Changes from previous version:
* added a section on medical doctor's knowledge about diets
* added text to the no ads policy to further clarify the policy
* updated info on the CLUB-100: Mark Mitcham's mailing list for persons 100 lb. (45 kg.) or more overweight
Obligatory disclaimer: The information contained in this posting is in no way guaranteed. This Frequently Asked Questions (FAQ) list is based largely on the personal experiences of the members of alt.support.diet, most of whom are not health-care professionals. As such, it should not be regarded as a complete or definitive manual on weight loss or maintenance, but rather as a concise collection of practical information and suggestions that you may find useful in your quest to achieve a healthier lifestyle. Before beginning a weight loss program, you may wish to first consult your physician to rule out the possibility of medical problems or conditions which should be factored into your diet and exercise plans (e.g., pregnancy, thyroid disorders, diabetes, hypoglycemia, heart disease, etc.).
Table of Contents 1 GENERAL QUESTIONS 1.1 What is the purpose of alt.support.diet? 1.2 Are advertisements allowed on a.s.d? 1.3 What is YMMV? 2 AM I OVERWEIGHT? 2.1 What do the terms "overweight" and "obese" mean? 2.2 Is using a standard height/weight chart a good way to tell whether I'm overweight? 2.3 I've decided to start a weight loss plan. How should I determine what weight I want to reach? 2.4 How often should I weigh myself? 2.5 Is using body fat percentage a good way to tell whether I'm overweight? 2.6 What's the best way to measure body fat percentage? 2.7 Are there any other ways to find out whether I'm overweight/overfat? 2.8 What is cellulite? 3 GENERAL DIET AND NUTRITION 3.1 Are doctors knowledgeable about all diets? 3.2 I keep hearing that a low-fat diet is supposed to be good for me. Why should I eat a low-fat diet, and how low is "low"? 3.3 Should I eliminate all fat from my diet? 3.4 How can I tell how much fat is in the foods I eat? 3.5 How do the new nutrition labels on processed foods differ from the old labels? 3.6 What is fiber? Is it important? 3.7 Is sugar a no-no? 3.8 What about artificial sweeteners? 3.9 What is the new "Food Pyramid" I've heard about? Is it similar to the Four Basic Food Groups"? 3.10 Is Promise Ultra Fat-free Margarine really fat-free? 4 WEIGHT LOSS PHASE 4.1 Are there any computer programs that will help me plan my diet or keep track of the foods I eat 4.2 How many calories per day do I need? 4.3 Can I lose weight faster by consuming fewer calories? 4.4 Is it really necessary to drink 8 glasses of water per day while dieting? 4.5 Is skipping a meal a day an effective way to lose weight? 4.6 I'm afraid that I'll have to give up all my favorite foods in order to lose weight. Is this true? 4.7 Can I lose weight without dieting? 4.8 Are surgical procedures like liposuction or stomach stapling a good way to lose weight? 4.9 How many pounds a week should I lose? 4.10 Why do men seem to lose weight faster/more easily than women? 4.11 Some weeks into my diet, my weight loss just stopped, even though I followed the diet plan to the letter. What did I do wrong? 4.12 Once I've lost the weight, how can I keep from regaining it? 5 LIQUID DIETS AND FASTS 5.1 Are liquid diets a good way to lose weight? 5.2 Is fasting a good way to lose weight? 6 WEIGHT LOSS ORGANIZATIONS, PLANS, AND DIET BOOKS 6.2 How does Weight Watchers work? 6.3 How does Jenny Craig work? 6.4 How does Nutri/System work? 6.5 How does Overeaters Anonymous work? 6.6 How does TOPS work? 6.7 How does "Stop the Insanity" work? 6.8 What is the Carbohydrate Addict's Diet? 6.9 What is Dr. Atkins' diet? 6.10 What is the Zone diet? 6.11 What is the "TJ Soup diet" (a.k.a. "The Sacred Heart Hospital Diet" or Cabbage Soup Diet")? 7 DIET AIDS (PILLS, ETC.) 7.1 I’ve heard about several weight loss aids like herbal teas, "fat-burning" pills, etc. Do any of these work? 7.2 What about prescription drugs (phentermine, fenfluramine)? 7.3 Do I need to take a supplement (vitamin/mineral pill) while dieting? 7.4 What is chromium? Can taking a chromium supplement help me lose or maintain weight? 8 EXERCISE 8.1 I need to lose weight, but I really hate to exercise. Can I lose weight by eating a low-caloriediet without exercising? 8.2 What are the most effective types of exercise for losing fat/weight? 8.3 How hard do I need to exercise? 8.4 What is anaerobic exercise? 8.5 How often and how long do I need to exercise? 8.6 How many calories do different types of exercise burn? 8.7 Does "passive exercise" (e.g., toning tables) work? 8.8 I move around a lot during the day; I try to use stairs instead of elevators, park my car on the far side of the parking lot, etc. Would I qualify as a "moderately active" person? 9 MOTIVATION 9.1 I've started a diet and exercise program, but I'm finding it really hard to stay on track. Any suggestions? 10 INFORMATION AVAILABLE VIA THE INTERNET 10.1 Newsgroups 10.2 Mailing lists 10.3 World Wide Web sites 11 BIBLIOGRAPHY AND RECOMMENDED READING LIST GENERAL QUESTIONS 1.1 What is the purpose of alt.support.diet?- To provide emotional support, encouragement, and practical advice to those who wish to improve their health, appearance, and/or self image through a weight loss or weight maintenance program. The name of the group, alt.support.diet, is somewhat unfortunate because: a) exercise is just as important as diet in weight loss, and b) the word "diet" is often interpreted as "a temporary regimen hat's somehow expected to lead to permanent weight loss," rather than its original meaning of "how one eats." The membership of a.s.d ranges from those who wish to lose relatively small amounts of weight (e.g., the 5-10 pounds that many of us tend to put on over the holidays), to those who are 100 ounds or more overweight, to those who have already completed a weight loss program and wish to maintain their new, healthier weight and lifestyle. 1.2 Are advertisements allowed on a.s.d?- Because a.s.d is not a moderated group, there is no way to prevent individuals or companies from posting advertisements for their products. However, anyone contemplating posting such messages should be aware that advertisements, particularly those for weight loss plans or diet aids are emphatically not welcome here. This includes, but is not limited to, herbalife, metabolife, colorad, chitosan, pyruvate, other weight loss supplements, plans, methods and aids . Our definition of an ad includes posting info about a product and saying e-mail me for more info, posting another's web site URL if the web site sells a product, and any other product recommendation where you stand to benefit financially should the readers of your post purchase the product recommended. Anyone posting any type of ad will reported their ISP for placing an ad in a noncommercial newsgroup that does not allow advertising. Furthermore, the web site host, should it be different from the spammer's ISP, will be alerted that spam is being posted in regards to the web site that they host. Many a.s.d readers have already learned the hard way that sustained, healthy weight loss doesn't come from over-the-counter remedies, and that "too good to be true" diets are just that. (a.s.d readers who encounter advertisements posted to the newsgroup should mail the advertiser a copy of this FAQ and report the ad to the spammer's ISP.) . Should there be a question posted about a product you sell, please do not respond. The fact that you stand to benefit financially from the recommendation you would make, makes the credibility and motivation of your recommendation suspect. There are a few newsgroups (those in the biz.* hierarchy, and those with "marketplace" or "forsale" in their names) where ads are permitted. Advertisers who are interested in reaching dieters or nutrition-conscious readers should check out alt.forsale.nutrition in particular. An alternative to advertising via Usenet is to set up your own site on the World Wide web. The URL (address) of your Web site can be included in the signature file that you append to posts you make in alt.support.diet, but please do not post articles that contain nothing more than pointers to your Web site--such articles fall within the technical definition of "advertisements." (Before including advertising in your Web site, be sure to check with your Internet service provider; many ISP's prohibit commercial ventures from personal accounts.) 1.3 What is YMMV? Your Mileage May Vary, is a very important part of the ASD philosophy on weight loss. No two people are alike. We differ in terms of likes and dislikes, metabolic speed and efficiency, health issues, moods, body clocks an many other ways. Many of us have learned the hard way that there is no "one diet fits all" weight loss solution. Therefore we ask that you do not insult other's diet choices or post that one diet is "the only one that works", or "the best diet" or "the only diet". Furthermore, we request that you do not post that a particular diet is not safe. This is especially relevant to low carb type of diets. We have learned through medical and scientific studies, as well as anecdotal evidence that for certain people, low carb is not only an effective weight loss method, but also improves their health, blood lipid profiles, and heart attack risk. All diets involve an element of risk and could be harmful to some people. Therefore, it is important that you educate yourself as much as possible about your chosen diet. Read any books written by the author of the diet. Do the necessary urine testing, blood work, and other medical suggestions made by the authors of the diet. That way you will know the state of your health and can access whether or not a diet is the right one for you. 2 AM I OVERWEIGHT? 2.1 What do the terms "overweight" and "obese" mean?- Physicians usually define "overweight" as a condition in which a person's weight is 10-20% higher than "normal", as defined by a standard height/weight chart. "Obesity" is usually defined as a condition in which a person's weight is 20% or more above normal weight. "Morbid obesity" variously means 50% to 100% over normal weight, more than 100 pounds over normal weight, or sufficiently overweight to severely interfere with health or normal functioning. 2.2 Is using a standard height/weight chart a good way to tell whether I'm overweight?- Your weight is only a very rough indicator of the amount of fat that your body contains, and most physicians feel that the percentage of your weight that comes from fat tissue is far more important than total body weight (which includes not only fat but also muscles, bones, and bodily fluids). Height/weight tables could indicate that a lean, muscular person is "overweight", while a person whose weight is within the "normal" range might actually be carrying around more fatty tissue than is healthy. Covert Bailey states in The New Fit or Fat that standard weight tables can be off by as much as 20-30 pounds for any given person. 2.3 I've decided to start a weight loss plan. How should I determine what weight I want to reach?- Remember that your weight is just a small part of the whole picture. Other, more valid, indicators of your fitness level are: * How do you feel--energetic or wiped out? * Do you have good muscle tone, or are you flabby? *¨ Are you able to walk up a few flights of stairs without panting? * Are you able to accomplish the daily tasks that you want/need to do? If you've been overweight since childhood or adolescence, you may not even know what a "good" weight for you would be. Setting a goal of a normal body fat percentage (see "Is using body fat percentage a good way to tell whether I'm overweight?") or a certain clothing size is probably more realistic than aiming for a specific weight, but even here you should use your common sense. Most women would love to wear size 6 (or smaller) clothes, even those whose large frames make this a totally unrealistic and unhealthy goal for them. 2.4 How often should I weigh myself?- As mentioned above, weight is only a rough indicator of fitness. However, many people engaged in a reducing or fitness plan find it desirable to check their weight regularly. Opinions on how often one should weigh vary widely. The natural tendency of a person on a weight loss plan is to weigh frequently, perhaps several times a day ("I've lost a quarter pound since this morning!"). It's important to remember, though, that your weight will increase and decrease throughout the day depending on your activity level, food and fluid intake, etc. Even your day-to-day weights will fluctuate, mostly due to varying degrees of fluid retention. (Many women tend to gain a few pounds during their menstrual periods due to "water weight," and men and women both tend to retain extra fluids after ingesting large quantities of sodium, e.g. Chinese food.) For this reason, many a.s.d members feel that it is more reasonable to weigh less often, perhaps once a week or once a month, to obtain a more realistic pattern of weight loss or maintenance. Even this approach has some drawbacks, though--what if you just happen to be heavy due to fluid retention on the one day per week or month that you weigh? If you do decide to weigh yourself regularly (at whatever frequency you think is most appropriate for your emotional well-being), we recommend that you: a) Weigh yourself under similar conditions each time. For example, if you weigh yourself daily, do it at the same time every day, wearing approximately the same clothes each day, on the same scale. Probably the best time is in the morning, right after getting up and going to the bathroom, before eating or drinking anything. b) Look not at specific numbers but at trends in your weight patterns. If you weigh daily, you might wish to average your daily weights to obtain one weekly average, which you can compare to previous weeks. Try plotting your weight on a graph, and look for a gradual downward inclination, ignoring the occasional sharp peaks and dips, which are probably due to differing degrees of fluid retention. Some people have abandoned the scales entirely, preferring to rely on other indicators, such as: * How well do your clothes fit? Are they tight or loose through the chest, thighs, or waist? * The "pinch test": Can you "pinch an inch" of fat at your waistline or at the back of your arm? * The "jiggle test": Jump up and down in front of a full-length mirror, nude. Does anything jiggle that shouldn't * Overall muscle tone: When you put your hand on your thigh or hip, do you feel muscle or fat? 2.5 Is using body fat percentage a good way to tell whether I'm overweight?- Most physicians consider your body fat percentage to be a far better indicator of overall fitness than weight. Normal ratios are 12-18% body fat for men and 19-25% for women; very fit people (e.g., athletes) may have much lower percentages. Unfortunately, body fat percentage is more difficult to determine than weight (see below). 2.6 What's the best way to measure body fat percentage?- Several methods are in use, and unfortunately the same person is likely to get different readings from different methods. As with weighing yourself, your best bet is to pick one method, stick with it, and watch trends rather than specific numbers. * Immersion: This method is based on the fact that lean tissue (muscles, bones, etc.) tends to sink in water, while fat floats. The client is seated in a chair which hangs from a scale, rather like a scale in a supermarket's produce section. The chair and the client are lowered into a pool of water until the client is completely immersed, and the client's weight (while immersed) is recorded. The fatter you are, the more you tend to float, and the lower your immersed weight will be--muscular people weigh more than fat people while immersed. The immersion method is highly accurate, but obviously requires a lot of equipment. Covert Bailey advises that you can estimate your fat ratio by seeing how well you can float on your back in a regular swimming pool: above 25% fat, people float easily; people with 22-23% fat (a healthy level for women) can usually float while breathing shallowly; at 15% fat (low for a woman, healthy for a man), one will usually sink slowly even with a full chest of air; at 13% or less fat, one will sink readily even with a full chest of air, even in salty ocean water. * Calipers: The physician or technician making the measurement gently pinches up folds of tissue in areas that normally accumulate fat readily (such as the back of your arm, your stomach just above the waistline, and your hip area), then uses calipers to measure the width of these folds. The thicker the folds are, the higher the fat ratio in your body. This method is only somewhat accurate since it measures just the fat which accumulates in these regions, not that which is imbedded between muscle fibers. However, it is a simple and inexpensive procedure. ¨ Electrical impedance: This method is based on the fact that fat and lean tissues have different levels of electrical conductivity (muscle tissue conducts electricity better than fat tissue does). The test is simple, completely painless, and takes just a few minutes; a couple of sensors are attached to the body (e.g., to a hand and a foot) and used to measure the body's resistance to a weak electrical current. * Infrared measurement: This method is based on the fact that an infrared beam travels faster through muscle than fat. An IR beam is bounced off a bone (e.g., in the upper arm) and the time that it takes for the signal to return is measured. As with electrical impedance, the procedure is simple and completely painless. 2.7 Are there any other ways to find out whether I'm overweight/overfat?- If you're overweight you probably already know it, but there are a couple of indicators that can let you know whether your weight increases your risk for health problems like heart disease. Waist-to-hip ratio is a useful indicator, and is simple to determine. Stand in front of a full-length mirror so that you can easily see the areas you are measuring. Use a tape measure to measure your waist circumference at the level of your navel. Next, measure your hip circumference at its widest point. (Do not pull the tape measure too tightly.) Divide your waist measurement by your hip measurement to determine your waist-to-hip ratio. For example, if your waist measures 26" (66 cm.) and your hip measurement is 36" (91.5 cm.), your waist-to-hip ratio is 0.7. For men, a waist-to-hip ratio of 0.95-1.0 or greater indicates an increased risk for heart disease. Women should have a ratio of 0.8 or less. Another useful measurement is your Body Mass Index (BMI). If you have a Web browser (such as Netscape) which is capable of displaying tables, check out http://www.loop.com/~bkrentzman/obesity/bmi1.html for a handy BMI chart. To determine your BMI manually, multiply your weight in pounds by 703, then divide by the square of your height in inches. For example, if you weigh 130 pounds and are 5'4" (64") tall, your BMI is (130 * 703)/(64 * 64) = 22.3. (If you use the metric system, divide your weight in kilograms by the square of your height in meters.) A BMI of 25 or less indicates that you are at low risk for heart disease; 30 or higher suggests that you are at moderate to very high risk. BMI, like height/weight charts, does not take into account individual physiques, body fat percentages, etc., but does at least allow for a range of weights. 2.8 What is cellulite?- Strictly speaking, there's no such thing, although vendors of high-priced creams, special scrubbing sponges, and exercise equipment would like you to believe otherwise. The term "cellulite" was coined at a European diet spa to describe the deposits of fat that many women (normal and overweight) accumulate on their thighs and buttocks. Concentrations of fat in these areas often have a wrinkled or puckered appearance because the fat bulges out between the fibers that connect the skin to underlying tissues; the actual fat itself is no different than that found anywhere else in the body. Short of surgical measures such as liposuction, there is no way to remove fat concentrations from one part of the body, although a diet and exercise program targeted at reducing fat throughout the body may eliminate, or at least reduce, such localized deposits. 3 GENERAL DIET AND NUTRITION 3.1 Are all doctors knowledgeable about all diets? In a perfect world, yes, but we do not live in a perfect world. Many excellent, caring, well educated doctors have, unfortunately, little experience with the many possible diets out there. If your doctor does not approve of your diet choice, listen to his concerns. Do your own study for : info by reading the books, etc. And do the blood work your doctor may suggest before starting the diet and then three months into the diet to access the diet's impact on your health. While it is important to listen to your doctor, you are the one who must live in your body. there fore it is necessary for you to be as informed and knowledgeable about your chosen diet as possible. Therefore, you can make an informed decision, based on all the info about the diet. Discuss this with your doctor and explain to him why you are choosing this diet and that you want your doctor to monitor your health while you are on the diet. This way his concerns will be addressed and dealt with while you are dieting. This will also allow you to examine the efficacy and safety of the diet on an on going basis and educate your doctor about a diet he may not be familiar with. This is in no way a recommendation that you should not listen and follow your doctors advice, just an alternative method, should you wish to follow a diet against your doctors advice. 3.2 I keep hearing that a low-fat diet is supposed to be good for me. Why should I eat a low-fat diet, and how low is "low"?- There is strong evidence that the high levels of fat consumed by most Americans (and members of other westernized cultures) cause, or are a contributing factor in, diseases such as gallbladder disease, cancer, and diabetes. High levels of saturated fats, which are found in animal fats, high-fat dairy foods, tropical oils, and hydrogenated (solidified) vegetable oils, raise your cholesterol level and promote heart disease and strokes. The "typical" American diet gets more than 40% of its calories from fat, with the remaining calories coming from protein and carbohydrates. The American Heart Association, the National Academy of Science, the American Cancer Society, and many other groups and nutrition boards across the country recommend a diet in which a maximum of 30% of calories come from fat (no more than 10% of total calories from saturated fats), 55-65% calories come from carbohydrates, and 10-15% of calories are provided by proteins. A growing body of authorities (Pritikin, McDougall, Ornish, et al.) suggest that even lower levels of fat (10-20% of total calories) are much better than 30%, and can actually reverse existing heart disease. Dr. Dean Ornish, for example, recommends a 10% fat vegetarian diet of fresh fruits and vegetables, whole grains, and legumes (peas and beans); nonfat dairy products and egg whites are also allowed. Alcohol (which suppresses the body's ability to burn fat) and processed sugars (which can trigger food cravings in many people) are discouraged. From a weight loss standpoint, a low-fat diet is ideal because it minimizes the amount of fat that your body has to store in the first place. Excess dietary fat can be directly stored by your body, no conversion needed (so perhaps there's some truth in the adage, "Cheesecake goes straight to my hips"). Proteins and carbohydrates, on the other hand, are usually burned up immediately rather than being stored. They can be converted to fat if they're present in sufficient quantities, but that's quite a bit of work for your body. 3.3 Should I eliminate all fat from my diet?- You couldn't even if you wanted to, and you really don't want to. Even "fat-free" foods such as raw vegetables and dried beans contain trace amounts of fat, so there's no way you can totally escape the stuff. Besides, your body does require small amounts of fat for lubrication, essential fatty acids, and fat-soluble vitamins. However, you could eliminate all pure fats (e.g., butter/margarine, cooking oils, etc.) and high-fat foods (non-skim dairy products, red meats, nuts, etc.) from your diet and still get all the fat that your body requires from those trace amounts. 3.4 How can I tell how much fat is in the foods I eat? For processed foods, check the nutrition information panel on the package, which should indicate how many grams of fat one serving contains; each gram of fat contributes about 9 calories towards the total number of calories per serving. For example, one serving of crackers might break down as follows: 60 calories, 1 gram of protein, 10 grams of carbohydrate, and 2 grams of fat. In order to determine what percentage of the calories in this food come from fat, multiply the weight of the fat (in grams) by 9, then divide this figure by the total number of calories in a serving. In our example, 18 calories (2 g fat * 9 cal/g), or 30% of the total calories (18 cal/60 cal = 0.30), come from fat. The remaining calories come from the protein and carbohydrate, which each provide only about 4 calories per gram. (If the weight of a serving of food is more than the combined weight of its fat, protein, and carbohydrate weights, the "missing" weight is probably due mostly to water, which has no calories.) NOTE: Take a closer look at those food products that proudly proclaim that they're "85% fat-free!". Such statements can be misleading, since they usually mean that the productis 15% fat by weight, not that the product gets only 15% of its calories from fat. (Gram for gram, fat contains more than twice as many calories as protein and carbohydrates.) For example, a serving of a brand-name turkey breakfast sausage which is allegedly "85% fat-free" has 6 grams of fat in each 80-calorie serving, and therefore gets more than 67% (6 * 9/80 = 0.675) of its calories from fat. You may wish to purchase an inexpensive book on nutrition information to look up foods which are not labeled with nutrition information. (Or, try the Nutrition Analysis Tool at http://www.ag.uiuc.edu/~food-lab/nat/. It works best with browsers capable of displaying tables.) Fruits, vegetables, berries, grains, legumes (peas and beans), and egg whites generally have little fat. (Avocados, olives, nuts, soybeans, and seeds--such as sunflower seeds, and even seeds from low-fat vegetables such as pumpkins--are exceptions.) Any food which looks oily or leaves greasy stains on a paper napkin is probably high in fat. This doesn't mean that you should never eat high-fat foods, only that you should balance them with lower fat foods such as grains, vegetables, and fruits. Keep the broad picture in mind; evaluate your diet over a period of a day (or a couple of days) and aim to keep your total fat intake under 30% at most (10-20% if possible). 3.5 How do the new nutrition labels on processed foods differ from the old labels?- The new nutrition labels, which debuted in May 1994, may make evaluating the nutritional values of processed foods a little easier for most people. The new labels list not only the amounts (weights) of fat (total and saturated), cholesterol, sodium, carbohydrates (total, fiber, and sugars), and protein in the food, but also the percentage of the "Daily Value" that most of these provide. (The term "Daily Value" replaces the old term "Recommended Daily Allowance," although the actual nutrition recommendations have not changed.) Daily Value percentages are also listed for vitamin A, vitamin C, calcium, and iron; depending on the food, percentages for other vitamins and minerals may be given. A Daily Value percentage is not given for protein. (FDA pamphlet #932260, "How to Read the New Food Label," states that "most Americans get more protein than they need"; presumably this is why no value is listed.) The Daily Value percentages are based on a 2,000-calorie-per-day diet in which no more than 30% of the calories come from fat, so if your needs are different, you'll need to keep this in mind when reading the labels. The U.S. Food and Drug Administration offers a simple rule of thumb: If the percentage of Daily Value for a given nutrient is less than 5%, the food is considered low in that nutrient. Therefore, you should look for foods that have low Daily Value percentages for fat, cholesterol, and sodium, and high percentages of carbohydrates (including fiber), vitamins, and minerals. Other provisions of the new food labeling standards: *All packaged, processed foods must now carry nutrition labels. Previously, nutrition labels were voluntary, and many foods were unlabeled. * Terms such as "fat-free," "low-fat," "lean," "light" (or "lite"), etc. are now defined by the government. Previously, food manufacturers were free to describe their foods in any way they liked. * The serving sizes used to determine the Daily Value percentages are now more realistic (read "larger") and are expressed in terms that are easier for consumers to deal with. For example, serving sizes for chips and crackers are now expressed as "x pieces" rather than "x ounces." 3.6 What is fiber? Is it important?- Fiber (also known as "roughage") is simply the non-digestible portion of the foods that we eat. (There are actually several different types of fiber, such as cellulose, hemicellulose, lignin, pectin, and guar.) Fiber is found chiefly in non-processed foods such as whole grains, legumes (beans and peas), fruits, and vegetables, especially in the outer layers of such foods. Fiber may be added to processed foods in the form of bran, which is the outer coating from a grain such as wheat or oats. A high-fiber diet has a number of benefits: * It speeds the elimination of fecal material from the body. This can reduce or cure constipation and intestinal polyps, alleviate hemorrhoids which often result from straining during bowel movements), and may greatly reduce the risk of colon cancer. It may also prevent or alleviate diverticulosis, a condition in which the intestinal lining develops small pockets in which fecal material can be trapped. * It fills out the stomach and intestinal cavity. This produces a sense of fullness which is a real boon in weight control. * It can alleviate conditions such as spastic colon and diarrhea because fiber absorbs excess water and produces a bulkier stool. *Some types of fibers, particularly those found in whole fruits and legumes, tie up sugar molecules so that the levels of insulin normally produced after eating are reduced, a big advantage for diabetics. (This effect is most pronounced when fruits and legumes are eaten whole, rather than as fruit juice or ground beans.) The typical American diet is high in processed foods, most of which contain little or no fiber. Most people get only around 10-12 grams of fiber per day, but you need 25 grams or more to get the real benefits. If your current diet is low in fiber, it's important that you increase fiber gradually over a period of weeks or months; sudden increases can cause bloating, cramping, and gas. Try having a small serving of a high-fiber, low-fat cereal with your breakfast; as your system becomes used to the higher fiber levels, start substituting whole-grain breads, cereals and pastas for the refined (white flour, low-fiber) varieties you've been eating. Increase your consumption of fresh fruits and vegetables, and consume edible peels and skins (e.g., on apples and potatoes) rather than trimming them. 3.7 Is sugar a no-no?- Sugar has gained a nasty reputation over the years largely because it is so often found in combination with high levels of fat in foods such as ice cream and pastries. Sugar is also a major source of "empty calories": calories which are not accompanied by any appreciable nutrient value. In terms of weight loss or maintenance, sugar is not necessarily objectionable, provided that you can keep your intake of it down to moderate levels. Since it is a carbohydrate, it is normally metabolized (burned) by the body immediately, and is converted to fat only if present in quantities too large to be used at once. Some people do find that even moderate amounts of sugar stimulate cravings for yet more sweets, often of the high-fat variety. If you are one of these people, you may wish to eliminate processed sugars from your diet, relying instead on the natural sweetness of fruits, vegetables, and grains. 3.8 What about artificial sweeteners?- Artificial sweeteners may be an effective aid for those who have occasional cravings for sweets, but probably work against those of us who have an active sweet tooth. The taste of artificial sweeteners can trigger sugar cravings about as well as real sugar can. Some long-term users of artificial sweeteners use sweeteners in addition to all the foods they normally eat, rather than as a substitute for part of the foods. 3.9 What is the new "Food Pyramid" I've heard about? Is it similar to the "Four Basic Food Groups"?- It replaces the "Four Basic Food Groups" plan, which was heavily influenced by the meat and dairy industries. It's quite possible to eat a healthy diet without using any meat or dairy products, which can be high in fats anyway. The new "Food Pyramid" is a step in the right direction, since it emphasizes fruits, vegetable, and grains, and suggests smaller amounts of protein sources (meats, legumes, dairy products, etc.) than did the Four Basic Food groups. /\ / \ /Fats \ / oils \ /sweets \ / go eassy \ /=========\ / | \ / Dairy | Protein \ / (23 | (23 \ /servings)| servings)\ / | \ /================\ / Veggies | Fruits \ / | \ / (35 | (24 \ / servings) | servings) \ /======================\ / Grains \ / \ / (breads, cereals, rice, pasta) \ / (611 servings) \ /............................................................\ (See http://www.nalusda.gov/fnic/Fpyr/pyramid.gif for a large color GIF of the Food Pyramid.) If the quantities of food suggested here seem excessive (eleven servings of bread and cereal a day?!), remember that the USDA's idea of a serving is often much smaller than the portion that a typical consumer actually eats. For example, a serving of vegetables is only 1/2 cup of cooked or raw, chopped vegetables, or 3/4 cup vegetable juice, or one cup of raw, leafy vegetables like spinach or lettuce. A serving of fruit is 1/2 cup of bite-sized fruit pieces, 1/4 cup dried fruit (e.g. raisins), 3/4 cup of fruit juice, or one medium piece of fruit (e.g., a medium orange, apple, or banana, or one half of a grapefruit). A serving of dairy products such as milk or yogurt (look for skim or low-fat varieties) is one cup; a serving of cheese (which should be used in moderation or replaced with low-fat varieties) is 1-1/2 ounces of natural cheese or 2 ounces of processed cheese. When it comes to proteins, many Americans far exceed the recommended servings per day: a serving of meat is only 2 to 3 ounces of cooked meat, a portion about the size of a deck of cards. One ounce of meat can be replaced by 1/2 cup of cooked beans, 1 egg, or 2 tablespoons of peanut butter (remember that whole eggs and peanut butter are high in fat and should be using sparingly). For grains, a serving is considered to be one ounce of bread (about one slice) or dry cereal (most of us consume at least 1-1/2 to 2 ounces of breakfast cereal at a time), or 1/2 cup of cooked grains or pasta. Since a typical serving of rice is 3/4 to 1 cup, and a plateful of pasta contains around 2 cups of the stuff, most of us have no problems meeting the suggested servings per day. 3.10 Is Promise Ultra Fat-free Margarine really fat-free?- According to its label, one serving (one tablespoon) of Promise Ultra margarine contains 5 calories, 0 g. protein, 0 g. carbohydrates, 0 g. fat, 0 g. cholesterol, and 90 mg. sodium. The ingredient list includes water, vegetable mono and diglycerides, gelatin, salt, rice starch, lactose, vegetable diacetyl tartaric acid ester of mono and diglycerides (Datem), potassium sorbate and lactic acid (added as preservatives), artificial flavor and color added including beta carotene, and vitamin A palmitate. Because of its high water content, Promise Ultra cannot be used to fry foods, and should not be substituted for regular margarine or butter in baked goods because the texture of the final product would probably be adversely affected. However, Promise Ultra could be used to sauté vegetables or to add flavor to moist recipes. Informal taste-tests by a.s.d'ers have produced mixed results, to say the least; some people find the taste acceptable on toast, hot vegetables, etc., while others find the taste repugnant. YMMV. 4 WEIGHT LOSS PHASE 4.1 Are there any computer programs that will help me plan my diet or keep track of the foods I eat?- The following programs are used and recommended by various a.s.d members: * Nutritionist IV (for DOS and Windows), published by N-Squared computing phone#: 800-289-1701). Analyzes the fat, carbohydrate, protein, fiber, sodium, vitamin, and mineral content of your diet; comes with a database of 8,500 foods (database values can be edited, and new foods and recipes can be added). Nutritionist IV is intended more for professional dietitians and physicians than for end-users, and therefore is rather too expensive (US$495) for most casualusers. * Diet Analyst [for PC-compatibles, I assume?--kbc], from Parsons Technology; about US$20 Diet Balancer for PC-compatibles, from Nutridata Software Corp. phone#: 800-922-2988); about US$60. Analyzes your food intake for fat, carbohydrate, protein, fiber, sodium, vitamin and mineral content. * Michael Traub (email@example.com) writes: "I have a freeware program that relies on data from the USDA. That data is available at http://www.nal.usda.gov/fnic/foodcomp/Data/SR11/. The program is available directly from me. The user will require a C compiler and an MS-DOS or Unix platform." * DINE for the Macintosh, available from Nutrition Action Healthletter for around US$80-90. (Note: The January/February 1995 Nutrition Action Healthletter lists a program called "Dine Healthy" for Windows or Macintosh; US$99 + US$5.50 shipping/handling. Call 800-237-4874 to order.--kbc) * DietLog for the Newton MessagePad, available from Mac Warehouse (800-255-6227) * Digital Gourmet for Macintosh, US$69.95, available from Mac Warehouse (800-255-6227) * Shareware/freeware available via anonymous ftp and national online services: ^ Diet Tracker for Win 3.1, tracks weight changes: available from America Online as DTK21.ZIP ^ From Scratch recipe program for Win 3.1: ftp://ftp.coast.net/pub/coast/win3/food/fscr40.zip ^ Gut-buster for Newton MessagePad, tracks intake for exchange diets: ftp://ftp.uiowa.edu/pub/newton/medical-health/gut-buster.hqx ^ Heart Rate Zone Calculator for Mac (Hypercard): available from America Online ^ Heart Smart for Windows, tracks calories, fat, cholesterol: available from America Online as HSMART40.ZIP (for Win 3.1) or SMT4095.ZIP (for Win 95). ^ NutriGenie publishes a wide variety of nutrition- and health-related shareware for Win 3.1, including "Fat to Fit," "Compleate Nutritionist," "Eat Well, Weigh Less," "Pregnancy Nutrition," "Diabetic Nutrition," and *Carbohydrate-Restricted (Atkins) Diet Meal Planner." The software is available through their Web sites at http://users.aol.com/nutrisoft/ and http://pages.prodigy.com/CA/nutrigenie/. The programs are also available by ftp at ftp://ftp.coast.net/pub/coast/win3/food/ (check the file .00_index.txt for descriptions and exact filenames) ^ Nutri-Base Jr. for Win 3.1, nutrition analysis: available through America Online as NUTRBSJR.ZIP ^ Weight Commander for Win 3.1, weight tracking program: ftp://ftp.interaccess.com/weightcmdr/dload.exe ^ Wellness Inventory for Mac (HyperCard): available from America Online as WELLNESS INVENTORY 4.2 How many calories per day do I need?- Your body needs a certain number of calories per day just to keep you alive and to maintain yourbodily functions (breathing , digestion, etc.); this figure is referred toas your Basal Metabolic Rate(BMR). You can estimate your BMR by multiplying your current weight (inpounds) by 10 for women,11 for men. For example, a woman who weighs 120 pounds would require about1,200 calories perday just to maintain her bodily functions. You'll also need some percentage of calories above your BMR to provide energy for your daily activities (using your hands and arms,walking, exercising, etc.); the percentage will vary widely based on your metabolism and activity level. A moderately fit and active person might need 30-50% calories above her BMR to maintain her current weight; our hypothetical 120-pound woman would need approximately 1,680 calories per day (1,200 + (1,200 * .40) = 1,680) assuming that she is somewhat active. A person who is very fit and exercises frequently might burn as much as 100-200% more than his/her BMR. If your goal is to lose weight, you'll need to take in fewer calories than you use up, or burn off additional calories through exercise, or both. If you choose to decrease calories, aim for the amount needed daily to maintain your ideal (not current) weight. Most health care professionals recommend that women take in at least 1,200 calories per day (1,400 for adolescent girls, 1,600 for men); at lower calorie levels, you're likely to be cheating yourself of essential nutrients. 4.3 Can I lose weight faster by consuming fewer calories?- Sounds like good math, but your body doesn't work like that. If you make a habit of consuming fewer calories than your body requires, your body will automatically go into "starvation mode." In effect, your body says, "If (s)he ain't gonna feed me, then I'd better slow things down until (s)he decides to eat again." There are some awfully compelling reasons to lose weight slowly. If you lose more than a pound or two per week, you're almost certainly losing muscle, not just fat tissue, and that's exactly what you don't want to do. (It's your muscles, after all, that work to burn off the calories you take in!) Also, weight lost quickly is far more likely to be regained than weight lost very gradually. 4.4 Is it really necessary to drink 8 glasses of water per day while dieting?- Many physicians, dietitians, diet plans, etc. recommend that you drink 6-8 glasses (8 oz./glass) of water per day, quoting one or more of the following reasons: * Most people already drink far less fluids than they should, and dieters in particular should avoid the physical stress that dehydration can cause. * You can be dehydrated without being thirsty; drinking this amount of water ensures adequate levels of hydration. *Fluids temporarily distend your stomach, relieving the hunger pangs that some dieters experience. Well, maybe. You should definitely drink whenever thirsty, and if you exercise regularly (as you certainly should), then it's an excellent idea to drink an extra glass of water both before and after you exercise. (Sipping cool water during exercise is also great, but may be impractical.) An easy way to tell if you're getting enough fluids is to check the color of your urine in the toilet bowl: if it's colorless or light yellow then you're adequately hydrated; if it's medium or dark yellow, you need to drink more. There's also a lot of controversy about whether you must drink only water, or if other fluids (Gatorade, fruit juices, diet pop, etc.) are acceptable. Gatorade and other "exercise drinks" are expensive ways to get sugar and minerals that you probably don't need unless you exercise for long periods (at least 90 minutes at a time); the calories from fruit juices can add up quickly, especially when ingested in large amounts; some varieties of soda pop (and coffee and tea) contain caffeine that you really don't need, and the carbonation can cause cramping in some people. Your best (and cheapest!) bet is plain water. 4.5 Is skipping a meal a day an effective way to lose weight?- All else being equal, it would probably work better to have more meals, not fewer. A large meal causes your body to release a lot of insulin, which promotes the conversion of food into stored fat. If you haven't eaten in several hours, your metabolism decreases and you actually burn fewer calories than if you "graze" (eat 4-6 small meals throughout the day). 4.6 I'm afraid that I'll have to give up all my favorite foods in order to lose weight. Is this true?- There are no "bad" foods; it's just that most of us tend to eat too much of foods that are high in fat and low in other nutritive values. If you can teach yourself to eat and enjoy fatty/sugary foods only occasionally, there's no reason that you can't indulge yourself every once in a while. Be warned, though: once your stomach has gotten used to a low-fat diet, you may find that greasy foods produce unpleasant gastric effects (bloating, nausea, diarrhea). Interestingly, dieters have traditionally listed starchy foods, such as bread, pasta, and potatoes as foods that they most missed while on a diet. Of course, we know now that these foods (preferably whole-grain varieties and without fatty sauces and toppings) are an important part of a balanced diet, and should in fact make up the bulk (at least 60-65%) of your diet. 4.7 Can I lose weight without dieting?- If by "dieting" you mean a temporary regimen of eating measured portions of raw veggies and expensive, funny-tasting "dietetic" foods, then the answer is yes. Your goal should be to adopt healthy eating and exercise plans that you can live with for the rest of your life; these two factors can be enough to cause gradual weight loss in most overweight people, without the need for regimented diets. And these plans will serve you well after you've lost the weight, too--most of us who have successfully maintained our weight losses find that we can eat whatever amounts of low-fat, nutritious foods (whole grains, fresh fruits and vegetables, low-fat dairy products, legumes, etc.) we need to satisfy our hunger, without regaining the weight. There's no need to deny real hunger pangs, so long as you satisfy them with healthy foods. Note that it is possible to lose weight (without changing your eating habits) by increasing youractivity levels dramatically, although this approach won't necessarily makeyou healthier. 4.8 Are surgical procedures like liposuction or stomach stapling a good way to lose weight?- Liposuction (also known as lipolysis or suction lipectomy) is a surgical procedure in which localized deposits of fat tissue are suctioned out of the body through a long, thin metal tube known as a cannula in order to improve body proportions (e.g., to reduce "saddlebag thighs," oversized buttocks, or double chins). Liposuction is not appropriate as a weight loss method; because of the large amounts of blood and body fluids that are suctioned out along with the fat, only about 2-5 pounds of tissue can be removed during the procedure. Most reputable plastic surgeons recommend that liposuction be used only on patients who are already at or near their ideal body weights and whose unsightly bulges fail to respond tosensible diet and exercise plans. [Since liposuction is not a weight loss procedure, it will not be described in detail here. For those interested inthe details of the surgery, check your local library or bookstore for references on plastic surgery, such as Dr. Paula Moynahan's Cosmetic Surgery for Women by Paula A. Moynahan, M.D., or The Complete Book of Cosmetic Surgery by Elizabeth Morgan.--kbc] Surgical procedures that are used to treat obesity include gastric bypass and gastric reduction or partitioning (a.k.a. stomach stapling). These are both drastic measures that are normally used only when more conventional weight loss methods have failed and the patient's health is compromised by his/her weight. The gastric bypass procedure involves stitching or stapling across the entire width of the stomach, closing off the bottom portion of the stomach and leaving only a fraction of the upper part of the stomach open to receive food. A small opening is made in this remaining "pouch" of stomach; the jejunum (a part of the small intestine) is brought up and ttached to this small opening. As a result, all food and fluids ingested by the patient must now pass through this small opening in the top of the stomach and then directly to the attached small intestine. The stomach stapling surgery also uses staples or stitches to close off part of the stomach, but in this procedure, the staples or stitches are not placed across the entire width of the stomach. A small opening, about 1/8 to 1/4 inch (.3-.7 cm) in diameter, is left through which food can pass into the lower portion of the stomach and then into the small intestine as usual. Both of these procedures reduce the size of the stomach so that only very small amounts of food can be stored in it at any given time; the patient feels full after eating tiny portions of food. Because the opening into the remainder of the digestive tract is also reduced in size, food must be chewed very thoroughly (or pureed) so that it will pass through the opening. Attempting to eat too much at one sitting, or failure to chew food slowly and thoroughly can result in upset stomach and vomiting. Weight loss following surgery is dramatic: 26-44 lb. (12-20 kg.) in the first month, with total weight losses of 50 lb. (23 kg.) or more being quite common. However, neither of these surgical procedures should be viewed as a quick or easy fix to a lifetime of obesity. Because the surgery drastically decreases the amount of food that the patient can eat, special care must be taken following the surgery to ensure that the patient consumes a nutritious diet which is low in fat and has adequate amounts of vitamins, minerals, and fiber. The patient must also accept the necessity of eating small meals and chewing food completely to prevent regurgitation. Some patients find themselves unable to tolerate the discomfort created by gas-producing foods such as carbonated beverages. Neither procedure is without risks. As in any major surgery, bleeding, infection, and anesthesia-related complications are possible. Increased occurrence of gallstones, vitamin deficiencies, and occasional stomach ulcers have also been reported, although patients who have undergone the stomach stapling procedure seem to be affected by these complications less often than are gastric bypass patients. Neither operation is foolproof, either--the size of the upper "pouch" of stomach can increase with time, as can the size of the opening left following stomach stapling. Either of these occurrences can allow the patient to eat more without feeling bloated or experiencing vomiting, and can result in gradual weight regain. It is also possible for patients to regain weight by consuming high-calorie foods such as milkshakes which will pass through the opening. The long-term success rate of these procedures is estimated to be around70-80%. 4.9 How many pounds a week should I lose?- Although it's tempting (and motivating) to lose a lot of weight quickly, this really hurts you in the long run, since you'll be losing muscle mass long with the fat. A rough rule of thumb is that you should lose no more than 2 pounds per week, with 1/2 to 1 pound being better. A more precise rule is that you should lose no more than 1 percent of your current body weight per week, so if you weigh 250 lb. (113 kg.), you could safely lose 2.5 lb. (1.13 kg.) per week. Again, this is a maximum weekly rate; to be safer still, aim for .5 percent of your current weight. Study after study indicates that the slower you lose weight, the more likely you are to actually lose fat, rather than muscle tissue, and that the slower you lose weight, the more likely you are to keep that weight off permanently. 4.10 Why do men seem to lose weight faster/more easily than women?- Sorry, ladies, this is just one of life's inequities. Men tend to have more muscle tissue than women, and muscle tissue is what does the work that burns calories. Women also have a genetic tendency to retain fat more efficiently than men, since adequate stores of fat are vital during pregnancy. Women may take some comfort in the fact that men tend to accumulate their fat deposits around the belly, which puts them at higher risk of heart disease than women, who tend to put on fat below the waist (hips and thighs). 4.11 Some weeks into my diet, my weight loss just stopped, even though I followed the diet plan to the letter. What did I do wrong?- Not a thing! You've encountered a "plateau," a normal (and temporary) pause in weight loss. Your body has learned to adapt to your lowered caloric intake and has slowed down your metabolism in order to conserve energy. The solution to getting past a plateau is not to lower your caloric intake even further, but to continue with your current eating plan, and perhaps to increase your exercise somewhat. Reducing your food intake will only reinforce our body's perception that it is caught in a starvation situation. Plateaus seem to be more common in persons who have dieted repeatedly in the past; their bodies have learned all too well to hang onto the few calories that do come in. 4.12 Once I've lost the weight, how can I keep from regaining it?- Continue whatever you did to lose it. Phrasing it another way, don't do anything to lose it that you aren't willing to continue as long as you want to keep the weight off (e.g., forever). For the overwhelming majority of people, weight lost on fad or crash diets is regained within a matter of months or years, leading to yet another fad diet, weight loss, weight regain, etc. (a pattern commonly known as "yo-yo dieting"). There is anecdotal evidence that repeated weight loss/regain make it more difficult to lose weight each time--presumably because your body comes to believe that it is encountering famine situations and becomes more and more adept at hanging on to whatever calories are present--and that the stress of repeated dieting may have other adverse affects. A 1988 study of over 11,000 Harvard alumni found markedly higher death rates from cardiovascular disease among male alumni whose weights had changed significantly (up or down) between the early 60's and 1977. 5 LIQUID DIETS AND FASTS 5.1 Are liquid diets a good way to lose weight?- They're probably not the best answer for most people, since slurping down a high-protein, low-fat, minimal calorie, blenderized concoction doesn't do much to teach you the new, healthier eating habits that you'll need to maintain your weight loss. These diets can also be expensive--an average of US$2,000-3,000 for a medically-supervised six month plan--especially in light of the fact that the "food" you're paying for isn't much more than dried egg whites (an excellent source of protein) and flavoring. Although nearly all liquid diet programs include classes to help participants ease back into eating regular food and to maintain their weight loss, the ratio of clients who actually maintain their new weight for long periods is low. On the other hand, some obese people have found that the fast, steady weight loss and ease of such diets (there's no need to plan menus) can help them lose significant amounts of weight for the first time in their lives. Liquid diets can succeed, but only if those who use them are dtermined to adopt healthy eating habits once the diet is over. 5.2 Is fasting a good way to lose weight?- No. Prolonged fasts can cause serious harm by depleting the levels of protein, calcium, phosphorus, sodium, and potassium in your body. Fasting can also cause toxic levels of ketone bodies (compounds produced when body fats are broken down) to accumulate in the bloodstream, despite the popular belief that fasting is a good way to "cleanse the system." On the other hand, short (1-2 day), occasional (no more than once every few weeks) fasts do not appear to be harmful to most healthy people. [The previous sentence is intended as recognition of the fact that many people fast for religious or spiritual reasons; it is not intended to encourage fasting, however briefly, or weight loss purposes.--kbc] 6 WEIGHT LOSS ORGANIZATIONS, PLANS, AND DIET BOOKS NOTE: Mention of an organization, weight loss plan, or diet does not imply an endorsement of that organization, plan, or diet. 6.1 How does Weight Watchers work?- Weight Watchers is a commercial diet organization that offers a variety of eating plans and aids for weight loss. Members who follow the selection plan (an exchange-type plan) are allowed to consume a certain number of servings from each selection group (breads, fruits/vegetables, proteins/dairy, and fats) each day. For example, if you've chosen to eat five bread selections per day, you can choose five servings of any item categorized as a "bread," be it whole wheat bread, rice, a corn tortilla, or any of the other foods that fall into the bread group. The number of selections you consume per group per day depends on how fast you wish to lose weight; the program recommends a maximum loss of 2 pounds per week. The selection plan allows members to stray from the plan occasionally to accommodate special foods or events, and a "Weekends Off" option permits less regulated eating on weekends in exchange for smaller portions through the rest of the week. The Weight Watchers 123 Success Plan was started in the US on August 24th, 1997. It gives all of the foods you eat a certain amount of points. You eat the foods, add up the points and you are done for the day. Everybody is given a different point range depending on their starting weight. They do give you some nutritional guidelines, such as drinking 6, 8-oz glasses of water a day, eating 5 fruits and vegtables, and having 2 milk products a day. You are encouraged to do at least 20 minutes of exercise a day, and for every 20 minutes after that, you can "earn" another point for your daily total. You can carry unused points, (also known as "Banking your points") from one day to the next.. But only after-you have consumed your minimum points allocated for the day, in your point range are you allowed to bank these unused points. If you don't use them by the end of the week, you lose them. You are given a "sliding scale" that helps determine point values for all foods with a nutritional label depending on fat grams, fiber and calories. They have new cookbooks, a "points manager" calculator to help figure out points, and other products to help make the plan even easier. There has been a really positvie response to this plan because of the flexibility. Members are happy because they can eat what they want, within reason, and not worry as much about getting all of their fat, protein, and bread selections each day. They just need to make sure they don't go above their point allotment for the day. The old plan "Fat and Fiber" was added in December 1994. Under this plan, members are instructed to limit fat intake to between 15 and 35 grams daily (men and youths can go up to 45 g/day), eat between 20-60 grams of fiber daily, consume a minimum of 2 servings of dairy foods daily (3 servings for youths), eat at least 5 servings of fruits and vegetables daily, and limit intake of refined sugars and alcoholic beverages. WW markets several types of processed foods, which are not necessarily lower in calories than "regular" or other diet plan products, but are designed to fit easily into the WW program; use of the WW brand foods is completely optional. WW encourages moderate exercise in combination with the diet plan. Each member sets his or her own goal weight based on a height/weight chart compiled by WW from several sources. A big part of the WW plan is weekly meetings, which feature a "weigh in" for each member (your weight is revealed only to you and the person doing the weighing, not to the rest of the group) and various activities such as motivational videos, discussions, distribution of program materials and recipes, etc. Members who attain their goal weights become "lifetime members," and can attend meetings for free so long as they maintain their new weights. There is an initial membership fee (~US$15-20, but low-cost or free specials are frequent), plus a fee for each meeting attended (~US$9-12). The June 1993 isse of "Consumer Reports" reported that the average cost for several months' participation in WW is approximately US$110. Weight Watchers has a Web site at http://www.weight-watchers.com/. There is also a Weight Watchers mailing list, run by Michele Coleman (firstname.lastname@example.org or email@example.com), which is intended as a friendly place for people following the Weight Watchers plan to exchange support and suggestions. To subscribe to the list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe ww-support email@example.com" (without the quotes) on a line by itself in the body of the message. 6.2 How does Jenny Craig work?- The JC program combines a diet of frozen and shelf-stable pre-packaged foods with one-on-one counseling, independent homework (which includes instructional workbooks and video tapes, and motivational audio tapes) and group classes on behavior modification. Participants initially purchase most of their food, particularly entrees, from JC; these foods are supplemented with regular (grocery store) foods such as dairy products and fresh vegetables. As the diet progresses, the ratio of JC foods to regular foods is gradually lowered. There are different menu plans (regular, no red meat, vegetarian) available. The prepackaged foods are intended to teach participants about portion control while freeing them from the necessity of weighing, measuring, and preparing food. The behavior modification classes are supposed to teach participants how to make healthy food choices once they've been weaned off the JC foods. (A maintenance program is available for those who've reached the goal weights that they've chosen for themselves; goal weights should not fall below those on a standard height/weight chart.) Exercise is encouraged. There is an initial registration fee (one a.s.d member reported a US$19 sign-up fee); the cost of the JC food averages US$60-70 per week. 6.3 How does Nutri/System work?- N/S is very similar to the Jenny Craig plan in format and price--it provides prepackaged foods (shelf-stable only, no frozen foods), individual counseling sessions, and group classes. Nutri/System has a Web site at http://www.nutrisystem.com/. 6.4 How does Overeaters Anonymous work?- OA is a 12-step program, very similar to Alcoholics Anonymous, designed for people who consider themselves compulsive overeaters, who believe that they are powerless over food and that their lives are unmanageable. (Not all members are overweight; some suffer from other eating disorders such as bulimia.) Members are encouraged to turn their lives over to a "higher power" (be it a personal deity or the strength of the group), to form a relationship with a "sponsor" (another OA member who provides one-on-one support), to give up "problem foods" permanently (as an alcoholic gives up alcohol), and to attend OA meetings regularly (daily, weekly or monthly) for the rest of their lives. OA does not advocate any specific diet plan; members who are interested in better nutrition are urged to seek qualified professional advice. (Note: One a.s.d reader reports that some OA groups are offshoots of various eating disorder clinics, and that some such groups do advocate specific diets which may not conform with current standards of effectiveness and safety.) There are no dues or fees, although donations are welcome. As with AA, members' anonymity is preserved; first names only are used during meetings. 6.5 How does TOPS work?- TOPS ("Take Off Pounds Sensibly") is an international, non-profit weight loss support group. TOPS does not advocate any particular food plan, but rather encourages members to consult their physicians for individually tailored diets. The TOPS philosophy includes weekly meetings at which members are weighed in (amounts lost or gained are publicly announced, although members' actual weights are not announced), using food diaries to track your daily intake, awards of non-fattening gifts from other group members for the person who loses the most each week, small monetary penalties (e.g., US$0.05-0.50) for those who gain weight, etc. TOPS encourages lifetime membership to keep the pounds from creeping back on; their maintenance program is known as KOPS ("Keep Off Pounds Sensibly"). One a.s.d reader reports that TOPS membership fees are US$16/year for the first two years, US$14/year thereafter; there are also weekly fees (usually a few dollars, but this varies from chapter to chapter). TOPS' official Web site is at http://www.tops.org/. Rick Stonehouse, a TOPS member, also maintains an unofficial TOPS Web site at http://www3.ns.sympatico.ca/stoner/tops.html. 6.6 How does "Stop the Insanity" work?- "Stop the Insanity" is a program promoted by Susan Powter, a trim, assertive, crewcut blond who formerly weighed 260 pounds. According to her 30-minute infomercial, the program is based on the principles that: a) diets don't work, b) you can lose weight by eating high volumes of low-fat foods, and c) you must exercise to burn fat and adequately oxygenate all parts of your body. Ms. Powter shuns the concept of weighing, advocating instead measuring your body fat percentage (using calipers provided with the program materials) and tracking weight loss progress in terms of how many clothing sizes you lose. The program materials consist of audio tapes, booklets, and videotapes that discuss deciphering food labels, exercise techniques, and motivational tips. The current cost of the program is about US$80. 6.7 What is the Carbohydrates Addict's diet?- The premise of this diet is that there are people who, for biological reasons, develop unmanageable cravings for carbohydrates which can lead to weight gain. The authors believe that this results from an overproduction of insulin, impairing glucose metabolism, and an insufficient rise of brain serotonin, responsible for the feeling of satiety. The objective of the diet is to control insulin release by minimizing the carbohydrate consumption which triggers it. The basic daily diet consists of two carbohydrate-restricted meals, and one "reward" meal which must be consumed within 60 minutes, but at which you may eat absolutely anything. At the restricted meals, you eat standard portions of such foods as eggs, fish, meat, cheese, salads and most non-starchy vegetables. The general rule of thumb for restricted meals is that an allowable food contains no more than 4 grams of carbohydrate per standard serving. Some surprises among the foods not allowed at these meals include fruits, broccoli, milk and yogurt. No snacks are permitted. Depending on the foods you select, the diet can be compatible with the standard recommendations for healthy eating (low-fat, high-fiber, etc.). The authors recommend a weight loss of no more than two pounds per week. Guidelines suggest variants on the diet based on how much weight you have lost in the past week, and what your goals are for the following week. A short paper and pencil test helps you determine if you are a carbohydrate addict. There are currently three books in the Carbohydrate Addict series, all by Rachael and Richard Heller: The Carbohydrate Addict's Diet, The Carbohydrate Addict's Gram Counter, and The Carbohydrate Addict's Program for Success. The first (and most useful) contains the theory, the diet, lists of foods permitted and not permitted for the restricted meals, recipes, and a host of success stories. The second is a small handbook with an itemized list of foods, identifying those believed to trigger addictive behaviors in carbohydrate addicts, which expands somewhat on the original material. The third book is a workbook with more success stories and general dieting tips, but no obvious new news. 6.8 What is Dr. Atkins' diet?- The Atkins diet is something of a precursor to the Carbohydrate Addict's Diet in that it advocates unrestricted amounts of protein and fat, but restricted carbohydrate intake. The diet was developed by Robert C. Atkins, M.D.; he published a book about the diet in the 1970's, and has recently released a new book titled The New Diet Revolution. According to Dr. Atkins, many people react unfavorably to carbohydrates by overproducing insulin, which causes the body to retain excess fat. Therefore, carbohydrates are held to an absolute minimum (in contrast to CAD, which allows the consumption of reasonable amounts of carbohydrates, but only during one meal per day). The goal on the Atkins' diet is to get your body into a state of ketosis, a condition in which the body burns stored fat, rather than carbohydrates, for fuel. The presence or absence of ketosis can be determined by testing your urine with Ketostix, which are readily available at drugstores. Dr. Atkins has a Web site at http://www.atkinscenter.com/. There are multiple mailing lists and Web sites devoted to the discussion of CAD, Atkins, and other restricted carbohydrate diets; please see the Mailing Lists and World Wide Web sites sections. 6.9 What is the Zone diet?- The Zone diet is described by Barry Sears, Ph.D., in his book The Zone: A Dietary Road Map. It recommends balancing one's intake of protein, carbohydrates, and fat so that, along with every 7 grams of protein, 9 grams of carbohydrates and 3 grams of fat are eaten. Carbs contribute about 40% of total calories on the diet, while fats and proteins each contribute about 30% of the calories. (This varies from current dietary recommendations from the American Heart Association and similar groups, which recommend 30% of calories from fat, 55-65% calories from carbohydrates, and 10-15% of calories from protein.) Serious athletes are advised to ingest 4.5 grams of fat for each 7 grams of protein, resulting in a diet in which approximately 40% of calories are supplied by fat. Sears believes that the diet, which restricts calories, carbohydrates, and saturated fats, and limits protein to the amount required for the individual (which depends on the individual's lean body mass and activity level) prevents excess formation of insulin and leads to optimum mental and physical performance (i.e., "being in the Zone"). The goal of the diet is to switch the body's metabolism from a carbohydrate-burning mode to a fat-burning mode. There are a number of Internet-based resources on the Zone diet, including a variety of Web pages and a mailing list. Russell Swan's Zone page (http://www.cs.umass.edu/~swan/zone.html) provides a list of pointers to other pages. To subscribe the Zone diet mailing list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe zone" (without the quotes) on a line by itself in the body of the message. 6.10 What is the "TJ Soup diet" (a.k.a. "The Sacred Heart Hospital Diet" or "Cabbage Soup Diet")?- The "TJ Soup" diet (also known as the "Sacred Heart Hospital Diet" or "Cabbage Soup Diet") purports to take off 10-17 pounds within one week through the use of a "miracle" vegetable soup, along with a strict rotating diet of fruits and vegetables, meat, and brown rice. The soup may be eaten as often as desired. Alcohol, carbonated drinks (including those made with artificial sweeteners), and fried foods are not allowed. Although the diet is adequate in vegetables (from the soup) and features fruit on several days, it is not well balanced. Day 5, for example, calls for 10-20 ounces of beef or skinless chicken, 6 tomatoes, and the soup. Aside from brown rice on the 7th day, no grains are permitted. Dairy products, which many women use to increase their calcium intake, are not allowed except on day 4, when you're supposed to consume 8 glasses of skim milk (along with 6 bananas and the soup). While you probably can lose weight on this diet, you should keep in mind that: 1) the first several pounds lost on any dit are usually water weight, not fat, and 2) almost any diet which forbids you to eat your usual foods will cause at least temporary weight loss. Although this diet has been repeatedly linked with one hospital or another (allegedly recommended for heart patients awaiting surgery), it is highly unlikely that any reputable medical practitioner or organization would recommend such a diet. (Check out the American Heart Association's position on this and other fad diets at http://www.amhrt.org/pubs/phoney.html.) The full text of the diet is available via WWW at http://kxan.com/special.html for the insatiably curious. 7 DIET AIDS (PILLS, ETC.) 7.1 I've heard about several weight loss aids like herbal teas, "fat-burning" pills, etc. Do any of these work?- Some of the non-prescription drugs can temporarily cause your weight to drop, but not because they're eliminating excess fat from your body. Most over-the-counter "diet aids" contain stimulants, which hike up your central nervous system and decrease your appetite, and/or mild diuretics which cause you to eliminate fluids (by urination) more quickly than normal. The stimulants can cause unpleasant side effects such as dizziness and nausea, and the diuretics can make it difficult for you to get too far away from a bathroom. And as soon as you go off the pills, your weight bounces right back up to its previous level, making such nostrums useless for long-term weight loss. 7.2 What about prescription drugs (phentermine, fenfluramine)?- On September 15, 1997 the perscription weight loss aids redux and fenfluramine were recalled by their manufactureers afte the FDA reccomendeed a that anyone who is taking them stop and consult with their doctors. Phentermine, is not affected by the withdrawal, but patients could no longer use the combination. The FDA asked manufacturers to withdraw the drugs after reviewing the records of 291 patients and found 30 percent had abnormal echocardiograms -- a test that shows doctors how the heart is functioning -- even though they had no symptoms yet. Some 92 patients had problems with their aortic or mitral heartvalves, the data showed. The FDA said the numbers were much higher than it had expected, prompting the agency to recommend stopping salesof the drugs. The withdrawal comes after doctors at the Mayo Clinic announced inJuly they had discovered 24 cases of a rare heart valve defect inwomen who took fen-phen. The FDA later announced that it had received 66 additional reports ofthis dangerous valve disorder, including some that were also seen inpatients taking Redux. These prescription weight loss aids had show somewhat more promise than the non-prescription nostrums. Fenfluramine (marketed as "Pondimin") suppresses appetite by acting on the brain chemical serotonin. Phentermine (marketed as "Ionamin") is an amphetamine-type stimulant and appetite depressant. The two drugs are often used in combination with each other in order to provide more effective weight control while minimizing side effects; a study on the combined effects of the drugs is available at http://www.weight.com/nongifphenfen.html. The newest addition to the pharmacological weight-loss arsenal is Redux (dexfenfluramine), which is essentially the active portion of fenfluramine and is used in smaller doses than fenfluramine. Studies indicate that these drugs do cause weight loss in many people, but they can also cause side effects: nervousness, dry mouth, rapid or irregular heartbeat, etc., in the case of phentermine, while fenfluramine and dexfenfluramine can cause dry mouth, sleep disturbances, diarrhea, depression, etc., and have been associated with a few cases of a serious condition known as pulmonary hypertension. Participants in studies of these drugs gradually regained the weight they'd lost when they stopped taking the medication. Additional information on prescription drugs used in weight control and the recall of redux and phenfluramine can be found at http://pharminfo.com/pubs/msb/obesity.html and http://pharminfo.com/pubs/msb/seroton.html. Barbara Hirsch (email@example.com) maintains a very comprehensive list of medication-related links on her Phen/Fen Web site at http://www.vais.net/~bhirsch/phenfen.htm. There is also a newsgroup, alt.support.diet.rx, which is devoted to the discussion of medications used in weight control. 7.3 Do I need to take a supplement (vitamin/mineral pill) while dieting?- A balanced diet (see "Food Pyramid") which is low in fats, sugars, and alcohol and is adequate in calories (no fewer than 1,200 cal/day for women, 1,400 cal/day for adolescent girls, 1,600 cal/day for men) may contain sufficient vitamins and minerals to meet the FDA's recommended Daily Value. However, not many of us meet those requirements every day, and some physicians and researchers feel that the FDA's recommendations regarding many vitamins and minerals are too low to promote optimal health. (The recommended Daily Values are intended to prevent deficiency-related diseases such as scurvy and pellagra; they do not necessarily reflect the amount of a vitamin or mineral needed to sustain an adequate reserve against illness or injury.) If you do decide to take a vitamin/mineral supplement as insurance against an inadequate diet, you should look for a brand which contains a variety of vitamins and minerals, and keep in mind that excesses (amounts greater than 100% of the FDA's recommended Daily Value) of certain vitamins and minerals, in particular Vitamin A and iron, can be toxic. - 7.4 What is chromium? Can taking a chromium supplement help me lose or maintain weight?- Chromium is a nutrient which plays a factor in maintaining blood glucose (sugar) levels. Chromium occurs naturally in the diet, and is found in foods such as brewer's yeast, whole grains, liver, and shellfish. Individuals whose diets consist mainly of processed foods may not have an adequate intake of chromium; symptoms of chromium deficiency include weight loss and impairment in the body's ability to maintain blood sugar levels. Although there is no recommended daily allowance for chromium, a daily intake of between 50 and 200 micrograms (µg) is recommended by many physicians and nutrition experts. Chromium is available in several forms, including inorganic chromium, high-chromium yeast, chromium picolinate, and chromium polynicotinate. Of these, chromium polynicotinate seems to be the best absorbed. While chromium does seem to be of benefit in regulating blood sugar in diabetics, its role in weight loss or maintenance for non-diabetics is not yet clear. Some individuals who have made a conscious effort to raise their chromium levels through diet changes or dietary supplements have reported that chromium does seem to lessen their cravings for sweets, but I am unaware of any formal studies that support this. Additional information on chromium picolinate is available via WWW at http://www.lifelines.com/libry1a.html. 8 EXERCISE 8.1 I need to lose weight, but I really hate to exercise. Can I lose weight by eating a low-calorie diet without exercising?- It's possible; many dieters (especially women) avoid exercise at first and rely on low-calorie diets for weight loss. However, these same dieters often find that exercise can be the key to restarting weight loss that has suddenly stopped (see the section on plateaus), and most people who successfully maintain their new weights find that exercise is a necessary component of a maintenance plan. Another benefit of exercise (especially anaerobic exercises such as weight lifting--see section on "What is anaerobic exercise?") is that it can increase the amount of muscle tissue in your body--the more muscle you have, the more calories you burn. 8.2 What are the most effective types of exercise for losing fat/weight?- Those that cause your heart rate to increase to 65-80% of the suggested maximum heart rate for your age group (which can be determined by subtracting your age from 220), and which will keep your pulse at that rate for at least 15-20 minutes continuously (i.e., "aerobic", or "oxygen-using" exercises). Depending on your current fitness level and how hard you work, many exercises, sports, or tasks can be aerobic in nature. You don't necessarily have to jog or go bicycling; you can count walking, dancing, or vigorous housework (e.g., vacuuming) as exercise so long as it causes your heart rate to stay in that 65-80% range continuously for 15-20 minutes. Note: While swimming qualifies as an aerobic exercise and does appear to provide all the cardiovascular benefits of other aerobic exercises, it appears to be less effective for weight loss than other exercises. Swimmers tend to have higher fat levels than other athletes; this may be because fat provides buoyancy and insulation against cool water temperatures. 8.3 How hard do I need to exercise?- Hard enough to get your heart beating fast, but not hard enough to exhaust you; this is the pace at which your muscles burn fat most efficiently. Exercising harder than this causes carbohydrates (sugars) to be burned, not fat. (For a detailed, easy-to-read discussion on this subject, check out The New Fit or Fat, by Covert Bailey.) There are several ways to tell whether you're exercising at the proper intensity: * Heart rate: Determine your maximum safe heart rate by subtracting your age from 220, then exercise hard enough to bring your heart rate to 65-80% of your maximum. For example, if you're thirty years old, your maximum heart rate is 190, and you should aim for a heart rate of 123 to 152 while exercising. If you're not in great shape (just starting to exercise, recovering from a minor illness, etc.), you should aim for the lower end of your range. Taking your pulse during exercise can be tricky, since you'll usually need to stop jogging, dancing, or whatever, to accurately feel your pulse (at your wrist or at your carotid artery, which is located at the side of your neck just under the jaw). Stopping for too long, however, can cause your pulse to drop down out of your target range. Measure your pulse briefly (Covert Bailey recommends 6 seconds, other authorities recommend 10 or 5 seconds), then multiply that figure by the correct amount (10, 6 or 4) to determine your average pulse per minute. (* If your normal, resting heart rate isn't somewhere around 70-80 beats per minute, the "maximum safe heart rate" formula above may not be an accurate indicator of exertion for you; use the "talk test," explained below, instead.) * Talk test": This method doesn't require that you stop exercising, but it can earn you some odd looks out on the jogging track. :) Try speaking out loud as you exercise--if you have enough breath to speak easily, without gasping, but not enough to sing, then you're doing ust fine. *Getting warm or working up a sweat: the least precise of these methods. If you exercise in warm conditions, you should exercise hard enough to work up a light sweat. In cold conditions, it's sufficient to work hard enough to make yourself warm. Keep in mind that as your fitness improves, you will have to work harder to get your heart rate up, so keep checking your pulse (or using the talk test) even if you've been exercising for some months. 8.4 What is anaerobic exercise?- Anaerobic exercise is activity which promotes the growth of muscle tissue, as opposed to burning fat tissue, which is the point of aerobic exercise. Anaerobic exercise involves pushing your muscles to the limits in order to encourage them to grow to meet the demands that you put on them. Unlike aerobic exercise, anaerobic exercise is short and intense. Weight lifting, sit-ups, push-ups, chin-ups, and squats are all examples of anaerobic exercises. Anaerobic exercise does not cause weight loss; in fact, those who exercise anaerobically on a regular basis may find themselves actually gaining some weight due to the increase in muscle mass (even though their bodies are becoming leaner and trimmer, since muscle is denser than fat). However, anaerobic exercise is an important part in overall fitness precisely because of that increase in muscle. Your muscles, after all, are what do the work that burn calories, and the more muscle you have, the more calories you burn. 8.5 How often and how long do I need to exercise?- In short, you should exercise aerobically as often as you can. 6 or 7 times a week is not excessive, although if you work out this frequently, you might wish to alternate exercises from day to day (e.g., walk or jog one day, bike the next) to avoid stressing the same sets of muscles repeatedly. Most authorities recommend a minimum of 20 minutes of aerobic exercise per session, and at least 3 sessions per week. Ideally, you should also include 2 or 3 sessions of anaerobic exercise per week to increase strength and build muscle mass. (You should always allow 2 to 3 days between anaerobic workout sessions to permit your muscles to recover and to prevent injury.) 8.6 How many calories do different types of exercise burn?- For those who like tables, here's a table from The Family Fitness Handbook by Bob Glover and Jack Shepherd, p. 185. These numbers are probably geared towards those who are just starting to exercise; people who are already fit may burn calories at much higher rates than those listed here. Exercise ~Calories Burned/Minute Cross-country skiing 10-15 Running 10-12 Handball/Squash/Racquetball (singles) 8-11 Handball/Squash/Racquetball (doubles) 6- 8 Canoeing/Rowing 7-11 Swimming (crawl stroke) 8-10 Biking 5-10 Jumping rope 7-10 Tennis (singles) 7-10 Tennis (doubles) 5- 7 Ice and roller-skating 5-10 Walking 5- 7 Dancing (rock/disco) 4- 6 Dancing (square, western, polka) 5- 8 Dancing (aerobic class) 5- 8 If you're into numbers, this may look discouraging. Seen from a "input equals output" standpoint, it appears that you'd need to run for nearly an hour to burn off a 560-calorie Big Mac. The wonderful thing about exercise, Athough, is that it raises your metabolic rate, even after you stop exercising. The effects of exercise linger for some time after you stop moving, and in time, regular exercise will cause your body to burn fat far more efficiently than it did when you were inactive. 8.7 Does "passive exercise" (e.g., toning tables) work?- Toning tables may help relax tense muscles, but they certainly don't work your muscles, which is what you must do to burn calories. Other gimmicks such as jiggling belts, rollers that "knead" fatty areas, electrical muscle stimulators, body wraps or suits, and the like, do not promote calorie burning. Some of these devices (like body wraps or sweatsuits) do cause fluid loss (sweating) which results in lower weight and body measurements, but these losses are fleeting. A couple of glasses of water, and you're right back where you started. 8.8 I move around a lot during the day; I try to use stairs instead of elevators, park my car on the far side of the parking lot, etc. Would I qualify as a "moderately active" person?- Not unless you really do move around a lot. According to physicians and dietitians, a moderately active person is one who exercises at least 30 to 60 minutes per day, whether all at once or spread out through the day. Every little bit of exercise that you get helps, but most of us do need to include a regular exercise program in our daily routines to meet that 30-60 minute requirement. 9 MOTIVATION 9.1 I’ve started a diet and exercise program, but I'm finding it really hard to stay on track. Any suggestions?- Eating tips: * Make sure that the eating plan you're following--whether it's a commercial plan like Weight Watchers or one you devised yourself--suits your needs and cravings. Do you need the control of weighing and measuring every bite that you eat, or do you need the freedom of eating whatever quantities of low-fat, nutritious foods that satisfy your hunger? Do you feel most in control if you eat 3 meals a day, or if you "graze" on 5 or 6 small meals throughout the day? Do you need to ease into a new eating plan gradually, adapting to new low-fat, high-fiber foods week by week, or would you be more motivated by going "cold turkey" on junk foods? Do what works for you, which may not be at all the same thing that worked for your best friend, husband, etc. * Don't beat yourself up if you "fall off the wagon" and indulge (or even overindulge) in something you think you shouldn't have eaten. An episode of uncontrolled eating does not mean that you or your diet failed, just as a minor fender-bender doesn't mean that you or your car are totally unworthy of ever appearing in traffic again. ¨ When it comes to improving your health, doing something, no matter how small, is always better than doing nothing. You may not be willing or able to adopt all of our suggestions regarding nutrition and exercise, but everybody can work some of these changes into their lives. Try switching from whole milk, regular mayonnaise and salad dressings to their nonfat counterparts. If you just can't live without meat, eat meat, but eat leaner cuts and smaller portions. If you can't exercise every day, at least take the stairs or walk around the block every once in a while. The more you can do the better, but even the smallest changes can improve your long-term health and your self-image. Exercise tips: * Don't overdo it; start out gradually. The point is not to exhaust yourself. * Try a variety of different exercises: walking, biking (outdoors or stationary bike), skating/rollerblading, dancing (in a class, to a tape, or put on some peppy music and make up your own steps), trampolining, hiking, etc. Even if you don't find an activity you like, maybe you'll find one you can tolerate. * Try listening to music, books on tape, or motivational tapes while exercising; maybe you can distract yourself. (Be extremely cautious and alert when using personal stereos with headphones outdoors, since these devices may leave you unable to hear approaching cars, bicycles, etc.) * Consider the possibility of "double-density" exercises: combining exercise with other activities that you do enjoy, such as reading or watching TV while riding a stationary bicycle, or using walks to catch up on quality time with your significant other or your kids. * Every little bit of exercise helps, so work in some extra motion whenever you can. Take the stairs instead of the elevator, park well away from buildings (if it's safe to do so), etc. Healthy people are active people; overweight people are good at finding ways to conserve their energy. * Try biking to work, school, etc. People commute up to 30 miles each way. This can be done in all weather that's passable by our-wheel-drive cars, day or night, and it's no less safe than in a car. Your exercise time is largely time you would have spent commuting anyway, and you save tons of money. [I strongly recommend John and comfortably.--kfl] * If your destination is 5 miles away or less, consider walking or jogging. * Stick with your exercise plan until it becomes a habit, one that you’ll enjoy brushing their teeth, but just as few would want to skip doing so for three or four days. 10 INFORMATION AVAILABLE VIA THE INTERNET 10.1 Newsgroups- The following newsgroups discuss nutrition, fitness, overweight, etc., and may be of interest to those who read a.s.d.: *alt.food.fat-free: very low-fat (7-15% of calories from fat) food and cooking, ŕ la McDougall/Ornish/Pritikin/Mirkin * alt.food.low-fat: low-fat (less than 30% calories from fat) eating * alt.support.big-folks: fat-acceptance with no dieting talk * alt.support.eating-disord: eating disorders (anorexia, bulimia, etc.) * alt.support.diet.rx: discussion of medications used in weight control (such as phentermine and fenfluramine) *¨ alt.support.obesity (moderated): weight loss support/resources for persons 100 lb. or more overweight. (Note: This group is currently in hiatus, but the moderator is hoping to implement a robomoderation program soon and to have the group active again by June. In the meantime, all relevant posts are being directed to the Club-100 mailing list [see below].) * misc.fitness.misc: physical fitness, exercise, body-building, etc. * misc.health.diabetes: diabetes and hypoglycemia *¨ rec.* and rec.sport.*: various newsgroups on specific sports, e.g., rec.running, rec.sport.rowing, etc. * rec.food.veg, rec.food.veg.cooking: vegetarianism and vegetarian cooking * sci.med.nutrition: nutrition and diet * soc.support.fat-acceptance: similar to alt.support.big-folks, but a little more focused 10.2 Mailing lists- NOTE: If you would like your mialing list included please e-mail firstname.lastname@example.org *CADERS: The purpose of the Carbohydrate Addict's Encouragement, Resource and Support list is to disseminate knowledge pertaining to the Carbohydrate Addict's Diet by Drs. Richard and Rachael Heller. The list also welcomes discussions on the sociological, psychological, and physiological aspects of being overweight, as well as weight loss strategies and methodologies. The list is endorsed by the Hellers. To subscribe to the list, send an e-mail message to email@example.com, and put the command "subscribe caders" (without the quotes) on a line by itself in the body of the message. * CLUB-100: Mark Mitcham's mailing list for persons 100 lb. (45 kg.) or more overweight. alt.support.obesity grew out of this list, and messages from the newsgroup are echoed to the list.) For info on Club-100 (e.g., the charter, etc.), send an e-mail message to firstname.lastname@example.org and put the command "Info Club-100_Mail_List-L" (without the quotes) in the body of the message. To subscribe to the list, send an e-mail message to email@example.com, and put the command "Subscribe Club-100_Mail_List-L Firstname Lastname" (without the quotes) on a line by itself in the body of the message, where "Firstname Lastname" is replaced with your name. (If you wish to remain anonymous, you may use a pseudonym.) * FATFREE: Michelle Dick's mailing list for the discussion of extremely low-fat vegetarian eating. To subscribe, send e-mail to FATFREE-REQUEST@FATFREE.COM, and put the command "info" (without the quotes) in the subject line of the message. * FATLOSS: Scott Compton's Fatloss Support mailing list, which provides one-on-one information and support to those who wish to lose excess body fat. To subscribe to the list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe fatloss_support" (without the quotes) on a line by itself in the body of the message. * LOWCARB: Dean Esmay (email@example.com) runs a mailing list dedicated to the subject of low-carb dieting. Its emphasis is on diets like those of Michael & Mary Eades and Robert C. Atkins, with a lesser emphasis on related diets such as the Stillman diet, the Carbohydrate Addict's Diet, and even The Zone. The goal is not to provide support but rather to encourage discussion among those already familiar with low carbohydrate dieting. To subscribe to the list, send an e-mail message to firstname.lastname@example.org and put the command "subscribe lowcarb Firstname Lastname" (without the quotes) on a line by itself in the body of the message, where "Firstname Lastname" is replaced with your name. * PHENFEN: This list is devoted to the discussion of prescription weight loss drugs, including phentermine (a.k.a. "Ionamin"), fenfluramine (a.k.a. "Pondimin"), and dexfenfluramine (a.k.a. Redux"). To subscribe to the list, send an e-mail message to email@example.com, and put the command "subscribe phenfen" (without the quotes) on a line by itself in the body of the message. * WEIGHT WATCHERS: Michele Coleman (firstname.lastname@example.org or email@example.com) runs a Weight Watchers mailing list which is intended as a friendly place for people following the Weight Watchers plan to exchange support and suggestions. To subscribe to the list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe ww-support email@example.com" (without the quotes) on a line by itself in the body of the message. *ZONE DIET: To subscribe the Zone diet mailing list, send an e-mail message to firstname.lastname@example.org, and put the command "subscribe zone" (without the quotes) on a line by itself in the body of the message. 10.3 World Wide Web sites- NOTE: Some sites listed here are run by commercial organizations; inclusion of a site does not constitute an endorsement or recommendation of their product(s). If you would like your web site listed, please e-mail email@example.com *alt.support.obesity FAQ at http://www.unm.edu/~markm/aso/ *alt.food.fat-free FAQ at http://www.fatfree.com/FAQ/alt-food-fat-free-faq *The American Heart Association's Web page on fad diets (such as the cabbage soup diet and the hot dog diet) at ttp://www.amhrt.org/pubs/phoney.html *Ask the Dietitian" at http://www.dietitian.com/ (was at Hopkins Technology's Web site at http://www.hoptechno.com/) *Claudia’s Cooking Newsletter with low-fat and sugar free recipes and cooking tips as well as dieting info, newsletter available by subscription. http://www.freeyellow.com/members/cookingnewsletter *Dr. Atkins' Web site at http://www.atkinscenter.com/ *The Center for Science in the Public Interest (the group that publicized the high levels of fat in Italian, Chinese, and Mexican restaurant foods and in movie theater popcorn) at http://www.cspinet.org/ *Chromium picolinate info at http://www.lifelines.com/libry1a.html *Fatfree Web site at http://www.fatfree.com/ *Good Health Web (misc. health news, searchable health-related articles, etc.) at http://www.social.com/health/index.html *The Hacker's Diet (written by John Walker, a software engineer who lost--and kept off--a large amount of weight using common sense techniques; features Microsoft Excel worksheets to help you track your progress) at http://www.fourmilab.ch/hackdiet/www/hackdiet.html *The Hardin Meta Directory of Internet Health Sources at http://www.arcade.uiowa.edu/hardin-www/md-nutr.html *Barbara Hirsch's Phen/Fen Web site at http://www.vais.net/~bhirsch/phenfen.htm *Dr. Ben Krentzman's Web site on "The Science of Obesity and Weight Control" at http://www.loop.com/~bkrentzman/ *Medical Science Bulletin on obesity (includes info on phentermine) at http://pharminfo.com/pubs/msb/obesity.html *Medical Sciences Bulletin on serotonin and eating disorders (includes info on fenfluramine) at http://pharminfo.com/pubs/msb/seroton.html *ourish Net (features weight loss, nutrition, and exercise tips) at http://rogue.northwest.com/~sbly19/ *Nutri/System's Web site at http://www.nutrisystem.com/ *NutriGenie's (nutrition software publisher) Web sites at http://users.aol.com/nutrisoft/ and http://pages.prodigy.com/CA/nutrigenie/ *The Nutritional Analysis Tool, an online program presented by the College of Agriculture, Consumer, and Environmental Sciences at the University of Illinois for analyzing calories, fat, carbohydrates, fiber, and vitamin/mineral content of any food in the USDA Handbook #8, at http://www.ag.uiuc.edu/~food-lab/nat/ (it works best with browsers capable of displaying tables) *Lee Rodgers' low-carb Web page at http://www.lowcarb.org/ *Stanford University School of Medicine's "Understanding Obesity and Weight Loss" Web site at http://www-med.stanford.edu/MedSchool/DGIM/Teaching/Modules/obesity.html *Study on phentermine and fenfluramine used in combination: http://www.weight.com/nongifphenfen.html *TOPS (Take Off Pounds Sensibly) official Web site at http://www.tops.org/ *Another (unofficial) TOPS site at http://www3.ns.sympatico.ca/ns/stoner/tops.html *Weight Watchers official Web site at http://www.weight-watchers.com/ 11 BIBLIOGRAPHY AND RECOMMENDED READING LIST *Abraham, Suzanne and Llewellyn-Jones, Derek, Eating Disorders: The Facts, Oxford University Press, New York, 1984 (ISBN 019261665X) *iley, Covert, The New Fit or Fat, Houghton Mifflin Company, Boston, 1991 (ISBN 0395585643) *Bailey, Covert, Fit or Fat Target Diet, Houghton Mifflin Company, Boston, 1984 (ISBN 395510821) *Colvin, Robert H. and Olson, Susan C., Keeping It Off: Winning at Weight Loss, Simon and Schuster, New York, 1985 (ISBN 0671532944) *Forester, John, Effective Cycling, 6th edition, MIT Press, 1993 (ISBN 0262560704) *Foreyt, John P. and Goodrick, G. Ken, Living Without Dieting, Warner Books, 1994 (ISBN 0446382698), available from Gurze Books (phone# 800-756-7533) for US$10.99 + shipping/handling. The authors, who are Ph.D.'s associated with the Baylor College of Medicine and its Nutrition Research Clinic, discourage restrictive dieting and encourage slow weight loss through lifetime modifications in diet, exercise, and attitude. *Gershoff, Stanley W., Tufts University Guide to Total Nutrition, Harper & Row, New York, 1990 ISBN 0060159189) *Glover, Bob and Shepherd, Jack, Family Fitness Handbook, Penguin Books, 1989 (ISBN 140468633) ¨*Hller, Rachael and Richard: The Carbohydrate Addict's Diet, The Carbohydrate Addict's Gram Counter, and The Carbohydrate Addict's Program for Success Jonas, Steven and Aronson, Virginia, I-Don't-Eat (But-I-Can't-Lose) Weight Loss Program, Rawson Associates (Macmillian Publishing Company), New York, 1989 (ISBN 0892563435) *Lapert, Leslie, "Fat Like Me," Ladies' Home Journal, May 1993, pp. 154-155, 214-215 *"Losing Weight: What Works, What Doesn't," Consumer Reports, June 1993, pp. 347-352 ¨ Morgan, Elizabeth, Complete Book of Cosmetic Surgery, Warner Books, New York, 1988 (ISBN 0446513709) *Moynahan, Paula A., M.D., Cosmetic Surgery for Women, Crown Publishers, New York, 1988 (ISBN 0517564297) * Netzer, Corrine T., Complete Book of Food Counts, Dell Publishing, New York, 1991 (ISBN 0440208548) * Nutrition Action Healthletter, published by the Center for Science in the Public Interest. 1-year subscription (10 issues) available for US$24 from CSPI, P.O. Box 96611, Washington, DC 20077-7216. This is the group that publicized the high levels of fat in Italian, Chinese, and Mexican restaurant foods, and in movie theater popcorn. Each newsletter is packed with the latest findings in nutrition research, reviews of (and recipes from) health-conscious cookbooks, and recommendations on the best and worst fast foods/prepared foods. * "Rating the Diets," Consumer Reports, June 1993, pp. 353-357. * Robertson, Laurel; Flinders, Carol and Godfrey, Bronwen, Laurel's Kitchen, Bantam Books, New York, 1976 (ISBN 0553225650) * Roth, Geneen, Feeding The Hungry Heart: The Experience of Compulsive Eating, Signet, NY, 1982 (ISBN 0451161319). In this book, Ms. Roth points out the reasons that people overeat, and the metaphor that eating is feeding a different sort of hunger: Love. Included are passages written by students in Ms. Roth's class, which teaches people to love themselves and thus break free from the destructive cycle of overeating. * Roth, Geneen, Breaking Free from Compulsive Eating, Signet, NY, 1984 (ISBN 0451168348). As a followup to her previous book, Ms. Roth details her personal program for successful weight loss from an emotional standpoint. Although this selection does not discuss healthful eating, it is an excellent supplement to a nutrition book, because it examines the emotional issues involved in undertaking any weight loss program. * Roth, Geneen, When Food Is Love: Exploring The Relationship Between Eating And Intimacy, Dutton, NY, 1991 (ISBN 0525249672). Ms. Roth completes her theme in this last book by discussing the concept of replacing love with food. She points out that people often use food as a means of avoiding intimacy, and explores ways to heal "the hurting child." ¨*Scanlon, Deralee and Strauss, Larry, Diets That Work (updated edition), Lowell House, Los Angeles, 1992 (ISBN 0929923715) ¨*Silverstein, Alvin and Virginia, So You Think You're Fat?, Harper-Collins Publishers, New York, 1991 (ISBN 0060216417) *Stare, Fredrick J., Aronson, Virginia and Barrett, Stephen, Your Guide to Good Nutrition, Prometheus Books, Buffalo, New York, 1991 (ISBN 0879756926) *Claudia’s Cooking Newsletter, published 10 x a year by GMO Enterprises, P.O. Box 1811 Bensalem, PA 19020. Availabele in e-mail and paper forums. Cost si $20.00 per year. Contains nutritonal info, Ask the Dietican, and Ask the Cook columns as well as low-fat, fat-free and sugar free recipes. Info at http://www.freeyellow.com/members/cookingnewsletter