Fighting Back From “Weight Bullies"

By Dr. Madelyn Fernstrom

When did the idea become acceptable that the personal weight issues of other people are somehow everybody’s business? Many people feel entitled to comment and judge others about whom they know nothing. They are who I call “weight bullies.” Weight bullies are occurring with increasing frequency, and I believe they are a big step in the wrong direction! 

Here is a case in point: an overweight television anchor in Wisconsin received an email from a viewer commenting on her obesity. The remarks included (1) surprise that her physical condition had not improved over the years, (2) that she should present and promote a healthy lifestyle, and (3) that she was a poor role model, especially to girls.

While many overweight and obese people are judged – both intentionally and accidentally – the usual response is silence and hurt feelings. Many patients have told me they feel obesity is the last “acceptable” area for open criticism and that they are not only hurt by comments, but feel they are somehow less worthy or deficient as human beings. 

This courageous TV anchor, Jennifer Livingston, fought back. She used the negative email she received as an opportunity to speak out against weight bullies. Talking directly to viewers while on the air, Ms. Livingston addressed all people who are not only struggling with their weight, but with other physical and emotional issues. Her message: “Don’t let your self worth be defined by bullies.” You can watch the entire four-minute broadcast of her inspiring words on YouTube by clicking here. 

Have you experienced weight bullying? I’d love to hear your thoughts on the topic!

The New Food Downsizing

By Dr. Madelyn Fernstrom

While “value eating” and supersizing for pennies seems to be everywhere, I’m happy to see a new trend emerging: portion-controlled single servings. And by single serving, I don’t mean eating the entire bag, but a small portion typically under 200 calories. 

From chicken breasts, to frozen desserts, to chips, it’s now easier than ever to find your favorite foods already portioned out. While a pricier option, it’s well worth it if it prevents you from out-of-control eating. Plus, there’s a lot of satisfaction from getting to eat the whole thing. Those are two great value-adds for paying a little bit more for single-serve packages.  

Nowadays, it’s hard to change our perception of a standard portion size because so much of what we see is gigantic and, by comparison, a healthy portion looks skimpy. But once you accept that portion control is key to calorie control, you’re well on your way to making some practical changes.

The best way to get started? Start by reading the package labels for serving size and calories per serving. Don’t be fooled by bags and bottles that look small, and don’t assume they are single serving.

Let me know if you’ve found other easy ways to downsize your portions. We need all the help we can get!

The Skinny on Weight Loss “Miracles”

By Dr. Madelyn Fernstrom

I’ve seen a big increase in “miracle” weight loss products to fight the battle of the bulge. We are bombarded with ads for quick weight loss in print, online, and on TV.

You’ve seen the ads with thin, muscled, and tanned men and women – with teeth as large and bright as Chiclets gum – standing near piles of high-calorie foods. There’s always a caption like “Eat whatever you want and lose weight if you add  ________!” Just fill in the blank with whatever product is being sold. Or maybe the ad is for a fitness contraption that provides a “total body workout” in just 15 minutes a day that promises to “boost your metabolism and weight loss.”

By law, there’s always a disclaimer included, usually in tiny letters at the bottom of the ad. “Individual results can vary” or “Results here not typical.”

And just when many of us have wised up to these kinds of product promotions and are no longer fooled, a new ad form has emerged that makes it much harder to figure out the truth. Advertisers now claim that “research shows” or “studies confirm” the product’s effectiveness.

Nowadays, it’s possible to find scientific evidence for nearly any claim. But many of these studies do not follow scientific principles, and the hard science that is found is not usually what is advertised.

The bottom line? It’s the adage “If it sounds too good to be true, it probably is.”

If you need advice for dietary supplements or fitness products, ask your doctor or another health professional, not Dr. Google.

Have you seen any crazy ads for weight loss or fitness products? Share them with us!

FDA Approves New Weight Loss Drug

By Dr. Madelyn Fernstrom

In a long awaited move, the FDA approved a “new” weight loss drug, Qnexa, this past July 18. Renaming it Qsymia (cue-sim-ee-a), it’s actually a lower-dose combination of two drugs already on the market. Not for casual weight loss, or those “last ten pounds,” Qsymia is approved for use in adults who are obese (BMI of 30+), or adults who are overweight (BMI 27+) and have at least one major illness, like high blood pressure, sleep apnea, or diabetes. This drug, intended for use along with a reduced calorie diet and increased physical activity, is a combination of an appetite suppressant (phentermine) and an anti-seizure medicine (topiramate), which has weight loss as a “side effect” of epilepsy treatment.

While weight loss after one year of Qsymia — plus lifestyle changes — produced an average weight loss of 6 to 9 percent (an impressive outcome), many people lost a lot more, but some lost much less. There’s no guarantee of weight loss, and Qsymia is far from a “magic pill.” 

And, like other prescription medications, it has side-effects. Two major concerns are an increase in heart rate and a risk of birth defects (cleft lip/palate). Other side effects include insomnia, dry mouth, constipation, and tingling in the hands and feet. But the FDA decision supports the evidence that the benefits outweigh the risks.

Could it be a good power tool for your weight loss toolbox? Obesity is a medical illness of epidemic proportions. With two-thirds of the U.S. population overweight or obese, there will be a subgroup of people who DO need some medication to adjust their hunger and fullness thermostat. But there are many reasons people overeat that have nothing to do with biology, and they won’t be helped by any weight loss drug. A medication can support, but not replace, a reduced calorie diet. It makes the lifestyle effort more manageable (easier, but not easy!) for the long term. 

Qsymia will be available before the end of the year, but availability will be limited. To ensure careful and appropriate use, the company (Vivus) will restrict who can prescribe this medication, and the once-a-day pill would only be available through mail order. An experienced bariatric (weight-loss) physician or psychiatrist are two specialties to check with if you want a consultation. 

Stop "Grazing" to Lose Weight

By Dr. Madelyn Fernstrom

I’m not sure when this change first occurred, but we’ve gone from a nation of structured “three square meals a day” to grazing all day with small, frequent meals. We do this all in the name of good health and weight control. Does this idea of “fueling” throughout the day really work? Not for most people! 

While it is well-documented that skipping meals leads to overeating later in the day, eating more often doesn’t really help to control calorie intake any better than eating three meals a day. In fact, eating less often can help cut calories. 

The more often you eat, the more likely you are to consume extra calories. And extra calories, healthy or not, contribute to extra weight. It’s also harder to keep track of daily calories when you eat more often — your six smaller meals can easily become six bigger meals.

When you eat three times a day (meals and a small snack if you prefer), you support the regulation of true hunger and fullness. With four to five hours between meals, it is much easier to recognize true hunger, eat a meal, and then sense contentment (fullness). When you’re eating every two hours, with smaller amounts of food, you’re never really hungry and you’re never quite full. That can cause mind-body confusion and lead to overeating.

So if your goal is to trim calories for slow and steady weight loss, I’d suggest starting with trimming how often you eat every day. Stay hydrated between meals with loads of water (flavored with a slice of fruit or splash of juice), herbal teas, or your choice of low-calorie beverage.

These suggestions should work well for healthy people. If you have diabetes or another chronic illness, or if you take prescription medications, always talk to your doctor or a registered dietitian for advice on how often you need to eat to support your personal health. 

Has this strategy worked for you? Let me know!

The 5 Ds of Dieting

By Dr. Madelyn Fernstrom

Do you struggle with food cravings? 

This is a giant barrier to weight loss success. It sets up a negative cycle of initially “battling” the craving, giving in, overindulging, feeling like a failure, and giving up. Sound familiar? 

I’d like you to try my easy “5 Ds” to help manage your food cravings. They really work! 

DELAY – DISTRACT – DISTANCE – DETERMINE – DECIDE.

Delay: Postpone eating for 10-15 minutes when you feel an urge. You’re not saying “no” – just stopping to think before you eat. You’re not ignoring the thought but dealing with it. While you’re delaying your decision, the next D makes it easier…

Distract: Try a non-food activity to give you something to do (so you don’t watch the clock for 10 minutes!). Often the wave of desire to eat disappears in a few minutes when you keep your hands busy without food. Clean out a drawer, call a friend, brush your teeth, surf the web, or even learn to knit!

Distance: It’s important to keep your eating environment at arm’s length – maintaining a distance. Keep food out of sight, not on counters; “out of sight, out of mind” can help. Stay out of the kitchen when a craving strikes. And use the kitchen only for food preparation and meal consumption. Avoid it as a place to hang out.

Determine: After waiting 10-15 minutes, determine whether you are physically hungry or just thirsty; these two are often confused. Also consider whether you might have emotional/boredom hunger, what I call “head hunger.” And avoid getting over-hungry, a main consequence of meal skipping. All of these situations can be helped with a structured eating schedule and pre-planned meals and snacks.

Decide: If you’ve made it through the first 4 Ds, it’s time to make a smart choice. Think before you eat and pre-plan what you are really looking for – sweet, creamy, salty, chewy – before you make a choice. Look for single-serving packaged items for built-in portion control. You also get the satisfaction of “eating the whole thing.” Aim for a snack between 100-200 calories.

How do you manage your own food cravings? Please share your thoughts!

Weight Loss: One Size Does Not Fit All

By Dr. Madelyn Fernstrom

If losing weight is your New Year's resolution, read on! This month, I'm going to share some of my favorite strategies to help you build your own weight loss tool box. I call it a BEAM box – and it's based on the four pillars of weight loss: Behavior, Eating, Activity, and Medical care. And no tool is too small to be included. It all starts with what you're both WILLING and ABLE to do. These are not the same thing, and when you think about the "able" part, you can set more realistic and practical goals.

One important question I hear all the time belongs with the eating tools: What about meal replacements? Good or bad?

Meal replacements can be a great help, since they make automatic portion control much easier. There's no guesswork in tallying your daily calories (studies continue to show that we all underestimate how many calories we eat). Meal replacements can be a great way to jump-start a reduced-calorie eating plan. This can be as easy as a complete bar or shake (along with a fruit), a large skim milk latte for breakfast, or a frozen calorie-controlled meal. You also might want to try a few weeks of a complete meal replacement plan, like Jenny Craig or Nutrsystems; some people find this the most helpful of all. 

Just one or two meal replacements a day can make the difference between weight maintenance and weight loss. It's a good way to enter the world of structured eating: a must-do for long-term weight loss success.

Whether you purchase a meal replacement, or create your own, these provide the security of easy food choices to both boost your confidence and help turn your attention to the flip side of eating less – being more physical active.