what works and doesn't work for weight loss

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I have a number of patients who are obese, as I am sure all of us do.As any of us could relate, I am sure, there are a myriad of factors, problems, self sabotaging behavior and emotional factors which play roles to varying degrees in any given patient's particular circumstances, which do have to be addressed.Nonetheless, there are some basics truths.I was trim when I entered medical school in 1992, and since that time I gained approximately 60 pounds, the heaviest I had ever been. I find it fascinating that we take such poor care of ourselves while learning to take such good care of others.A little bit more than a year ago, I found myself sitting in front of my patients and telling them what to do and how to do it, realizing at the same time that I was not taking my own advice.I started to do so, and by the end of this last summer, I had lost approximately 30 pounds. My patients noticed, and I shared with them what I had done and how I had

done it, no different than what I had been telling them all along.Although there may be other methods, various diets, weight watchers, calorie counting, overeaters anonymous, South Beach, North Beach, probably East and West Beach too, there are just plain some simple basic fundamentals which make common sense, and are relatively easy to do, which work over time, if applied consistently.It's not magic, it doesn't involve feeling deprived, and there are no drastic changes, no switching from one diet to another.I reassure my patients that they really do know what really is best; if they don't, I educate them, teach them to read labels, make recommendations on what to avoid, and counsel them that it is the consistent application over time which shows results. Sometimes it's as simple as tapering to off of soda. Many of them are able to demonstrate results within two to three months.These are permanent dietary changes, implemented in what I call

incremental sustainable change, combined with an increased level of activity.In my mind it's not really about weight loss, it's more about an increased level of fitness and good health, the weight loss is the gravy. Clothes fit more loosely too.Maybe I'll write a book.LOLLL" Malia, MD" wrote: All diets work. We Americans are great at losing weight ... but we are horrible at keeping it off.Diets tend to work (with mild variation from one to another) because any time a person "buys in" they

psychologically want it to work. Also, by "being on a diet", one becomes more mindful of what they are eating (both quality and quantity of food) and will tend to make better choices.It's all part of human nature.But, the research is pretty clear that most folks who maintain a big weight loss do it with --A lot of regular exercise (aerobic and anaerobic)... like an hour / day.A fundamentally healthy diet that controls calories (ie-portion control)Watch not too much TV.Google the NWCR (National Weight Control Registry) -- they've studied people who have maintained significant weight loss over a few years.TimOn Wed, January 30, 2008 5:56 pm EST, Locke's in Colorado wrote: I believe we

were recently talking about a lecturer who was talking about foods and absorption and weight, etc. I posted this recently on a clinical list. Not the be all and end all for the topic, but always an interesting area. Locke, MD From: Locke's in Colorado [mailto:lockekcomcast (DOT) net] Sent: Thursday, April 19, 2007 10:18 PMTo: Clinical ProceduresSubject: [clinical] "Glycemic load" of diet has no effect on weight loss On the one hand, I often wonder about some of the many diets -- high protein, low glycemic index, etc -- in some ways they sort of make sense, but in other ways I always figure it's calories in and calories out that determines weight loss/gain. Locke, MD ============================================= "Glycemic load" of diet has no effect on weight loss By Amy Norton 2 hours, 19 minutes ago NEW YORK (Reuters Health) - When it comes to losing weight, the number of calories you eat, rather than the type of carbohydrates, may be what matters most, according to a new study. The findings, published in the American Journal of Clinical Nutrition, suggest that diets low in "glycemic load" are no better at taking the pounds off than more traditional -- and more carbohydrate-friendly -- approaches to calorie-cutting. The concept of glycemic load is based on the fact that

different carbohydrates have different effects on blood sugar. White bread and potatoes, for example, have a high glycemic index, which means they tend to cause a rapid surge in blood sugar. Other carbs, such as high-fiber cereals or beans, create a more gradual change and are considered to have a low glycemic index. The measurement of glycemic load takes things a step further by considering not only an individual food's glycemic index, but its total number of carbohydrates. A sweet juicy piece of fruit might have a high glycemic index, but is low in calories and grams of carbohydrate. Therefore, it can fit into a diet low in glycemic load. However, the effort of figuring out what's an allowable carb might not be worth it, if the new study is any indication. Principal investigator Dr. B. , of Tufts University, Boston, and colleagues found that a reduced-calorie diet, whether glycemic load was high or low, was effective in helping 34 overweight adults shed pounds over one year. Study participants who followed a low-glycemic-load diet ended up losing roughly 8 percent of their initial weight, as did those who followed a high-glycemic-load diet. "The bottom line is that in this study we don't see one single way to eat that is better for weight loss on average," told Reuters Health. Of course, that doesn't mean "anything goes" as long as you're cutting calories." A super-sized serving of French fries won't do any dieter any good, she noted. Both diets her team used in the study were carefully controlled. For the first 6 months, participants were provided with all the food they needed, and both diets were designed to cut their calories by 30 percent while providing the recommended amount of fiber, limiting fat and encouraging healthy foods like fruits and vegetables. The comparable outcomes suggest that, among healthy diets, no single one stands out as better, according to . So the focus should be on calories, rather than specific foods to avoid or include. "Focusing on calories is something we need more of, especially when portion sizes are so absurd," said, referring to the portions served at so many U.S. restaurants. This doesn't mean, however, that there's no

place for diets that focus on glycemic load, according to the researcher. Some studies, for example, have found that low-glycemic index foods might help control blood sugar in people with type 2 diabetes. And in their own research, said she and her colleagues have found that low-glycemic index diets do seem more effective for overweight people who naturally secrete high levels of the hormone insulin, which regulates blood sugar. SOURCE: American Journal of Clinical Nutrition, April 2007. =====================================================

American Journal of Clinical Nutrition, Vol. 85, No. 4, 1023-1030, April 2007© 2007 American Society for Nutrition ORIGINAL RESEARCH COMMUNICATION ORIGINAL RESEARCH COMMUNICATION Long-term effects of 2 energy-restricted diets

differing in glycemic load on dietary adherence, body composition, and metabolism in CALERIE: a 1-y randomized controlled trial1,2,3 Sai Krupa Das, Cheryl H Gilhooly, K Golden, Anastassios G Pittas, J Fuss, A Cheatham, Tyler, Tsay, A McCrory, Alice H Lichtenstein,

Gerard E Dallal, Chhanda Dutta, Manjushri V Bhapkar, P DeLany, Saltzman and B 1From the Mayer US Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, MA (SKD, CHG, JKG, PJF, RAC, ST, MT, MAM, AHL, GED, and SBR); Tufts–New England Medical Center Hospital, Boston, MA (AGP and ES); the National Institute of Aging, National Institute of Health, Bethesda, MD (CD); the Duke Clinical Research Institute, Durham, NC (MVB); and the Pennington Biomedical Research Center, Baton Rouge, LA (JPD) Background:There remains no consensus

about the optimal dietary composition for sustained weight loss. Objective:The objective was to examine the effects of 2 dietary macronutrient patterns with different glycemic loads on adherence to a prescribed regimen of calorie restriction (CR), weight and fat loss, and related variables. Design:A randomized controlled trial (RCT) of diets with a high glycemic load (HG) or a low glycemic load (LG) at 30% CR was conducted in 34 healthy overweight adults with a mean (±SD)

age of 35 ± 6 y and body mass index (kg/m2) of 27.6 ± 1.4. All food was provided for 6 mo in diets controlled for confounding variables, and subjects self-administered the plans for 6 additional months. Primary and secondary outcomes included energy intake measured by doubly labeled water, body weight and fatness, hunger, satiety, and resting metabolic rate. Results:All groups consumed significantly less energy during CR than at baseline (P body weight, body fat, and resting metabolic rate did not differ significantly between groups. Both groups ate more energy than provided (eg, 21% and 28% CR at 3 mo and 16% and 17% CR at 6 mo with HG and LG, respectively). Percentage weight change at 12 mo was –8.04 ±

4.1% in the HG group and –7.81 ± 5.0% in the LG group. There was no effect of dietary composition on changes in hunger, satiety, or satisfaction with the amount and type of provided food during CR. Conclusions:These findings provide more detailed evidence to suggest that diets differing substantially in glycemic load induce comparable long-term weight loss. ---You are currently subscribed to clinical as: lockekcomcast (DOT) netTo unsubscribe send a blank email to leave-1347043-15242257Ylyris (DOT) aafp.org ---------------------------------------- Malia, MDMalia Family Medicine & Skin Sense Laser6720 Pittsford-Palmyra Rd.Perinton Square MallFairport, NY 14450 (phone / fax)www.relayhealth.com/doc/DrMaliawww.SkinSenseLaser.com-- Confidentiality Notice --This email message, including all the attachments, is for the sole use of the intended recipient(s) and contains confidential information. Unauthorized use or disclosure is prohibited. If you are not the intended recipient, you may not use, disclose, copy or disseminate this information. If you are not the intended recipient, please contact the sender immediately by reply email and destroy all copies of the original message, including attachments.----------------------------------------

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