Paging Dr La Puma

Oct28

Weight Regain: Not Your Fault. It’s Your Hormones. But Which?

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

34 people whittled down from 50 were followed over 16 months after a 10 week crash diet and lots of counseling: they lost 29# on average, and gained back 12#. Their hormones (leptin, peptide YY, cholecystokinin, insulin, ghrelin and gastric inhibitory polypeptide) continued to scream…eat!

And they were hungry, thought about food, and wanted to eat way more than when they started.

This is a very small study with no control group: it’s not the last word, except that maintaining is harder than losing.

But it’s getting lots of attention, because it proves something every dieter hopes: it’s not my fault. And that’s right: keeping weight off is not about willpower: it’s about planning.

It’s not my fault that I started eating tortilla chips, fudge ripple and layer cake. It’s not my fault that I feel like eating and I’m hungry all the time.

My take: Yes, your hormones are screaming. And yes, you can plan for it. Thousands already have, and won.

Over 5500 people nationally have shown that you can lose 66 pounds on average, and keep it off for an average of 5.5 years.

I’m proud that some of my patients are in that group. And you can be too–it takes being accountable, and taking a first step.

Two quick reality checks: first, the researchers didn’t measure estrogen and testosterone: I think these hormones, especially for men, figure in to weight loss and maintenance.

And second, your hormones are not destiny. You are not your pancreas, or adrenal or thyroid, or inner GI track: after 50, your health is mostly your choices, not your genes.

Leave a Comment
Sep7

How Employers Pay for Childhood Obesity Treatment

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

Employers are going to begin being asked to pay for childhood obesity treatment. And it may be in their best interest to do so.

The two largest health care costs for employers are employees who are “heavy users” (interestingly, the same term is used in the fast food industry for diners who eat-in 14x/week or more)…and kids.

One-third of large employers’ beneficiaries are dependents under age 25. Kids and teens are responsible for 14.7% of a typical large employer’s health care costs.

Obese kids have twice as many MD visits and 3x the hospitalization rate as normal weight kids. That’s where the dollars are.

The National Business Group on Health has a Toolkit which highlights case studies, covers benefit plan construction, identifies employee education opportunities, suggests how to make the most of on-site facilities and looks at bang-for-the-buck philanthropic opportunities.

The Institute on Innovation in Workforce Well-being, a coalition of Fortune 1000 employers (Gen Mills, Amex, Cardinal Health, Coca-Cola, Costco, Dell, Express Scripts, Fidelity Investments, Honeywell, IBM, J&J Ethicon, Kellogg, Kraft, Medtronic, Microsoft, among others) and representatives from Weight Watchers, the CDC, HHS and United Health, underwrote the Toolkit.

There are many routes to success in this area.

I hope one of the routes is showing how helping kids learn to cook with their parents improves employee productivity and lowers health care utilization…of the entire family.

I’m working on a Santa Barbara Foodbank program–a reality TV pilot (sort of a Dr Oz meets Jamie Oliver in the Foodbank and at home)– to do just that, later next year.

Access the toolkit free.

Leave a Comment
Jul19

Restaurant Calorie Counts: How Accurate? How Relevant?

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

A new JAMA study of calories from Tufts shows that the single serving take-out portions of solid foods (not beverages or buffets) from 14 large-chain quick-service restaurants (e.g, Chipotle, McD’s, Bob Evans) vary widely but have about the calories their websites claim.

Sides, desserts, salads and carb-rich foods, however, often have more. On The Border Mexican Grill & Cantina’s chips and salsa contained about 1,000 calories more. About 19% of all take out has over 100 calories more than listed, and sometimes way more–1000 calories more for Outback Steakhouse’s classic blue cheese wedge side salad.

But there was a difference between sitting and driving-thru. For quick-service drive-thrus, the calorie counts are likely to be accurate. A national nutrition database would save time, create competition and help.

In sit-down quick-service, if you are taking home an entree of less than 600 calories, it’s likely to be more than that.

If you’re taking home an entree with more than 600 calories, it’s likely less than that.

I just don’t think this is useful information! And it’s confusing! And it’s a jungle to eat out at quick-service of any kind! And those 600 calories are usually not a bit filling, and gone in 60 seconds!

I tell my patients that when they eat out (at a quick-service restaurant, driving or sitting), they need to reach into their glove compartment, handbag, backpack or briefcase and pull out their bag of 35 almonds and bottle of water with lime, jamaica or bitters, so they have something to eat and drink until they get home.

When that’s not practical, sit down and order a double order of steamed or grilled vegetables without sauces and steamed or grilled fish-of-the-day, with lemon or salsa.

If it’s served on a platter or a big plate, ask for it to be served on a salad plate, or divide it yourself, at the table, and take home half. You’ll eat less, enjoy it more and save your waist and dollars.

Leave a Comment
Jun29

Is it the Carbs? Or the Calories? Or Both?

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health
Two interesting takes on the new Harvard study in the NEJM that shows that some foods fatten Americans…and by how many pounds per year.

Marion Nestle at Food Politics believes that “people who eat potato chips and fries also tend to eat too much in general, making these foods markers for a diet leading to weight gain.”

She’s right!

She also notes the top 6 sources of calories in U.S. diets, in order:
- “Grain-based” desserts (i.e., cakes, pies, cookies, cupcakes)
- Breads
- Chicken and chicken mixed dishes (i.e, nuggets)
- Sodas, energy, and sports drinks
- Pizza
- Alcoholic beverages
Potato chips are #11 and fries are #17.

And Andy Bellatti at Small Bites shows the real nutritional science of carbs.

Our carb intake has not changed in nearly 100 years, on average (except for sugar, now at 156# per year). But our fiber intake has plummeted. (see the graph to the right).

So he thinks, as Nestle puts it, “it’s not the carbs, it’s (the) calories.” And too much processing!

Here’s also a key driver of childhood obesity: teens 24 percent drink at least one sugar-sweetened soda a day, according to a new CDC study. No fiber, all sugar, no satiety…and dulled taste buds.

That’s the real killer: your palate can’t taste what you eat with too much sugar, fat or salt.

Leave a Comment
May19

Is a Chef a Doctor?

Posted in: Child Obesity, Obesity and Weight Loss, Wellness and Health

“…when asked about all the gouty feet and engorged livers he had left behind him, [Bocuse once said] “A chef is not a doctor.”

So writes Josh Osersky, in “Fine Food and Fat: Are Chefs to Blame for Obesity?” about Paul Bocuse (famous chef, French Cuisine ambassador, and admired teacher).

Au contraire.

Actually, a chef can do more day-to-day good than a doctor. Because chefs teach people, especially Americans who eat out, more about what and how to eat than any other group…including physicians.

I recently taught cardiologists and ophthomalogists in Illinois how to write (free download) 3 of my recipes (and websites for healthy recipes) on prescription slips. Earlier, I did a cooking demo for 100 hungry eaters, in the Chicago suburbs, for Alexian Health Systems.

When doctors do write recipes on Rx slips, or talk about food, it has a huge impact on our patients and their families. Almost as much as setting a meal before them, as chefs do.

Some chefs are leading by example. Rocco DiSpirito, Alton Brown and Guy Fieri–all prominent TV chefs–have slimmed down. Nate Applebaum, now head chef at Chipotle, has lost 90#.

What these chefs have in common is using smaller quantities of high quality ingredients, without calories first, but quality. They’re eating less highly processed, prepackaged, grab-it food, and more natural food.

Leading by example is the most persuasive way to lead. Doctors could be next.

Leave a Comment