An Action Plan for a New Year and New You

I often sit and wonder how to crack a person's code. Why are they constantly engaging in detrimental behavior (lack of exercise, poor eating habits) and how do I motivate them to change. It's an area of science that scientists are well, stumped about. Why do people lose a ton of weight and then put it back on? Why does a pro athlete go through their workout sessions but end up so tempted by fried food and alcohol that they don't lose the weight they need to drop to perform at their best. SMART goals be damned, you have to first have some sort of intrinsic motivation to change or an actual push over the edge (and everyone's edge is different) to make a change and stay on course.

So where do you get this motivation? You work on your head first and foremost. And, it's my firm belief that everything you say to yourself and your goals should be deep entrenched with positivity versus negative, beating yourself up behavior (oh and try to avoid people who constantly nag you about your smoking, drinking, eating etc. because that does nothing for your self esteem; though I do think sometimes there is a place for Dr. Phil moments). The majority of people I've seen that spend long periods of time flip flopping back and forth trying to change haven't completely made up their mind that what they want (say weight loss) is actually better than the alternative (eating whatever, whenever, not exercising) and they also go about their goals with very restrictive, unrealistic expectations and then see just about anything as a setback that totally derails them.

So for instance, here's a few switches I commonly help people incorporate into their thinking pattern:

1) Instead of: I have to eat X calories per day or cut out carbohydrates to lose weight.
Try: Adding what you want to eat to your diet. Focus on all of the good food you want to incorporate into your daily nutrition
plan, and recipes you'd like to try. There are a ton of foods that are delicious and nutritious (oh and by eating more of these,
you'll displace some of those less than healthy foods).

2) Instead of: I'm injured, I'll never lose weight now, I can't walk or do aerobics.
Try: Focus on your physical therapy, getting better and a chance to get stronger.

3) Instead of: I ate a piece of cake, I went way over my calories for today, now I'll never lose weight.
Try: Wow, that tasted great! (let it go, enjoy it for what it is and eat a reasonable portion). Get used to eating enough to
satisfy that craving but not consuming the entire cup, bowl, plate or basket of food.

4) Instead of: I never stick to anything, logging my food just isn't for me.
Try: Logging my food intake is not for me, I'm going to try another approach.

Think of any goal as a road trip. If you are on your way from FL to NY I can just about guarantee you'll have to change lanes multiple times, stop for gas a few times, you may have to take a detour and you'll probably get stuck in traffic when you hit my hometown (the Washington DC area). But, never once will you question the fact that you actually will indeed make it to NY. Now, take this thinking and incorporate it into your daily life. Your road trip may not be perfect and it may include points where your speeds slows or stops but if you keep traveling, you will reach your goal.

Your Medical Tests: When Normal Isn’t Quite Normal

Any time you go to a physician’s office and have a lab test done, x-rays taken or any other diagnostic test performed, get a copy for your records and, if you go to another healthcare provider for the same issue, bring a copy of your test results. Never settle for “they said it was a little low but I don’t need to take anything.” On many occasions I’ve asked people to bring in their lab tests only to find that a “little low” isn’t acceptable. And, the most common tests that doctors aren’t aggressive enough with – vitamin D and iron.

While the “normal range” of vitamin D is 30 – 74 ng/mL, experts recommend doses of 50-70 ng/mL for optimal health. And, even if you are just a little below normal, supplemental doses of vitamin d may take a long time to get your blood levels up above the lower cutoff. Keep in mind that people respond very differently to both supplements and prescription doses of a vitamin or mineral. Some of us need less while others need a lot more to maintain adequate levels of the nutrient in our body.

Testing for iron isn’t so clear cut, mainly because you should, optimally, get a full iron panel to see where you stand. Just getting your hemoglobin and hematocrit tested may mean very little. And, even if your ferritin (your storage form of iron) levels are within normal limits they may still be indicative of iron deficiency anemia. For more information, see Figure 1 on this page titled Diagnosing Iron Deficiency Anemia.

Be your own health advocate by doing your homework so you are informed and know what questions to ask. After all, you know your body and how you feel better than anyone.

Tackling Weight Loss in the New Year

There are two times during the year that I hear a dramatic spike in talk about calories and weight - Nov – January and pre-beach weather. The questions come late at night in atypical settings after a food & alcohol guilt sets in. First, I’m listening to a conversation about the NFL lockout and all of the sudden, just like that, there’s an abrupt change in topic:

“I heard there are some foods that help you burn fat, have you heard about this? And what do you think about carbs? Do I need to cut out all carbs to lose weight? I’ve got this belly I just can’t seem to lose.”

After a month of throwing moderation out the window and choosing the shopping mall and holiday parties over the gym, its panic time for many people. Clothes aren’t fitting, work is about to get busy and the gym will be slammed in the New Year. So what’s a person to do? Follow these steps to lasting weight loss in the New Year:

• Consider what works and what doesn’t work for you. While the sound of a brand new diet promising big results is very enticing, it may not fit your weight loss style. Likewise, if you hate the idea of attending meetings and counting the points in food, Weight Watchers is not for you. Just because it worked for your neighbor, why start something you know you’ll quit when you could design a plan that fits your needs and lifestyle (a dietitian/personal trainer combination can help you figure this out).

• Always think success. If I had a dime for every time I heard the words “I can’t lose weight” I’d be sitting outside my vacation home in Tuscany right now picking grapes. The saying “if you think you can’t, you can’t” is oh so true. I don’t care if you don’t believe yourself right now, continue positive self talk: “I can and will lose this extra weight.”

• You must combine good nutrition habits with an effective exercise routine. I have seen many people go to the gym year after year and not lose the weight. And, they are doing one or two things wrong – not exercising the right way and not watching what they eat. I don’t care if you do CrossFit every day, if you don’t change what you are eating, you’ll never get the results you are looking for.

• Surround yourself with people you want to be like. Oprah says this all the time for a reason. When it comes to weight loss, there are people who will, often unknowingly, want to sabotage your efforts. Why? Because they don’t feel good about themselves or they feel guilty so they want you to eat that plate of chili cheese fries with them. Do you have any friends that weigh you down? If so, you’ve got to watch this Oprah Show on this topic.

Weight loss can be boiled down to finding what works for you, incorporating it into you life, surrounding yourself with people who cheer you along the way and sticking with it. It isn’t magic but it is easy once you find a plan that fits your lifestyle.

Weight Loss: 1+1 Doesn’t Always Equal 2 in the Human Body

Lately there’s been much chatter about the new Weight Watchers PointsPlus program (I’ll get to that in my next blog). Participants are confused, they think a calorie is a calorie and the machines in the gym tell the truth “I burned 700 calories doing 40 minutes on the treadmill!” And then, Weight Watchers catches up to the body of science over the past 3-4 decades and Bam! Everything dieters have been clutching onto for years must be thrown out the window. They have to learn a new system and attempt to release their firm grip of the belief that 200 calories is the same whether it comes from a fat free chocolate cake or turkey meat. Worse yet, they must embrace the fact that semi-starvation and deprivation interspersed with “I’m just going to eat anything I want” just doesn’t work.

So what’s a dieter to do? First, be flexible. Science changes and sometimes it takes a program a while (in this case decades) to catch up. Second (and this is critical), stick with it. If I had a dime for every time a weight loss client disappeared into thin area or dropped off the radar then popped back up again, I’d be home day trading right now. It’s critical that you stick with it through the days of fresh salads and grilled fish as well as the days you down your weight in chips and cheese dip. And, that brings me to my third point – let it go. So you ate some chips and chased them down with a few brewskies. Get over it and move on. Don’t let that slip become a slide into a period of “whatever, I can’t lose weight, I’ll just eat anything and everything.” Because it’s times like this that the most damage is done. And last, but not least, believe you can do it and set yourself up for success. Tell everyone (well, the supportive people) around you about your goals and team up with someone to go to the gym (or hire a trainer), take classes or make you accountable to that boot camp. See a dietitian….regularly and tell them you want the accountability! Or, join Weight Watchers and get to know the people in your group so you can’t pull the disappearing act one day without anyone noticing.

Now, why did I title this blog post 1+1 doesn’t always equal 2 in the human body? Because, you can’t trust the machines at the gym – most overinflate how many calories you are burning. And, most people (especially those who are obese) underestimate how much they eat. And finally, calories are not all the same. A diet of 1,500 calories may make you lose weight or it could keep your weight steady depending on what you are eating and to an extent, when you are eating it. Oh and P.S., those calories you eat between Friday at Happy Hour and Sunday morning, they count too. If you are my client, I’ll make you account for those hours. If you aren’t and I’m out somewhere dining with you, don’t tell me with a guilt-ridden voice what you plan or ordering or start counting the calories or fat grams because, I’m off duty ☺

Vitamins and Minerals Added to Food, Does it Really Matter?

Once in a blue moon I like ice cream. But, I’m certainly not walking up and down my local grocery store searching for the ice cream with added calcium and vitamin D. I’m ISO (in search of) whatever mint chocolate chip looks closest to the stuff I’d get from Candy Kitchen on the boardwalk. I choose ice cream based on taste, not on it’s nutrient content. But, there are times when you should pick up a fortified food and others, like when you get a chocolate hankering, where it makes little sense to. (Unless of course you know about Vita Muffins which taste so good you won’t know they are healthy).

Food fortification has been in place over 90 years and was one brilliant public health intervention that has helped curb or eradicate several diseases due to nutrient deficiencies including goiter, rickets, beriberi and pellagra. Early on, iodine was added to salt, milk was fortified with vitamin D and flour was enriched. The purpose behind fortification is simple – people are going to eat. And, why not put a vitamin or mineral most people aren’t consuming enough of in popular food items to ensure they get it? Pure brilliance.



Now, close to 2011, fortification has reached a whole new level. Yet we are still lacking in key nutrients across the globe. From iron to vitamin D, there are plenty of us who don’t get enough the nutrients we need for good health. So when should you choose a fortified food? When you don’t eat a widely varied diet of at least 2,000 calories daily (the more food you eat, the greater the chance that you’ll consume the nutrients you need every day). In addition, if you don’t take a multivitamin mineral supplement but you avoid certain foods or food groups rich in vitamins or minerals, it may be time to make some simple switches so you are adding foods rich in the nutrients you are missing. Take a look at these fact sheets on vitamins and minerals and see what you may be missing.

The Most Common Nutrient Deficiency in Bariatric Patients

If you’ve had bariatric surgery, congratulations on the new you! Now its time to learn to take care of the different nutrition needs brought on by your surgery. Though surgery will help you take and keep weight off, it also increases your risk of developing several nutrient deficiencies. And, because the best defense is a good offense, it is wise to talk to your physician and dietitian about the nutrient deficiencies common in bariatric patients.

The most common nutrient deficiency you are likely to experience is iron deficiency anemia. And, a related issue to this deficiency is pica – a condition where a person craves and eats non-food substances such as laundry starch, ice, dirt, clay, cigarette ashes and more. Patients who have undergone operations such as Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BD), with or without duodenal switch are at an increased risk of developing pica.

Additional reasons bariatric surgery increases your risk of developing iron deficiency anemia and pica include:

• Immediately post surgery your intake of iron rich foods may be minimal
• Surgery means decreased hydrocholoric acid production in the stomach and this acid is essential for the absorption of some micronutrients
• Food and supplements now bypass the typical iron absorption sites in the small intestine
• There are fewer receptors to transport iron and change iron to the form that is absorbed best by the body

All of these issues make it essential that you talk to your physician about getting checked for iron deficiency anemia and how best to supplement if you are low in iron.


Reference: Bariatric Times 2010;7(11)22–23

Something to be Thankful For: An Abundance of Good Food

4,000 calories, hundreds of grams of fat and a food hangover. I’ve heard a lot the past few weeks about how much people eat on Thanksgiving, how they’ll stay on their diet and how much exercise it takes to burn off the calories they consume. And, I get it, people are worried and feel like their confessions to a dietitian will ease their anxiety and keep them on track.

But, for all of those dieting and freaking out this time of year, I ask that you turn that attitude around to a little gratitude. Approach the Thanksgiving spread before you thankful that you have food on the table and delicious, nutritious choices to fuel your body and mind. Get rid of the food fear mentality and look at the plate before you a bit differently. Sure, be aware of what you are consuming – but do so in a “am I still hungry or did I eat enough and I can save this until tomorrow” type of way.

While I don’t advocate gorging on food, ever, a few extra calories won’t put a dent in your weight loss efforts if you are tuned into your hunger and satiety cues. Our bodies typically compensate if you listen hard enough. Eat too much one day and you probably won’t be so hungry the next day. Under eat and you’ll be hungrier the next day. You just need to listen closely.

Thanksgiving food should be enjoyed and shared with family and friends. After all, hunger is still a problem across this country and abroad. And food banks are in desperate need to make up their shortages. If you have food on your table, be thankful! And if it tastes great, be extra thankful!