Obstacles to Weight Loss with David Katz, MD

What's standing between you and a healthy weight?

WebMD Weight Loss Clinic - Live Events Transcript
Event Date: Jan. 16, 2003

If this year is not the first time you've made a resolution to shed some pounds, you already know the kinds of obstacles that stand between you and a healthy weight. We discussed the hurdles and pitfalls of weight management when David Katz, MD, co-author of The Way to Eat, joined us on as part of WebMD's New Year's Challenge.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome, Dr. Katz. Your book is called The Way to Eat. That's a subject of great debate these days, especially when it comes to weight loss. The low-carb versus low-fat argument continues to rage. Where do your book and your medical opinion fit in this fight?

Katz: I think the goals for weight control must include life long health as well. I am unapologetically opposed to fad diets. They are about short-term weight loss but not long-term health. Health and long-term weight control can and should be pursued together. I think people's common sense guides them in the right direction. We all do really know that a balanced moderate diet rich in grains, fruits, and vegetables is good for us. It's worth noting that some very bad diseases like cancer, cholera, tuberculosis, and AIDS produce rapid weight loss and lower your cholesterol. Clearly these are not good for you. And what that points out is that not just any approach to rapid weight loss is good for you, either.

In my view, learning the skills and strategies for lifelong nutritional health and weight control is like learning to ride a bicycle. Until you know how, it's scary. If you try it without knowing how, you will tend to fall down and get hurt. And by that I mean failed attempts at controlling weight -- which really are painful for people. In response to epidemic obesity, many nutrition experts are unfortunately fussing about which bicycle you should ride or which bicycle you should buy without stopping to consider that you don't know how to ride. Fad-diet authors say forget about learning to ride a bike; come take a ride in my limo instead! The Way To Eat teaches you to ride that bicycle. Once people know how to pursue a healthy lifestyle and diet for lifelong weight control, the appeal of quick fix fad diets dissipates.

Moderator: Of course, exercise is part of that equation, and we have a question about that:

Member: So how long should we exercise daily? Is it OK to exercise two hours daily?

Katz: In terms of how long you should exercise for weight control, there are several considerations. I won't bog down in math now, but unless you work out very intensely, usually the number of calories consumed in exercise is limited. Most of our calories are spent on basal metabolism. But the benefits of exercise go far beyond control of weight. Exercise certainly contributes to weight control, improves cardiac health, seems to reduce cancer risk, is clearly good for mental health, and is associated with longevity.

If you are not fit, starting intense exercise abruptly can, of course, be dangerous. But if you build up your physical activity level gradually, there probably is no amount of exercise that's too much. Frankly, I wish I could find the time every day for two hours of exercise. The one caveat is that some exercise is very stressful to joints. Listen to your body. If you are producing aches and pains as a result of your workout you are either overdoing it, or doing it wrong. But most of us would benefit from more physical activity as part of our daily routine.

Member: I don't have a sweet tooth; I have a salty tooth. I crave things like chips and cold cereal and popcorn. It seems that's all I eat sometimes. I'm not terribly overweight for my age (mid-30s) but I think my diet may catch up to me one day. Is it unusual to crave foods like this, and am I on course for health/weight issues later?

Katz: It's not at all unusual to crave salty food. For the most part, human beings are born liking sugar. Salt is more of an acquired taste. But we are predisposed to like salt. Salt is relatively hard to find in natural foods. That's part of the reason, for example, that deer will come to a salt lick. In our case, the more salt we eat, the higher it tends to raise our threshold for tasting and appreciating salt in our food. It seems likely that you would indeed benefit by trying to break this cycle.

Here is what I suggest: Identify lower-salt alternatives to those foods you mentioned. A good example would be health-food brand cereals, such as Nature's Path, as alternatives to the commercial brands. Taste buds are creatures of habit, but they can be re-trained. When you first taste the lower-salt foods you will miss the salt. Stick with them anyway for one to two weeks. By that time, your taste buds will already be acclimating. If you keep making such substitutions, you will gradually shift downward your affinity for salt.

I think in the long term this is important, both because salt directly affects blood pressure, and because your taste preference may steer you toward processed foods and away from natural foods. Retrain your taste buds NOW to accrue lifelong health benefits.

Moderator: We have a comment about your earlier statement that learning good nutrition is like riding a bike:

Member: Learning to ride a bicycle is MUCH easier than learning about nutrition because of all the conflicting information. I understand why that is, so moving right along with the information researchers have NOW -- how important do you think grains are to a well-balanced diet?

Katz: First, I want to agree entirely with your comment. Learning to eat well is much more complicated than learning to ride a bike. The basic benefits, though, are the same.

Once you learn how to do it, you really can do it forever. Without much effort, even! As for grains, the volume of evidence available overwhelmingly suggests that they protect us against the leading causes of death and disability, including obesity, diabetes, heart disease, and cancer. For that reason alone, I am very dubious about any approach to diet and weight control that restricts consumption of whole grains.

Do bear in mind however that the nutritional properties of whole grains and highly refined carbohydrates such as sugar, simple starch, or white flour, differ as night and day. We should not be misled by overly simplified labels. Carbohydrates are a diverse nutrient class and, in terms of health and weight control, containsthe good, the bad, and the ugly. These should not be lumped together. Definitely make whole grains a part of your diet.

Member: How do I not to get frustrated when I am clearly eating less, feeling hungry, and exercising, but not see any results or even worse, gaining weight?

Katz: I am not sure you can avoid frustration completely, but let's give it a shot! First and foremost, you can't choose what to weigh. You CAN choose the way you eat and your activity level. If you are eating well, and being physically active, I congratulate and commend you. You are succeeding and you should not let the mirror or the scale tell you otherwise. There is a saying often sold in greeting card stores, "Give me the strength to change the things I can, the patience to change the things I can, and the wisdom to distinguish between the two." You are appropriately focusing on the things you DO control. Keep up the good work.

But to try and help you with your weight control, consider that most people overestimate their physical activity and underestimate their caloric intake. This occurs because we are often inattentive to some sources of calories, especially spreads, dressings, sauces, and snacks eaten while doing other things. Consider that a salad may be mixed greens with a balsamic dressing rich in nutrients and low in calories, OR a salad may have few greens, many croutons and blue cheese dressing. Both are called salads, but nutritionally they have very little in common. Conduct an honest and detailed audit of your diet to track down calories to which you have been inattentive in the past. This may help alleviate your frustration.

Finally, I understand that some people eat very little and gain weight nonetheless. This is not fair. But it is reality. Understand that in your case, you may be working against a particularly efficient metabolism. If that is so you may need to modify your expectations for weight loss somewhat so that you don't wind up in a constant, frustrating struggle.

Member: My 4-year-old son has been diagnosed to have ADHD. He is very finicky on what he wants to eat and to get him to eat at all we have to give him what he wants. How can I get him to change his likes to eat things that are really healthy so we can change our total diet and get on the right track to eat healthier. I am now 40 and I am overweight. So is my husband. We would like to change they way we eat, but it seems we can't because of our son. We also have two smaller children that are becoming finicky. What can I do?

"I actually don't think rapid weight loss diets are such a great idea."

Katz: It's a great question. And one I am pleased I can respond to from rich personal experience. I am a father of five children. And while none of them has ADHD, their dietary preferences do vary considerably. There is a great deal of detailed advice regarding this very issue in The Way to Eat. But let me offer a simple overview now: All of us, children and adults alike, are profoundly influenced by the nutritional environment. In other words, the foods that surround us on a daily basis. In your own home you can construct a safe nutritional environment. So for example, your son may like chips, but if you have the chips in the house are baked and not fried, they will likely be satisfied with those. Your son may like ice cream but if what you keep at home is sorbet, this can become ice cream to him. Little by little you can find the best nutritional alternative in virtually any food category. Once your house is a safe nutritional environment your son can be finicky all he wants, because all of the options will be good ones.

Do note that as you transition to new foods there may be some resistance because we all like what we are used to. But the transition period is short, so tough it out. It is worth it. It's clear that your entire family could benefit from making these changes. Think how wonderful it would be if your young children grew up simple accustomed to healthy food choices and if as long as they lived they never had to struggle with weight control. This is a gift we in fact as parents CAN give our children. If we learn and practice the right way of eating our own health and weight control improves in the bargain -- making this a real win-win situation.

Lastly, preserve some indulgences for your son. Remember that for him, just like for you and me, eating should be pleasurable. We should all balance the pursuit of health and weight control against the pleasure we derive from eating our favorite foods.

Member: What is your opinion of humans drinking cow's milk? The dairy industry would have us believe we'll DIE without it! Are there any problems you know of with regular milk consumption? Soy milk is becoming more popular but I can't find it in fat-free.

Katz: There are no universal health problems associated with drinking cow's milk. For people not intolerant to milk, I recommend regular consumption of low or preferably non-fat dairy. There is, in fact, evidence from clinical trials such as the DASH study, which stands for Dietary Approaches to Stop Hypertension, of unique benefit from diets that include non-fat dairy. Certainly the calcium is beneficial to bone health. However, there is some evidence to suggest that introducing cow's milk early in life, within the first year, may contribute to food allergies and might even contribute, through an immune system effect, to the risk of diabetes. These effects are uncommon, but among other things argue for human breast milk whenever possible for the first nine to twelve months of life.

Many adults are deficient in the enzyme lactase, and as a result experience discomfort when they consume milk or other dairy products. For people in this category substitution of soy milk for cow's milk is a particularly good idea. For most others it's fine but not necessarily worth the effort, for as you point out soy milk may be much harder to find.

Member: When I eat, I like to drink wine with my meal. They say alcohol is bad for weight loss, but how true is it? Can you give me enough reason to quit drinking?

Katz: I like to drink wine with my meal, too, so I won't try to talk you out of it. There is convincing evidence that approximately one glass of wine per day for a woman and up to two glasses of wine per day for a man lowers cardiovascular disease risk. There is a tradeoff with regard to calories. Let's talk about calories: Carbohydrates provide 4 calories per gram. Protein provides 3 to 4 calories per gram. And fat provides 9 calories per gram. This, by the way, is why most nutrition experts agree that some restriction of dietary fat is so important to lifelong weight control. Alcohol provides 7 calories per gram, placing it toward the high end of the spectrum. These calories however will not make you gain weight if they are instead of, rather than in addition to, other calories consumed that day.

Life is made of choices and tradeoffs. If you are struggling with your weight it might indeed help you to cut alcohol out of your diet. But there are doubtless many other places in your diet those calories could come from. If your glass of wine is a priority for you find someplace else of lesser priority from which to cut those calories. L'Chaim!

Member: Thank you for being here! I'll be getting a copy of your book!

Katz: Thank you.

Member: I am 42 years old and female. I have no health problems. I have been following a low-calorie diet for about three weeks. The first week I lost 4 kilos with 1,000 calories, the second week I lost just one kilo with an 850 calorie diet, and the third week I lost only half a kilo with a 750 calorie diet. Can you tell me why I stopped losing weight despite having a small amount of food?

Katz: Yes, I can. But before I do, let me suggest to you and everyone else that I actually don't think rapid weight loss diets are such a great idea. If I had to guess, I would guess you have "been there, done that" before, and the reason you are doing it again, is because the weight loss before has been re-gained. I actually recommend to people that they never go on a diet again. Instead, if you learn to eat well, for the rest of your life, you can optimize your weight without that exasperating up and down, roller coaster ride.

Now to your question. You are hitting a weight loss plateau. This occurs because most of our calories are burned in basal metabolism, which is simply the work required to keep all of our cells alive. Basal metabolism is directly related to body mass. So in other words, the calories required to maintain your weight will go down as your weight goes down because there is less of you. When calories are cut from the level required to maintain weight, weight loss occurs. Weight loss continues until a new equilibrium is reached, where the number of calories you are now consuming is sufficient to maintain your new, lower weight.

The only way to lose additional weight is to do what you've done: Cut out even more calories. The scenario then repeats. It often ends when you reach a level of calorie intake you simply can't tolerate, and then go off the diet altogether. Don't let that happen to you. Work on optimizing the way you eat and your activity level. And then don't let the scale tell you that you're not succeeding. Making such changes is success. It will lead to better weight control. It will lead to improved health. It's definitely the way to go.

Lastly, I would add that 4 kilograms of weight loss in a single week very strongly suggests the loss of body water as well as fat. This often occurs right at first when calories are restricted. Once body water is lost it's lost and that weight loss will not continue. This may be another reason why your weight loss dropped off so much between the first and second weeks.

Member: What is your suggestion, Dr Katz, about losing weight gained from being in a hypothyroid condition?

Katz: My suggestion is that you should not remain in a hypothyroid condition. It's very important for overall health that thyroid function be normal, because thyroid hormone regulates so many aspects of our metabolism. For most people, difficulty with weight control has nothing to do with thyroid dysfunction. But thyroid dysfunction can certainly lead to difficulty with weight control. Your doctor can very readily check your thyroid function with a test called, "TSH." This stands for thyroid stimulating hormone. If this level is clearly normal, so, too, is your thyroid function.

If the value is in the normal range but on the high side many physicians are now willing to try low-dose thyroid supplementation to achieve a value in the lower end of the normal range. So if concerned about your thyroid function address it with your doctor, ask about your TSH, and discuss the value to make sure that hypothyroidism is not further complicating the already difficult challenge of weight control.

Member: But if it is treated, then what? Would a regular diet work or would anything special be necessary to get a proper metabolism to be normal? (I gained 125-150 pounds or thereabouts from being undiagnosed hypothyroid for two years).

Katz: In general, once the thyroid condition is treated, the same dietary recommendations would pertain to you as to anyone else. But as you doubtless know, when overweight is very severe, more aggressive treatment options should at least be considered. Your weight may be compromising your health and you may not be able to lose as much as you need to through lifestyle change. If that is so, you should discuss weight loss interventions such as medication or perhaps even surgery with your physician. But again, the dietary practices and physical activity recommendations that are useful to everyone else should be equally useful to you. I wish you good health.

Moderator: We are almost out of time. Before we wrap up for today, do you have any final comments for us, Dr. Katz?

Katz: We live in a modern environment that is very challenging to us. We are creatures well adapted to high levels of physical activity and having barely enough to eat. What we have constructed around ourselves is a world where we are increasingly inactive and have altogether too much good food to eat all the time. We have no natural defenses against this modern environment. We are like polar bears in the Sahara Desert. But we are smarter than the average bear. We can acquire the knowledge, the power, the skills, and strategies to overcome the many challenges to lifelong health and weight control. It is sharing these skills and strategies to which The Way to Eat is devoted. People can learn more about the book by checking out www.thewaytoeat.net. Thanks for chatting with me!

Moderator: We are out of time. Thanks for joining us, members, and thanks to David Katz, MD, for being our guest. For more information on eating well for lifelong weight management, be sure to pick up Dr. Katz's book, The Way to Eat. And explore the WebMD Weight Loss Clinic Community. Goodbye and good health!

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