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Health Talk: Weight Loss and Fitness
Hosted by Craig Stoltz
Washington Post Health Editor

Tuesday, April 11, 2 p.m. EDT
Craig Stoltz
Craig Stoltz

This week's Health section focuses on faith-based weight loss as a means to motivate the believer in shedding extra pounds. Our nutrition expert answers your questions and clarifies some of the pros and cons regarding this and other types of weight loss plans.

Barbara J. Moore, Ph.D. is President and Chief Executive Officer of Shape Up America!, a national initiative to promote healthy weight and increased physical activity in America. Committed to providing achievable science-based messages, Shape Up America! was founded by C. Everett Koop, M.D. in 1994.

Please read the transcript below.

Craig Stoltz: Good afternoon, everyone, and thanks for joining us for our weekly Health Talk. In today's Health section in The Washington Post, we profiled a faith-based weight-loss program in operation in Prince George's County. By embracing the Bible and drawing on their faith for self-control, people there report some impressive results. But in today's forum, we're taking questions about all sorts of weight-loss and nutrition programs. And we're lucky to have Barbara Moore, who has been involved with a wide range of programs, both public and private, to handle your questions and comments. So with no further delay, let's get to the questions.

Washington, DC: I am 31 years, African American female, and approximately 190 lbs., with a medium to large body frame. I've been told that I should be somewhere between 156 and 161 lbs. Will the regimen of 20 minutes of exercise, 3-5 times a week, alternating weight lifting on days off, help to reduce the poundage. What is the safest, quickest, most effective, method to lose the weight?

Barbara Moore: In order to know your BODY MASS INDEX or BMI I need to know your height as well as your weight. If you don't want to submit that information, you can go the BMI center on the Shape Up America! Web site -- www.shapeup.org -- Visit the BMI Center on the Washington Post Web site. If your BMI is 25 or higher, you have increased health risk for hypertension, heart disease, diabetes, and even certain cancers. But yes, if you exercise, you can reduce your health risk and reduce the poundage. Weight lifting is an excellent form of exercise for weight management. It will tone and strengthen your muscles and if you keep at it, it will increase your metabolism. That means you will burn more calories which will help you to manage your weight. I do want to encourage you to exercise aerobically -- even if just walking -- everyday. But for weight lifting, you should rest a day or two before going at it again.

Fairfax Virginia: I am 29 years old and I weigh about 135 pounds, I'm trying to lose weight and I want to know if eating an egg everyday is good or not. Does it increase my weight?

Barbara Moore: An egg has two basic parts -- the white part is high quality protein and is considered one of the highest quality proteins in your food supply. The yellow part is a rich source of iron and other valuable nutrients, but it also contains cholesterol. For this reason, it is recommended that you curtail your intake of eggs to four a week. Even if you were to eat an egg each day, it would not contribute to your weight gain if your intake is moderate and appropriate for your height and activity level.

Arlington, VA: I'm intrigued by the connection between mind and body, not necessarily spiritual. Isn't it axiomatic that when you're feeling happy, you feel less of a need to overeat and when not, you feel less of an ability to resist food?

Barbara Moore: The concept that is in "Going Weigh Down" in today's Washington Post is that the body is a temple and that it needs to be treated with respect. This is a valuable concept for weight control. One needs to treat the body with respect by taking care of the fuel you feed your body. Increased fruits, veggies and whole grains should form that foundation of your diet. If you eat meat, it is wise to do so in moderation. Same for dairy -- an excellent source of calcium and vitamin D -- very important for women but also for men. Many people experience a hunger -- not always a hunger for food. It may actually be a spiritual hunger, but they mistakenly fulfill the hunger with food. It is important to learn to identify true hunger. Physiological hunger. And to distinguish it from hunger for spiritual fulfillment. If you can learn how to do this, you will learn how to use food appropriately, will avoid overeating, and will have greater success managing your weight. This issue is fundamental for many people, although not all. For those for whom it is an issue, the article entitled "Going Weigh Down" offers valuable insight. There is also a "Soul Food" section in the Shape Up America! program entitled "Shape Up and Drop 10" on the Shape Up America! Web site -- www.shapeup.org -- so check it out.

Landover, Maryland: I am a 35 yr. old female. I weight 150 lbs. I am 54. I have started going to the gym to work on my body. I am basically in good shape--I have four kids, and for my age, most people don't believe it--but I want to tighten up my stomach. What can I do, other than keeping up with going to the gym and staying away from chocolate?


Barbara Moore: At age 54 the tough news that I have to tell you is that there will be a tendency to gain inches around the middle. You need to know that this can be curtailed by including some strength training 2-3 times a week in your exercise regimen. You will want to include all large muscle groups in your legs and arms but also in your back and "abs" -- or stomach. I recommend you invest in one or two sessions with a personal trainer if you can afford it because the trainer will teach you how to use weights (or weight resistance machines) safely and correctly. Good form is very important for best results. So go for it but be sure to warm up and cool down properly before each session and rest for a day or two between strength training days. Aerobic exercise can be done safely EVERY day.

Falls Church, VA: My father 54 years old, is over 350 lbs. and growing. How can I get him motivated to start eating and exercising? He is becoming increasingly incapacitated and seeing him jeopardizing his health like this is taking a real toll on all of us. What should be the best years of his life are spent doing nothing because he is getting so he can't move!

Barbara Moore: How about this idea for your father. On his birthday or on father's day, why not give him the gift of having a personal trainer visit him perhaps 6 or 7 times to get him started on a strength training regimen? Men at almost any age respond very positively (and quite quickly) to strength training. When they see positive results, this can motivate them to start pursuing aerobic activities and even improvements in diet. So it might snowball into a vastly improved lifestyle. Give it a try.

Washington, DC: I exercise regularly--usually running--about 5 times a week and recently injured my foot (though that was not sports-related). Could you suggest a cardio activity to help me prevent weight gain that won't put too much stress on my foot? Thanks.

Barbara Moore: Perhaps the ideal form of exercise for you until your foot heals is swimming. Depending on where the injury is in your foot and which muscles are involved, you might be able to do recumbent biking. But you would have to verify this with a trained health care professional who is familiar with your case. I realize that not everyone has access to a pool but swimming will place little or no strain on that foot.

Washington, DC: I have a 6-year-old son who is very obese; he weights 120. I have been taking him to weight management to review what he eats, without luck. He is not a big eater; in fact, he is always spitting up from reflux. He started gaining his weight when he was three and on asthma medication. I have done everything to help him lose weight, now his blood pressure is going up. He is getting teased at school, can't find clothes that fit. I don't let him eat out, prohibit fried foods, and he does not like meat. However he keeps a large amount of gas. I feel so sorry for this little boy trapped in this big body that keeps gaining size. He drinks 8-10 glasses of water, 1 8 oz juice and 1 8 oz milk a day, that's it. Any thoughts about what we can do?

Barbara Moore: This child urgently needs a thorough evaluation by a pediatric endocrinologist who is sensitive to the child's plight. At 6 years of age, he is already undoubtedly suffering social stigmatization that we know goes on among children. The child's thyroid or pituitary may be abnormal or there may be other metabolic problems. The truth is that pediatric obesity should be treated as a FAMILY problem and the entire family needs to be treated. That means all caregivers and all siblings. Everyone needs to be involved and willing to be treated. There may be family dynamics that have to be faced if this child is to lead a healthy and productive life. So a health care professional who is trained and qualified to treat the entire family is in order. In closing, I want to tell you about a study published about a year ago of obese children. They divided the group in half. One half of the kids were treated directly. The other half was left alone and their parents were treated. Weight loss in the second group was significantly greater than in the first. That gives you an idea of the power of treating the caregivers in pediatric obesity.

Adams Morgan, D.C.: Three weeks ago I started a fairly rigorous weight training, exercise and eating program designed to lower my weight from 186 lbs., while also adding some muscle. So far I've lost three pounds and am happy on the pound a week program. What I don't know is what weight is ideal for me, as a 5'11" man who is also adding muscle. Thanks.

Barbara Moore: For a man 5'11" tall weighing 186 pounds, your BODY MASS INDEX or BMI is 26. By government standards (published by the National Institutes of Health or NIH) you are considered overweight but only by six pounds. So to bring your BMI into the desirable range of 25.0 or less, you would need to lower your weight by only 6 pounds. However, having said that, if you can improve your body composition by reducing your body fat and increasing your muscle, you are on the road to good health, even if you do not lose any more weight.

Reston, Va.: Hello! I was hoping you had an answer to this question: Does fat burning exist? I've heard the whole "go low intensity for longer" to burn more fat theory but so many disagree on it. I know that if you exercise at a high intensity you burn more calories, which is an absolute in weight loss. But what about the concept of "fat burning"?

Barbara Moore: You have already got the fundamental concept just right -- to reduce body fat content you must burn more calories each day than you consume in food (and drink). However, the fat burning zone refers to the fuel mix your body will burn during exercise. And yes, you will optimize the amount of fat in that fuel mixture if you exercise within that zone. But at the end of the day, regardless of the fuel mixture in a specific exercise bout, what counts is the total number of calories burned and compared to the total number of calories consumed in food and drink.

Craig Stoltz: Still some time to take your questions for Shape Up's Barbara Moore. . . .

Laurel, Maryland: I am a mother of five years who has been completely unsuccessful with losing the weight I gained during my pregnancy. I gained 22 pounds at pregnancy and had my gall bladder removed 2 months after delivery. I remained bloated from the surgery, and even gained additional pounds. I have tried running, eating right, documenting my daily intake, but I seem to get extremely slow results. My doctors have suspected a thyroid problem, but my results came back negative. Any thoughts?

Barbara Moore: When evaluating your hormonal situation after childbirth, I recommend you get a medical evaluation by a qualified endocrinologist -- ideally one who is trained in the assessment and treatment of obesity -- but they can be hard to find. If you need to contact me through the Shape Up America! Web site -- www.shapeup.org -- please feel free to do so and I will come up with some names for you. For sure you need to start our slowly but you need to develop a healthy eating and exercise regimen -- such as our Shape Up and Drop 10 program. You can get started by visiting our Web site. But be sure to have your physician review your plan in case you have medical issues that need to be taken into account. For weight control, you will probably have to exercise more than 45 minutes (and perhaps as much as 60 minutes) each day and you should go for a few sessions with a personal trainer to learn how to do safe and effective strength training exercises 2 or perhaps 3 times each week. The aerobic exercises can be done each day if you wish. Slow results are just fine, by the way. The goal is to enjoy the process of following a healthy more balanced lifestyle.

Arlington, VA: Can you explain the phenomenon of measuring body fat? I am a petite female, around 5 feet tall and weight 110 lbs. I thought that I was fairly fit but when a personal trainer measured my body fat today, it was equal to 45, or on the border of average body fat to above average. How can that be? Am I considered to be close to unhealthy?

Barbara Moore: You did not tell me HOW your personal trainer measured your body fat content. Did he/she use calipers or a bioimpedance analyzer? If the calipers were used, there can be a very large error in such a measurement. Perhaps as large as a 10 percent error. For bioimpedance, if done properly, the error will likely be no larger than 3% or 4% at most. There is a new body fat analyzer on the market that can be used at home with considerable accuracy. Now for the bad news -- you can have a low weight -- be quite thin in fact -- but still not be fit. But my guess is that at 5 feet tall and 110 lbs., a body fat percentage of 45% is highly unlikely. My guess is that your trainer made an error in the measurement.

Brandon, Manitoba:
How healthy is it to take soy [instead of meat or other protein] or become a vegetarian? What do I need to do to ensure I'm getting adequate nutrition if I'm not eating meat?

Barbara Moore: Pursuing a vegetarian diet can be quite healthy although you do need to be aware that certain nutrients like Iron and vitamin B-12 will likely need to be supplemented. My recommendation is that you visit a Registered Dietitian (an R.D.) once or twice to review your dietary regimen so that you can be assured of getting all the nutrients you need. We have received many requests for vegetarian weight management plans so our Shape Up and Drop 10 program includes a vegetarian food plan -- one for strict vegans -- and one for lacto-ovo vegetarians who include eggs and dairy in their diets.

Rockville, MD: I recently went to a diet center where they put me on a very low calorie diet -1000-1200-. I actually GAINED weight the first week and then lost the weight I gained on the diet, but no more. I have heard that your body can actually retain weight on very low calorie diets because it goes into starvation mode. Is there any truth to this?

Barbara Moore: You can estimate your daily calorie needs on the Shape Up America! Web site CYBERKitchen at http://www.shapeup.org. Let's assume your calorie needs for the day are 1800 calories. If you consume only 1000 calories for several days, your body will soon sense that you are taking in fewer calories than you require. The metabolic response mode for your body is to turn down your metabolic rate -- the rate at which your body burns calories. This energy-conserving mode is helpful to maintain your body tissues. It has been documented over and over again and it is real. But the principle behind a weight reduction diet is to consume FEWER calories than you require. If you do this consistently, you will burn fat to make up the missing calories. If the calorie reduction is a modest one -- perhaps 500 calories a day, you will lose approximately one pound a week. To lose more than one pound or at most two pounds a week is not recommended. You want to avoid loss of muscle tissue and you want to maximize loss of fat tissue. You also want to avoid "SHAM" loss, that is, water loss. The high protein Atkins diet promotes water loss and is dehydrating. But that is why people on the Atkins Diet often experience large weight loss in the first few weeks. They are actually dehydrating themselves.

Fairfax, VA: I have a pocket of fat under my chin. The only exercise I do at this time is walking. What exercise can I do to firm this area under my chin or get rid of it completely, short of having it sucked out?

Barbara Moore: It is possible that you could undergo a surgical procedure to remove fat in an area that can't be exercised. The area under the chin is not very easy to exercise, but I would definitely talk to a personal trainer about face toning exercises that can be done. It is common for responsible surgeons to recommend exercise even if they also recommend a surgical procedure to remove fat. And exercise is usually cheaper and safer. There is some risk associated with surgery and this needs to be at least considered.

Darnestown, Md.: I take Metamucil three times a day, not only for regularity but to control by cholesterol -the doctor says if I don't get it under control he'll put me on a cholesterol drug, which I'd rather avoid-. In three servings, there is something like 30-plus grams of fiber a day, just from that source. Is there any danger in getting that much fiber?

Barbara Moore: If you are obtaining 30g of fiber a day in the form of Metamucil you are NOT exceeding the recommended total fiber intake for the day. The only downside is that you are probably getting some fiber from other foods you are eating so your total intake may be considerably higher than 30g. This is certainly a great deal of fiber to handle if your body is not used to it. So it is usually recommended that you slowly step up your fiber intake adding only one serving a day for the first week or two. Then step up to two servings a day for the next two weeks. And finally work up to the full three servings a day. The other thing to think about is that Metamucil usually offers only ONE TYPE of fiber. Fruits, vegetables and whole grains offer you MANY TYPES of fiber. They are all important and beneficial. So I would focus on improving the rest of your diet and not just on the Metamucil.

Reston: Hi. I am a 25 yr. old male who recently began exercising after a long hiatus. My weight is currently 170lbs., and I am 5'8" tall. Several years ago, I quit smoking and my weight went from about 135 to 160, and has increased about 10 pounds since. What I'm wondering is, what would be an ideal body weight for me? Obviously I underwent quite a transition once I quit smoking, due in part to an increase in my eating habits. Please advise. Thank you.

Barbara Moore: To reduce your Body Mass Index or BMI to less than 25.0 you need to lose only about 6 pounds. BUT to improve your body composition you need to increase your muscle mass (through strength training) and reduce your body fat content by consuming fewer calories than you expend each day. The amount of aerobic exercise needed for weight loss is greater than that needed for general improvements in health. For example, the Surgeon General recommends about 30 minutes of moderate exercise daily, but for weight loss, 45 - 60 minutes daily may be needed. The Shape Up America! CYBERKitchen on our Web site -- http://www.shapeup.org -- can be helpful in explaining how to balance the food you eat with physical activity. It might be a useful place to start.

Craig Stoltz: Well, that's all we have time for today. For more information on reaching or maintaining a healthy weight, do check out shapeup.org, which has plenty of useful information and tools, including a downloadable BMI chart. (Keyboarding note: shapeup.com is a site operated by a private fitness trainer; don't be fooled.) Thanks, Dr. Moore, for sharing yours time and expertise.

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