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Health Talk: Diets, Nutrition and Weight Loss
Hosted by Craig Stoltz
Washington Post Health Editor

Tuesday, May 30, 2 p.m. EDT
Craig Stoltz
Craig Stoltz

Seems like every other month there is a new diet that's sweeping the nation--protein diets, all-fruit diets or cabbage diets. Have you ever wondered why those no-carb and low-carb diets work? What are the dangers behind these popular yet controversial types of weight loss? Regardless of how you are trying to lose weight, find out the truth about how and what you eat effects your body.

Fielding your questions and concerns is Dr. F. Xavier Pi-Sunyer, Director of the Obesity Research Center and Chief of the Division of Endocrinology, Diabetes and Nutrition at St. Luke's-Roosevelt Center in New York City. Among Dr. Pi-Sunyer's many credentials, he is also a member of the International Obesity Task Force of the World Health Organization.

Below is a transcript of today's discussion.

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Craig Stoltz: Good afternoon, weight-watchers (and I mean that in the generic, not brand-specific, sense of the phrase), thanks for joining us for an hour of Health Talk. Today, the leaders in the world of nutrition convene in Washington to discuss, among other pressing topics in public health, why Americans are so overweight and what can be done about it. In today's Health section, in connection with the summit, our own veteran nutrition journalist Sally Squires offers a provocative look at a method of controlling weight that many experts agree is among the most successful: a series of small changes to diet and lifestyle that reduce one's caloric intake and increase one's caloric use. The idea is not to try to change your life dramatically, and "lose 15 pounds in 15 days," as many commercial weight loss products claim, but to let small, positive changes accumulate to your benefit over time. In this plan, patience and moderation--not a quick fix or little-known trick--are the keys. And today we are grateful to be joined for our Health Talk by Dr. F. Xavier Pi-Sunyer, a renowned expert in obesity research, chief of nutrition at St. Luke's-Roosevelt in New York, and an advisor on obesity to the World Health Organization. He's agreed to take your questions, whether raised by today's story, by the summit, or by your own experiences. We have plenty of questions and comments waiting already, so let's jump right in.


Washington: I have been overweight my whole life, though at times I've been less overweight than I am now (and vice-versa). I'm constantly reading that weight loss is different for everyone. So what should I do? I've never gone to a nutritionist, never had a trainer, never done one of those diet programs (Weight Watchers, Jenny Craig, etc.).

How do I reform my lifestyle of next-to-zero activity and a diet of high-fat, high-sugar? They always say never say "diet," but thinking of adopting a healthy lifestyle (i.e., for the rest of your life) sounds so tragic. You mean, I'll never be able to eat a pint of ice cream in one sitting again?

Dr. F. Xavier Pi-Sunyer, M.D.: I think the answer to your problem is that you really do need to see a health professional who will help you improve your weight and therefore improve your health. This will require some changes in your nutrition style. Whether you call it diet or not. It will require you to change some of the foods you eat, the quantities and the timing. It will also require some change in your activity patterns. So that you can utilize more energy and therefore balance the intake of food with the amount of energy you are doing.

It is difficult to do all this alone and I therefore suggest that you ask your doctor to guide you to appropriate people or groups that can help you.


Bowie, MD: How much is metabolism a factor in weight loss/gain? Do pills such as "metabolite" work, and if so, are they dangerous and what(substance)makes them work?

Dr. F. Xavier Pi-Sunyer, M.D.: Well metabolism is another word for saying that the foods that you eat are utilized to give you energy to do the activities that you do: including breathing, having your heart glands work, having your sweat glands work, having your digestive system work, walking and running. Although it is said that people who are overweight have a "slow metabolism," it usually is not true. But it is true that people who are gaining weight are eating more energy in food than they are expending in activity. As a result, the extra energy is deposited as fat in the body.

I would not suggest that you take substances that feed up your metabolism. Because they can have serious side effects such as heart rate elevation or increase in blood pressure. I would rather suggest that you either cut back in your food intake or increase your activity.


Washington: Hi Doctor:

I have been overweight (30-50 lbs.) all my life. About 2 years ago, I lost 50 lbs. But the last several months have been very very stressful and I have not been able to keep up my exercise and healthy food routine. So I have gained back about 20 lbs.

Now, the very thought of starting all over again makes me just wanna eat some more and feel sorry for myself.

What should I do?

Thanks,
Susan

Dr. F. Xavier Pi-Sunyer, M.D.: It is difficult to lose a great deal of weight and then begin to gain it back. But you should not feel defeated. The fact that you have lost it once means that you can lose it again. It will just require you working and not allowing your stressful life to dictate what you eat, how much you eat or your activity pattern. I would recommend that you go back to whoever helped you lose the weight the first time and ask them to help you once again.

Don't be afraid to seek help. Losing and maintaining weightloss is a very difficult process.


La Plata: Hi!!

-I have read yes and no over and over to the following question. What do you think?]

Does eating a lot of sugar on a daily basis put you on the road to adult-onset diabetes?

I have loved sugar my whole life. In fact, I could live on sweets. I have gone through days where I have not had regular meals, just lots of chocolate, cookies, some soda and that's about it.

What's best for someone like me? Kick it cold turkey? Ween myself little by little?

My mother keeps telling me I'm gonna be a diabetic. (PS: I'm about 30 lbs. overweight)

Help!

Dr. F. Xavier Pi-Sunyer, M.D.: The problem with sugar is not so much that it directly leads to diabetes but that it is a very energy dense food and it is very easy to overeat. The fact that you are 30 lbs. overweight attests to this. The other problem with sugar is that it is a food that we call "empty calories," in the sense that when you eat sugars you get no accompanying vitamins or minerals. It is therefore wise to limit the amount of sugar intake. This does not mean however that you have to totally deprive yourself of sugar. You can certainly eat sugar in moderation everyday of your life.


Washington DC: I am ready to try anything. What do you suggest would be a great diet for someone trying to loose 10 pounds in two weeks?

Dr. F. Xavier Pi-Sunyer, M.D.: I do not advise you losing 10 pounds in two weeks. A healthy approach in weightloss is to try to take the weight off slowly. I would suggest that you try to somewhere 1 to 2 pounds per week. I also believe that you should try to do this using a balanced diet that will give you an appropriate amount of protein, some fat and some carbohydrate. You should use the U.S. Dept. of Agriculture food pyramid as a guide and go strong on fruits, cereals and grains.


Anchorage, Alaska: How do I help my 10 year old son control his weight? He is 5 feet 2 and 126 pounds. He is moderately active, and though I try very hard to promote healthy eating habits by offering healthy choices he invariably prefers high fat, high carbohydrate items. His paternal grandfather died of a heart attck at 36 and my child has borderline high cholesterol himself. I feel like the food police! Since 3 years of watching and encouraging are not helping, should I just back off completely?

Dr. F. Xavier Pi-Sunyer, M.D.: I think trying to deal with overweight in children and adolescence can be a very difficult problem. However, you can't just ignore it. Obese children very often become obese adults and this is accompanied with increased health risks for diabetes, high blood pressure and heart disease. I would therefore continue to strive to encourage your son to be more active and eat a healthier diet. Sometimes this is easier done by having your son join other children who have similar problems and having them work together in groups. Also, joining afterschool sports programs or interesting him in a particular activity may get him stirred up to do more exercise. But I certainly would continue to try to help him.


Columbia, South Carolina: I burn 1,000 calories every day (at least 5 times a week) by working out for 100 minutes on a treadmill (10 degree incline at 3 mph). Still having trouble losing weight. I am getting stronger but not slimmer. What can I do to achieve weight loss? Diet is mostly rice and lentils and bread.

Dr. F. Xavier Pi-Sunyer, M.D.: I think that you should continue to do your activity. There are certain individuals who have a great deal of trouble losing weight but if they improve their fitness with the kind of exercise that you are doing, they greatly decrease negative health consequences from the overweight. An obese person who does the kind of exercise that you do over a period of time will actually have lower health than someone who has normal weight but does no exercise at all. Therefore I would encourage you to continue your exercise.


Arlington, VA: I have 28% body fat and a BMI of 32. I realize if only for health reasons, I need to lose but as I have so far to go, I am not able to motivate myself down a path to thinness. Is there a secret to success?

Dr. F. Xavier Pi-Sunyer, M.D.: Even if you were to lose only 10% of your body weight, you would greatly improve your great status. If you have a BMI of 32, then moving down to a BMI of 29 would greatly improve your health. Therefore I would not feel that because you are so heavy you should not try to improve your condition. It is not necessary or even desirable for someone who is as heavy as you to return to normal weight because it is too difficult to do or too difficult to maintain. But a modest change downward in your weight would be very beneficial to your health.


Herndon VA: What are your thoughts on the Weight Watchers 123 program? I have been on it almost four months and lost 40 lbs, and I think it is the most sensible and healthy weight loss plan I have ever heard of!

Dr. F. Xavier Pi-Sunyer, M.D.: I think that you are correct that the Weight Watchers 123 program is a good sound program. It is based on the sound principle of a balanced diet and a sound exercise program. The diet however does allow you to pick and choose and gives you more freedom than is the case with many diets.


Washington: Why is America fat?

I have 2 theories:

1. Because we are a quick fix society, used to getting results fast. Consequently we eat a lot and are sedentary because those behaviors produce immediate gratification. Let's be for real: Who wants to eat turkey and veggies all the time and get on a Stairmaster 5 times a week? I'd rather eat fried chicken and watch TV on the couch ANY day.

2. But let's imagine that there are people out there who do eat healthy and work out. Their "hard" bodies didn't come overnight. It took months (probably years) of healthy eating and exercise to get them to be "healthy." That just takes too long.

Dr. F. Xavier Pi-Sunyer, M.D.: Well I disagree with you. I think that you are making a mistake that eating fried chicken and sitting on a couch are ways to lead your life. I would suggest to you that many people get a great deal of pressure in being more active and selecting a more variable and healthy diet. I would recommend that you do that which would be much more beneficial to your health.


Forestville, Maryland:

I workout and I know it's what I eat that's the problem. I gained 15-20 pounds in 1 year or longer and I can't stand it. I can't fit in any of my pants anymore. I am a woman, 5'9 and weigh about 150-155 and I am very unhappy with myself. I have to stay in shape because I am in the Military Reserves. My question to you is what should I really eat, morning, lunch and dinner time. I have never been so miserable as I am today about my weight. I go on a cruise the first week of August and my stomach is too big to go into a bikini at this time. I will try whatever you suggest.

Dr. F. Xavier Pi-Sunyer, M.D.: My suggestion to you is that you seek help from a nutritionist in trying to construct a nutrition plan that will allow you to cut back on calories and still be pleasurable to you. This can be done. It requires you to switch the kinds of foods you eat, how much of them you eat and how you cook them. You really need a strategy for change and the best way to work out that strategy is to get someone to help you with it.


Bethesda, MD: Hi Doctor,
Since the beginning of last summer I have been having hypoglycemia attacks that include dizziness, sweating, nausea and shaking. They come on unexpectedly and for no reason. I know the vast majority of people with hypoglycemia are diabetic but I don't show any of the other characteristics of diabetes. Is there such a thing as producing too much insulin?

Dr. F. Xavier Pi-Sunyer, M.D.: Hypoglycemia or low blood sugar may be a sympton of early diabetes. It often occurs in people who are somewhat overweight and with no other classical symptons of diabetes like weight loss, frequent urination or hunger. You should be sure that you are tested for the potential that you are an early diabetic by having blood sugars measured 2 to 5 hours after you eat a standard meal.


Mt. Rainier: For Anchorage: Exercise is always going to be more effective if the person doing it enjoys the activity. And for a kid especially it's valuable if he's put in charge of deciding what kind of exercise he enjoys. He probably hates gym (as a fat kid, I know I did), and thinks exercise is something you do with other people taunting you or ignoring you. Video tapes used alone can beat that. But let him find an activity he likes, and he'll do it more regularly.

Dr. F. Xavier Pi-Sunyer, M.D.: I would agree with this comment as wise counsel.


WDC: You've recommended seeing a nutritionist several times, however, they're very expensive. Do you know if insurance companies cover things like this or if they will with a doctor's recommendation?

Dr. F. Xavier Pi-Sunyer, M.D.: It is true that a health professional like a dietician or nutritionist can be very expensive. If you see your physician and have an associated condition such as high blood pressure, high blood lipids, diabetes, gout, arthritis or some other disease made worse by the overweight, you can often get reimbursement from your health insurance or HMO. However, this is not always true and you may need to avail yourself of some of the cheaper but still good and sound commercial weightloss programs that are available in this country.


Fairfax, VA: Good afternoon...
What are your views on a weight loss program of fat burner pills coupled with a regular walking program? I would like to rid my frame of 10 to 15 pounds and think it will take all summer if I just walk everyday.

Dr. F. Xavier Pi-Sunyer, M.D.: I believe that walking is good and will help burn off calories. However, I am not in favor of so-called "fat burner pills," because they don't really work. My suggestion to you is that you gradually increase your walking time, increase the grade at which you walk, and possibly gradually graduate to more active exercise like jogging or biking.


Rockville, MD: I am morbidly obese and am currently having success with a low-fat diet. I would like to begin exercising, but am way too embarassed to go to a health club. Is walking enough, or are weights/strength training an essential part of fitness? I am 31 years old, and don't have any other health problems.

Dr. F. Xavier Pi-Sunyer, M.D.: I congratulate you for doing walking. My suggestion to you is that you gradually increase the amount of walking you do. Also, for people like you who are very heavy, it is sometimes easier to do non-weight bearing exercise like swimming or using a sedentary bicycle or rowing machine.


Arlington: How do I convince my husband to lose weight? Every time I try to nag him about cutting calories here and there, and working out, he always gives me the same line:

"Why bother? I could be 100 pounds overweight and live healthily to 100, OR I could lose 100 pounds and eat well and work out and die of a heart attack at 40."

Dr. F. Xavier Pi-Sunyer, M.D.: I think that it is very difficult to try to motivate someone else. Losing weight and keeping the weight off is a very difficult process. And the person who is doing it must have the desire to make that effort. You really cannot do it for him and whereas I would try to gently educate him, I would not continually nag him. Hopefully, one day you will change his mind.


Leesburg, VA: Four or so weeks ago my husband decided to go on his own version of the now famous low carbohydrates diet. After I told him over and over about how bad it is for him, he's meanwhile lost almost 15 pounds on his steady diet of tuna, eggs, salads, and other non-carbohydrates. Why on earth is this working, and what can he expect from continuing it?

Dr. F. Xavier Pi-Sunyer, M.D.: There is evidence that the low carbohydrate high fat diet does work initially. There are two reasons for this:
1. When people stop eating carbohydrates, they get a diuresis and lose a lot of water from their body.
2. Much of the 15 pound weight loss your husband has lost is water and as soon as he begins eating carbohydrates, much of this will return. I agree with you however that such a high fat low carbohydrate diet is bad for him for the long run because it increases the risk of high circulating fats in the blood stream which we know leads to cardiovascular disease.


Silver Spring: I'm the type of person who blends five fruits and veggies almost every morning, walks a lot and would take martial arts classes (but I can't find a place that teaches Muy Tai kickbox and I'm not into the tai bo thing). My mother doesn't see it the same way. She only works three days a week and has time for walks but is too lazy to do them. I guess you heard this before but what can I do to get her out of the house?

Dr. F. Xavier Pi-Sunyer, M.D.: Well my answer to you is the same as the one to the woman with her overweight husband. You can try to educate your relatives and friends to lead a healthier lifestyle but you can't do it for them. They must be motivated themselves.


Washington, DC:

Question: Do you think it is possible for a 145 pound, 28 year old female to lose 15 pounds thru moderate exercise? I have been jogging 3 times a week since March and have lost and gained back 7 pounds, nothing to call home about. I am seriously thinking about the "buying food" program, either Jenny Craig or Nutrisystem. I'm embarassed that I have to go this route, because I don't consider my habits unhealthy. But I am at my wit's end and worry that if I stay this way much longer (I used to be 130 for most of my adult life) it will not be as easy to come off. Do you suggest any pills either? I see them in nutrition stores but worry about the caffeine! What about Jenny Craig?

Dr. F. Xavier Pi-Sunyer, M.D.: I think that 15 pounds are a number of pounds that can be taken off slowly over time at the rate of 1 or 2 pounds a week. You don't necessarily have to go to a program that provides you the food as long as you can discipline yourself to buy smaller quantities of food that have less fat, less sugar and less total calories. This would be less expensive for you and I think that you could be successful. However, if you have plenty of money, programs that will supply you with the food are perfectly reasonable.


Cottage City MD: I have a friend (very overweight) who stocks her kitchen all the time with sugar-heavy, fat-heavy foods. Her oldest daughter (15) is overweight, and she nags her all the time but doesn't get rid of the fat-factory in her fridge. I really believe that parents have a responsibility not just to OFFER good foods but to make sure that BAD foods aren't available in the house. Yes, hard to control outside, but sheesh, at least control what you can. It doesn't have to be punitive if you just say WE aren't going to eat this stuff because it isn't good for US.

Dr. F. Xavier Pi-Sunyer, M.D.: I would agree with you that some families have healthier food in their household than others. And that it is difficult for a child or adolescent who has a propensity to overweight to control their weight if these foods are all around them. Therefore I would agree that the environment in which the adolescent lives can be very important in determining his/her weight.


DC: I have always been fat. And always been told "If you only lost weight....." (fill in the scenario)

No wonder I am a weight-loss nightmare. All my life I've been told being fat is bad, is ugly, is failure. All my life I've only seen thin people on TV, in movies, on the street.

So I've spent decades trying to find that elusive perfect life. The perfect life only thin people can lead.

How do I get out of this emotional prison?

Dr. F. Xavier Pi-Sunyer, M.D.: I believe that it is very difficult to be overweight in our society and that there are many people who are biased against overweight and obese persons. My suggestions to you is to not have a bad self-image and be proud of your own self-worth and to gradually try to work at a different lifestyle that might help you reduce somewhat.


washington, d.c.: I recently read of two small though supposely well done obesity/diet studies. The first addressed the question of whether caloric mix of fat/protein/carbs makes a difference in weight loss, and its conclusion was that it pretty much doesn't matter the proportions, total calories are all that mattered in achieving weight loss. The second study addressed whether you feel hungrier on some diets compared to others, and it too featured several groups of dieters on different food group proportions. This study concluded that it doesn't matter what mix of foods, most folks report feeling very good the first two or three weeks of a diet and then report feeling hungry during the last two -three weeks (the study lasted five weeks). I would appreciate your thoughts on these studies'conclusions.

Thanks.

Dr. F. Xavier Pi-Sunyer, M.D.: I do agree with the studies that the total calories are what are important. If you are taking less calories than you expend each day, you will lose weight no matter where the calories come from. However, it is important to get an appropriate mix. You need protein to replace the protein that breaks down in your body each day. You need a certain amount of fat because it is essential for metabolism. And you need a certain amount of carbohydrates for use of the central nervous system and brain. So a mixed diet is the healthier diet and the one that I would recommend to you.


Craig Stoltz: Well thank you, Dr. Pi-Sunyer, for handling our readers' questions today. Unfortunately, we didn't get to everybody's questions, but we're sure to take up the topic of weight loss in the future. So check back for future installments of Health Talk. Meantime, eat well, stay active and do check out Sally's story today. See you next week. . . .


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