaries and janitors in his building on campus for “breakfast” last week. Employees had set up a waffle machine and they brought in egg/bacon/cheese monstrosities, donuts and cinnamon rolls. Larry chose not to eat the food, but he asked for a glass of juice. Problem was, no one brought juice. Or fruit. Or vegetables.

Food in the workplace is a dicey subject (as Barbara knows well). Many of you believe it’s a matter of choice, that no matter what is offered, we ultimately choose what we put in our body. Fair enough. But I don’t believe we can afford to have a complete laissez-faire attitude about food in the workplace or in schools or in other public gathering places, at least not without offering full disclosure so people have the option of understanding what they’re putting in their bodies.

For instance, if someone brings in en egg/bacon/cheese dish, so, too, should they bring a written list of the ingredients used to make it. If someone brings in a store-bought cake, they should also be required to post a printout of ingredients and nutritional information. People would still be free to bring in food to the workplace, but with the condition that everyone is informed as to exactly what that food is, from the inside out. These conditions might, just might, help people make better choices.

Education is key in restaurants, too. Let’s lay every bit of nutritional information out there, including the effects of foods on the body. For instance, on a double cheeseburger with bacon, restaurants should have to list the calories, fat grams, sodium content and a statement about how a diet high in fat and sodium can increase blood pressure which can lead to hardening of the arteries which can lead to heart attack or stroke. Something like that.

Radical? Yes. Impossible? No. A lot of work? Absolutely. But with millions of Americans suffering from obesity-related diseases, it’s imperative our society insists on drastic changes in the way food is marketed.

Many people would like to stay ignorant and hope they don’t develop high blood pressure, diabetes, heart disease, arthritis, or other weight-related problems, or if they do, they hope a pill or surgery will cure them. But I believe if bombarded with education, some people will rise above ignorance. Some people will change. And their changes and their choices will affect (trickle down to) others – their children, spouses, friends, coworkers.

I take a different view with schools, however. I support a total ban of food outside the cafeteria. No more candy bar sales. No vending machines. No “alternative” lunch line. And school lunches must be overhauled to offer only the most nutritious food possible. We must raise up a generation of children highly educated in nutrition, just as my generation was raised with smoking and drug education. Did it prevent all of us from smoking or doing drugs? No. But what we learned affected many of us. And from the many came better choices and better health policies. If I choose to smoke a cigarette or drop acid and I get sick, I can’t say it’s because I didn’t know better.

I believe people will change if their environment changes, and unless we make even the most basic, fundamental changes to our food environments, many people will remain powerless over their weight.

One Against the Many: Time to Take a Broader Perspective

By Barbara Berkeley

Yet another disappointing weight loss trial.

On February 26, the New England Journal published the results of a study of 881 adults being treated for obesity with varying food plans. The purpose of this study was to determine whether certain nutrient combinations were superior to others in promoting weight loss. Patients were assigned to one of four diets and followed for two years. The length of the trial was unusual because very few weight loss studies extend past one year.

At the end of the day, all the participants were basically in the same place. The media went into their usual frenzy, reporting that these results proved that no one diet was any better than any other. But a closer look at the data showed something very different.

First, the study showed that, yet again, people lost weight and then began to regain it. Second, it proved that even under monitored conditions, people were unable to stick to precise ratios of fat, carbs and protein. In the end, participants could not sustain diets that required detailed counting nor could they really sustain calorie reduction. The average subject on any diet had lost about 13 pounds at 6 months. By two years, and despite group and individual counseling sessions, losses averaged only 7-9 pounds and weight regain was continuing in a seemingly inevitable upward path. Granted, these results are better than no intervention at all. At least the average participant was still at a lower weight than where he or she had started, yet the curve suggested that this situation was not to be long-lived.

Writing in an editorial in the New England Journal, Dr. Martijn Katan commented, “The inability of the (study) volunteers to maintain their diets must give us pause…Even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic…Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices.”
Dr. Katan then suggested a paradigm shift. He went on to describe a total–community approach that was tried with great success in two small towns in France. Called EPODE (a French acronym for Together Let’s Prevent Obesity in Children), the program used multiple fronts to bring down obesity levels in kids.

“Everyone from the mayor to shop owners, schoolteachers, doctors, pharmacists, caterers, restaurant owners, sports associations, the media, scientists, and various branches of town government joined in an effort to encourage children to eat better and move around more. The towns built sporting facilities and playgrounds, mapped out walking itineraries, and hired sports instructors. Famillies were offered cooking workshops and families at risk were offered individual counseling.”

Within 3 years, the prevalance of overweight in children in EPODE areas was 8.8% whereas it had climbed to 17.8% in neighboring communities. The program is now in place in 200 European towns.

Dr. Katan concluded:

“Like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action…The apparent success of such community interventions suggests that we may need a new approach to preventing and to treating obesity and that it must be a total-environmental approach that involves and activates entire neighborhoods and communities. It is an approach that deserves serious investigation, because the only effective alternative that we have a present for halting the obesity epidemic is large-scale gastric surgery.”

This assessment rings completely true to me. Day after day I read about the successes of people like you who follow this website. But day after day in my medical practice, I deal with the realities of endless numbers of patients who can’t make permanent change work. These are sincere, determined people who very much want to change. But they can’t. Why not?

I believe that it is because the modern environment is leaning on them like a crushing weight. It leans on most of them so heavily that they can’t be successful. Permanent maintainers are an unusual group in that they have found ways to shelter themselves from this pressure. This takes a certain unique level of determination, imagination and interest, and an ingenuity that may not be available to the majority. Even the most determined may be crushed when life circumstances divert their attention and make them more vulnerable. Unless one’s healthy lifestyle has become utterly ingrained, it is apt to be obliterated when a parent gets hospitalized, a child goes through a crisis or a divorce threatens.

It’s clear that the individual approach to permanent lifestyle change is not working, but that doesn’t say much about either the approach or the individual if we haven’t given that person a fair chance. After all, how can we expect someone to climb a mountain when they’re saddled with a thousand-pound environmental back pack?

As Dr. Katan suggests, let’s think about lightening the load.

1. Let’s have the new administration turn the tide by lobbying for new initiatives that would make taking care of your health “cool.” Bring back the Presidential Physical Fitness tests and awards that were part of every gym class during the Kennedy years. Appoint a Wellness Czar who would start nationwide health challenges and set an agenda for clear health goals we want to accomplish.

2. There is a lot of talk about being more responsible. Banks, investors, mortgage holders and big business all have suffered from going beyond their reach; consuming too much. The same can be said for Americans regarding their health. Besides reorganizing our insurance industry, we need to call on our citizens to become responsible about their health. That means setting national standards and trying to get there. Responsibility is “in.” We should extend the message to taking care of our bodies. That, much more than electronic medical records, will ultimately have the greatest impact on the cost of health care in the future.

3. We should reduce the amount of food stimulation in the environment by getting rid of food ads for kids and by running nutritional information in a crawl at the bottom of the screen over food ads for adults (as they do in France). Cigarettes have a warning and so should many food ads.

4. Our stimulus package spending should include the building of bike paths, walking courses, community fitness facilities and other wellness related projects.

5. We should move lots of people (the community at large) toward wanting to take better care of themselves. If everyone wants to do something, no one person is an outlier. I believe the way to do this is to incentivize healthy behaviors. That might mean giving insurance discounts, bonus pay or other perks to people who keep their weight stable from year to year, or to those who can prove they have attended exercise sessions, or to people who are successfully keeping off at least some of the weight they have lost.

6.  Having just worked on a project that created six weeks of menus for a magazine, I can tell you that I was amazed at the calories in most of the foods we eat. We could make it a lot easier for people if all restaurants were required to post calories next to their menu items.

7. And what about one of my favorite ideas (although most people don’t like it): the food-free workplace. Food in the office would have to be confined to designated eating spots like break rooms or cafeterias. Second-hand food exposure is a major environmental “lean” for people who are trying hard to control weight. Like second-hand smoke, the presence of food where it’s not wanted triggers all sorts of brain and gut responses. Since obesity causes as many deaths a year as smoking, why don’t we take it equally seriously in the work environment?

I believe that creating a healthy America will ‘take a village’. At a time when bold new projects seem to be in vogue, there couldn’t be a better moment for action.