Being Well 302: Weight loss & healthy eating for a lifetime


Uploaded by weiutv on 24.10.2012

Transcript:
Just ahead on Being Well, Registered Dietician Kristina Adams from Sarah Bush Lincoln Health
System will be here to talk about weight loss, food and eating strategies that can help you
maintain a healthy weight and relationship with food for a lifetime.
[music] >> Lori Casey:
Well Kristina, thank you so much for coming on Being Well, and we are going to talk about
a subject many of us deal with: losing weight, keeping it off, thinking about how to make
food just a part of our life and not our life.
We have all, either personally or we know people, who have lost weight and then gained
it back.
Why do you think people fail at keeping it off for the rest of their life?
>> Kristina Adams: After having done this for over 12 years now,
it seems to be that we tend to pick a diet that's not going to work long-term.
I think the word diet also has its own little idiosyncrasies to it.
But I think it has to be more of a lifestyle focus, and make sure that you are looking
at something that is realistic for you that you can follow long-term.
Not just for the here and now, to get me to the class reunion that is coming up, but something
you can live with.
>> Lori Casey: So why, in theory and as we talk about it,
lifestyle, that just seems such an easy concept but it's really hard.
Why are we so centered on food?
>> Kristina Adams: Well I think that's why.
I think [unclear dialogue] lifestyle thinks, "Oh my gosh, that's forever and always."
So it's such a long-term thought and sometimes we can't think that far ahead.
If you think about all the planning we put into going on vacation, that's actually how
we should approach how we eat and how we live our lives, that we are putting in that much
detail and that much effort into making healthy food choices, being physically active, stopping
smoking, all those things that go into being healthy.
>> Lori Casey: Do you think sometimes people say, "I'm going
to make a lifestyle change, and I'm going to start exercising and lose weight and quite
smoking, and not drink pop."
Is it a problem when you try and change everything all at once?
>> Kristina Adams: It can be because it's overwhelming, so sometimes
you get flustered if one thing flubs up then you think, "Oh, I can't do this," and you
throw the towel in.
But I think it's good to have those goals, but they are very global, so I think you need
to narrow it down to, "Ok, well I'm going to start exercising."
Well, what does that mean?
How much?
What kind of exercise?
What time of day?
What's going to work for you?
You know, is it taking a walk during your lunch break?
Great, that's fine.
It doesn't have to be, you know, train for a marathon type of activity.
Same thing for eating healthy, you know?
Maybe you eat out every day of the week, maybe back that off to three days a week you will
eat out and you will take your lunch two days a week to work.
You know, just try to ease in to it and make little changes as you go, but you always have
to constantly be evaluating.
>> Lori Casey: So what are some of the things that you tell,
you are a dietitian and this is your field, what are some things that you say, "Let's
make some lifestyle changes.”
You mentioned a few of them; not going out to lunch every day, maybe going to lunch three
times a week.
Give us some other practical things that we can think of.
>> Kristina Adams: Probably the best place to start is record
keeping, it's very easy to do, you can just start right now.
Write down everything you are eating for the day, and if and when you exercise, and how
long, put as much detail into it as you can.
Use that as kind of your skeleton, per say, if you want to, as what to pick and choose
from as needing to work on.
So you can really identify are you snacking all day long, and what are you snacking on?
So that might be some places to make some changes.
So if you are constantly running to the vending machine, if you are constantly running for
fast food, then that is kind of a red light that, ok I need to start back tracking and
thinking 'ok, I need to grocery shop smarter, I need to pack lunches.'
If you're like me I need to remind myself to get my lunch out of the refrigerator and
take it with me to work.
I don't know how many times I have left it in the refrigerator.
And just kind of take it a step at a time, but record keeping is always going to tell
you the good, the bad, and the ugly.
>> Lori Casey: It's right there on paper or technology--if
you have a smart phone, there are so many applications that are free that can track
your food.
>> Kristina Adams: Oh my gosh, those have just exploded in the
last year.
Some of my patients really love them, because we start with paper record keeping and some
of my patients were coming to me with these new ways they would do it on an excel spreadsheet
and all this stuff, and all of a sudden the apps came out, and it has really made a difference
to a lot of people, especially those that really didn't like the pencil-paper route.
They were more analytical, they wanted more of the techie part of it, and whatever works,
whatever works for you is fine.
We have a specific record book sometimes we tell patients to pick up, but I am like, "Whatever
works for you."
I need to have lines.
Some of the record books are just blank pages; I need to have like lines to write on.
So just making it whatever is easy for you.
>> Lori Casey: So let's talk about how much weight does someone
need to lose?
Do you always go by you need to lose x amount of pounds?
Or is it better to look at as a percentage of body fat or reducing your body mass index.
>> Kristina Adams: That is a great question because a lot of
times we have in our mind what is going to be good for me, or you see on a chart this
is what I should weigh kind of thing.
But I always pose to the patient, what is a weight you have felt comfortable at that
you have been at before that would be a good target.
Because let's pinpoint what is individual to everyone that will work.
And then also looking at what is realistic as far as activity level, what your age was
when you were that weight and what you are now, your lifestyle, maybe you have a few
kids and your job has changed, there are a lot of factors that go into it.
But there is an easy math rule of thumb; for women we take our weight times ten, for men,
take your weight times eleven, and that will give you a rough idea of how many calories
you are actually consuming to keep yourself at the weight you are at.
So that being said, easy math, if you are a woman and you weigh 200 pounds, 2000 calories.
So if you want to be 150 pounds, you want to be down to 1500 calories a day, so you're
cutting out 500 calories--so that is daily.
Sounds like a lot, but it could be a bagel and a can of pop.
It could be two food items you cut out per day.
But most of us would like to see a balance, you don't want to have to cut things out,
so maybe add in a little exercise, cut out a little food.
>> Lori Casey: Because there is a math you have to expend,
whether through exercise or not eating this or that, 3500 calories is what gets rid of
every pound.
>> Kristina Adams: Right, which as I found...
>> Lori Casey: Oh, she brought a pound of fat.
Look at that.
That's just one pound.
>> Kristina Adams: And you have to keep in mind sometimes we
think, "Oh, I'm going to lose that right here," but it's over all.
So when you lose a pound you may not notice it, you may show on a scale and think, "Big
deal."
That's a pound.
>> Lori Casey: Yeah, so carry 10 extra.
It's heavy, It's kind of gross.
>> Kristina Adams: I relate it to when I pick my child up, he
is 3 years old, he just had his 3 year physical--he's 32 pounds.
That's about how much weight I gained when I was pregnant, I am lugging him around like
'wow.'
When you put in in perspective, if you gain weight and you are carrying it around, it
may not hit home as much as when you are picking something up.
I have patients who have picked up bags of salt in the winter, something like that, and
they realize like, "Oh my gosh, I lost that much weight."
And there is just something about it that doesn't quite click until it is like outside
of your anatomy or something.
>> Lori Casey: Or if you are at the gym and lifting weights,
and you are holding two 10-pound weights, you can feel that pressure on your feet and
you think, "Wow, I carried that much extra around."
That really kind of comes to light.
>> Kristina Adams: When you compact it like that, I know I watched
The Biggest Loser one time and they had them put weighted vests on for the amount of weight
they had lost at that point and had them walk a track or something.
And I was like, "Oh!" that was a great idea because then it hits home a lot more.
Because I think as you lose it gradually, you start feeling better and you notice the
weight coming off, but when you put a number to it and a weight to it as far as an object,
I think it really...
>> Lori Casey: Well let's talk about weight loss per week,
what is a realistic goal?
Because when we do see shows on TV where people are losing a 10, 12 pounds in a week, that's
not very realistic for the rest of us who have jobs and kids and that sort of stuff.
What's a good target, if you really want to start a weight loss program, how much weight
should you be losing per week?
>> Kristina Adams: Ideally, one to two pounds, that's a pretty
standard recommendation.
Men are always going to lose it quicker than women, so we can't compare to those guys,
darn it.
Also we can't compare to someone else, because we are all going to lose weight and different
rate based on how much we are starting with, what our starting weight is.
Also how much activity we're able to do.
Maybe, you know, like you mentioned what lifestyle factors are interfering or kind of holding
you back a little bit, so trying to work around those things.
So I think it is just a good nice steady pace, and you might notice one week you might not
lose any, but the next week you might lose two or three, you know?
So I think overall you want to see the balance.
So I think that sometimes when you mentioned earlier why it gets in the way, why we can't
keep this weight off, we don't see that steady weight loss every week so we think, "What
am I doing wrong?"
I have a friend on my Facebook message about, "I started this exercise, I exercise every
day and I haven't lost anything."
So I just commented, "Make sure you are bringing in plenty of fluids," because I think sometimes
we overlook just simple things like that, you know, when you start exercising that is
a lot of processes your body is going through metabolically, so fluid is number one that
is going to feed the fuel you need to get the muscles.
>> Lori Casey: And that first week or two of any diet or
weight loss program, you do lose a lot of weight.
>> Kristina Adams: Yeah, the honeymoon phase, as I call it.
>> Lori Casey: But it's not eight pounds of this.
It's maybe a little bit of this, and a lot of fluid.
>> Kristina Adams: That's correct.
>> Lori Casey: It still makes you feel good though.
>> Kristina Adams: Yes it does, and that is what helps inspire
us too, get that jump-start right off the bat.
>> Lori Casey: Let's talk about where there are hidden fat
calories, salt, sugar in our diet that we, and you brought some examples, so I'm just
going to place the fat over here next to me.
Talk about sugar?
>> Kristina Adams: Sugar has been in the news a lot lately.
It is definitely challenging because the idea is we don't want to eat a lot of added sugar,
so what is added sugar?
You know, sometimes we aren't physically adding sugar to foods, but it is all the little sweet
treats and things that are around us, and with Halloween around the corner, there are
a lot of sweet treats out there, so we are all becoming victim to the candy aisle.
So when you look at the amount of sugar, typically it comes from empty calories is what we call
the sugars, so your regular soda pops that you are drinking, the dessert kind of foods,
pastries, donuts, things like that, you are getting a lot of extra sugar calories.
One example we have, a can of soda pop, is actually about 39-42 grams of sugar, something
around there, which is equal to 10 packets of sugar.
So if you think about it, would you put 10 packets of sugar on something you ate?
Probably not.
But we are drinking it, and I don't think sometimes it registers how much sugar is in
foods.
>> Lori Casey: Here we have got the sugar culprit, I know
that you've got salt.
Salt is another one that, if you start looking at milligrams of sodium, there is a lot of
salt.
How much salt should we be taking in?
>> Kristina Adams: About 2400 milligrams per day--2000 to 2400
milligrams--which is equivalent to about a teaspoon of salt.
So if you think about it, once again, that's in everything, I'm not just talking about
what you might be salting your food with a saltshaker, that's in any foods you are eating
where it is already present.
A lot of your canned foods, processed foods, convenience foods, will probably have a lot
more salt than not.
Some foods naturally have salt, some foods naturally have sugar in them, I am not talking
about those.
It's all that added stuff that is going in there.
So usually some foods that have a lot of hidden salt in them, marinara sauce--a lot of your
spaghetti sauces can have hidden salt in them--also a lot of cereals can have a lot of hidden
salts in them.
So places that we are not really familiar with them being in there, but also you know,
some of the obvious--potato chips, canned soup.
Campbell's has gotten a bad rap--sorry to diss Campbell but they always seem to be in
the news, and they come out with a lot of healthy request, healthy choice type of versions--but
a regular can of soup that is not low sodium or any version has over a teaspoon of salt
in it, usually closer to a teaspoon and a half.
So that is equivalent to 9 salt packets.
So once again if you think about it, how much is in a saltshaker, if you think a few dashes
here and there, and there are so many different saltshakers out there, who knows how much
you are getting.
>> Lori Casey: So is all salt the same?
You get those fancy sea salt grinders, you know the salt is pink, or it's flavored, is
that any better?
>> Kristina Adams: Not really.
I had that question about sugar too, about corn syrup versus fructose.
And I am like, "Sugar is sugar, salt is salt."
The only difference is you may not use as much because they are more flavored sometimes
depending on the granulation of the salt, so you might notice you use a different amount,
which might help you cut back.
A rule of thumb I always tried to help with patients who were accustomed to using salt
a lot, was to put a teaspoon of salt like in a bowl, and use that throughout your day
to pinch in your food, so then you control it, instead of just shaking around and mindlessly
not knowing how much you are salting your food.
>> Lori Casey: And you have got one other culprit.
Sugar, salt, and fat.
>> Kristina Adams: Fat.
>> Lori Casey: The thing that tastes so good in so many things.
>> Kristina Adams: Exactly, and there are healthy fats and bad
fats, just like we said there is natural sugar and salted foods, so when we think of fat
we have to be careful with all the unhealthy fats, which are the saturated fats.
So we think, your fried foods, the solid fat that is visible on meat or something, those
kind of places are where your heavy fats are going to come from.
So everybody has probably had one of those big old fried onions at a fair or festival
sometime this summer, if you go out to eat.
This is how much fat is in one of those fried onions.
>> Lori Casey: That is a lot.
>> Kristina Adams: About 215 grams of fat is what you are looking
at.
>> Lori Casey: So can you give us some recommendations when
we look at food labels--because we all need to be better label readers--what are some
of the things we should look for that might be red flags when you are looking at grams
of fat, grams of sodium?
Do we have some ranges that we should look for?
>> Kristina Adams: I don't necessarily have ranges, but I always
tell patients even if, sometimes that nutrition label can be a little overwhelming for some,
because like you just said, what do we read on there?
I always tell patients to turn the label around and look at the ingredient list, because we
know it's listed from most to least, so look and see what those first 3-5 ingredients are.
That tells a lot right there of how much is in that food.
If you are not into numbers, you are not into percentages, you don't like the nutrition
number label part, the ingredient list will tell you a lot right there.
So you can look and see is corn syrup the first ingredient, is salt in the first five
ingredients, what kind of fat is used, is it hydrogenated, partially hydrogenated, you
know.
There is a lot that can be said in that ingredient list.
>> Lori Casey: So be a smart label reader, but also look
at the serving size.
On that can of soda, how big is the serving size?
>> Kristina Adams: This one is actually right on the money--one
serving is one can--but yeah you're right, when you get the 20 oz bottle you are supposed
to be 2 and a half servings, so you are supposed to share that with someone.
>> Lori Casey: Or those bags of potato chips that you get
at the convenience store that is a small bag, sometimes they're three servings and you could
easily eat the whole thing.
>> Kristina Adams: Yeah, so the number of servings is definitely
part of the label to pay attention to.
>> Lori Casey: Well now a lot of our restaurants, fast food
restaurants, some sit down restaurants, are starting to post calories on their menu.
What do you think about that as a dietician?
Is that a helpful thing?
>> Kristina Adams: I think it can be.
It can be very helpful.
I know they have done a lot of research behind the scenes looking to see if what is on the
label is what they have got served kind of thing.
And usually there is some discrepancy because you have to look at who is working that day,
who is serving your food, who is making it.
So yes, they set the standards and put those in the menu that this is a healthy choice,
but you have to be mindful of different staff may not be paying attention to exactly what
the serving size is that is going out.
For the most part they are pretty accurate and on the money that that is what you are
going to be getting.
>> Lori Casey: So you probably need to look at those calories.
So if you are a woman and your calorie intake is 1500 calories, if you are eating something
that is 1000 and it is only lunch, you might be eating a bag of carrots for supper.
It's really all about balance and sort of picking and choosing what you eat throughout
the day, which brings me to my next question.
We often see this; is it better to eat 3 meals a day, 2 meals a day, or 6 small meals, what
do you recommend?
>> Kristina Adams: The earlier the better definitely.
There is tons of research that shows a lot of those that lose weight and keep the weight
off eat earlier in the day, and they start the day off with breakfast, whenever that
might be for you know, jobs times are different.
But starting and eating earlier in the day, and not eating as late at night, which I tend
to find is the opposite when I run in to patients and I do a food recall with them, or food
frequency--they skip breakfast, eat a quick lunch, and then they rush through and get
something quick and easy at home, and all of a sudden they eat all night long.
So you know it is kind of the opposite.
We want to be eating earlier in the day and having smaller more frequent meals throughout
the day, and not high-ending or overloading food calories at the end of the day.
>> Lori Casey: I think there is this old saying when it comes
to breakfast and lunch; eat breakfast like a king, lunch like a something, and supper
like a pauper.
So it's just what you said, eat big during the day and then scale it back.
Which can also help if you have some digestion problems, not eating that big meal at 8 o'clock
at night and then going to bed.
We have a lot of women that watch this show and when I said we were doing something about
weight loss a lot of them say, "Ask her about as we get older, my hormones are all crazy
and I can't lose any weight--in fact I gain weight."
Talk about as we get older, specifically for women, do we need to be eating less and by
how much?
>> Kristina Adams: That is a great question, I get that a lot.
It is definitely something that happens to be more affecting to women because of the
changes with hormone levels--we can't completely blame it on that-- but there are changes happening
naturally.
As we get older, we are gaining a little bit of fat and we are losing muscle mass as we
get older, so we definitely want to be fighting that along the way as much as we can.
So we are not talking about going in a powerlifting or anything, but just doing some lightweight
lifting, gardening, golfing, anything that kind of uses those muscles is going to help
to keep them toned and keep the muscle preservation there, so that will make a big difference
and that will help keep metabolic rates up going, too, so that once again in long term
will help the calorie burn going.
But as we get older, just processes are changing and things are slowing down because natural
process of life metabolism does slow, so we don't need as many calories as we once did.
And I mentioned earlier as we are trying to lose weight, realistically what we once weighed
when we were 22 won't be the same that we will be able to weigh when we are 42 or 52,
because of not only that we are older, but what is happening in our life at that time,
so same thing applies.
When you are 42 or 52 and you notice you can't lose weight as easy, there are some things
to look at, and so one of those would be diet, look at food records.
Are you still eating like you did when you were 22?
Maybe not be the plan, especially the same types of foods you were eating when you were
22.
So yeah you have to not only look at how you are eating, but the types of foods you are
choosing.
>> Lori Casey: We just have a few minutes left.
I want you to explain just a some quick, easy things about portion sizing, because that
seems to be a problem for a lot of people sometimes, myself included.
There are easy ways to remember what's the portion size for meat, starch, so give us
those real quick.
>> Kristina Adams: Some of the objects that have been compared
to a portion size for a piece of meat have been a deck of cards or a computer mouse,
also a baked potato has been referenced to like a computer mouse size, a golf ball for
the amount of cheese that is a serving, a little nine-volt battery would be a good example
for that too.
A baseball is a good size for a cup of food, or a half a baseball for a half a cup.
So for your vegetables, your rice, your pasta, those kinds of things.
So objects that are pretty familiar to all of us.
A checkbook size would be the size for a piece of fish, so you get a little more because
it is lower calories so you can do that.
One of them that you might not know of is your hand.
It is an easy reference for our portion sizes; our fist is roughly about a cup.
The palm of your hand for meats, red meats, chicken and pork.
>> Lori Casey: Not the whole hand, just the palm.
>> Kristina Adams: The whole hand is for fish, but the palm is
just for those meats.
Then your thumb, the whole thumb is a tablespoon and the tip of the thumb is a teaspoon.
Hopefully when you are eating out we have all got a hand that we can portion size.
>> Lori Casey: So if you get there and that piece of meat
is your hand plus somebody else's, you probably need to cut that up then.
>> Kristina Adams: That's right, we aren't going to have those
objects with us while we are eating in a restaurant, so your hand is a good handy tool.
>> Lori Casey: Last minute, we just have a few seconds left,
give us a last little tidbit of thoughtful advice as we move forward into thinking about
food in a different way.
>> Kristina Adams: I think everything we talked about can be
overwhelming.
So just make it what is going to work for you realistically.
You know, what can you do.
You get stories from the media, you get stories from your friends what they are doing; find
out what is going to work for you and try to go from there, and just make small little
changes along the way, but make sure you are evaluating if that is working or not.
>> Lori Casey: Ok, sounds good.
Thank you so much for coming on.
>> Kristina Adams: You are welcome!
>> Lori Casey: Bringing some fat, other fat, sugar, great
advice, thank you so much Kristina.
>> Kristina Adams: I'll take my models with me, thank you.
Being Well is also available online at our You Tube channel at www.youtube.com/weiutv.
Just look for the Being Well playlist. Here you can view current as well as past episodes.
Calorie counts will soon be front and center on soda machines in the City of Chicago.
It’s part of a new challenge aimed at urging city employees to make healthier choices.
Chicago is teaming up with major soda makers to offer more low-calorie drinks in drink
machines. Vending machines will also display calorie
information. The new wellness challenge is also pitting
Chicago versus San Antonio to see which city can lose the most weight.
A five-million-dollar prize courtesy of the beverage industry is up for grabs.
The drink machines with healthier options will eventually be made available across the
nation. F as in Fat, that’s the name for a report
on the future of America’s waistline. The study conducted by the Trust for America’s
Health and the Robert Wood Johnson Foundation uses government data on obesity to make predictions
about our weight in the coming years. This year Mississippi topped the Centers for Disease
Control list of chunkiest states, with nearly 35% adult obesity rate. But according to the
new report, by 2030, 13 states could have obesity rates over 60%. Some experts question
the accuracy of this weighty research, saying it is difficult to predict future weight trends
accurately. The report proposes to put American on a weight loss challenge, saying if all
adults reduced their body mass index by 5%, states could save billions on health care.
Genetic discoveries are making diagnosis and treatment of many diseases much more effective.
Take a condition called hypertrophic cardiomyopathy, for example. It’s a serious heart problem
that runs in families. It often goes undiagnosed for years, and sometimes the first symptom
is cardiac arrest. This is the condition most commonly associated with sudden death in athletes.
But with genetic testing, patients who have the gene can take preventive steps to keep
themselves heart healthy. (Narrator) To Amber Kindberg, nothing is more
important than the safety and health of her kids.
I want them to be able to go and do the things they want to do.
(Narrator) That’s why, when she learned that a genetic
condition called hypertrophic cardiomyopathy runs in her family, and was the cause of some
of her relatives’ deaths, Amber went to a cardiologist to find out if she should be
tested to see if she has the gene.
I think knowledge is power.
For an individual that with hypertrophic cardiomyopathy, there would be a 50 percent chance that they
would pass this gene along to their children and possibly the disease, and there would
be a high likelihood that you would find this disease in other close family members.
(Narrator) Dr. Steven J. Lester says hypertrophic cardiomyopathy is a condition that causes
the heart muscle to thicken. The thick heart muscle can impair the ability of the heart
to fill and eject or pump blood properly.
It can cause symptoms such as shortness of breath, and chest pain but unfortunately sometimes
the first symptom is sudden death.
So when we see individuals with hypertrophic cardiomyopathy, it's important to embark upon
a family-screening program.
Heart ultrasound also called an Echocardiogram is used to look for structural changes. And
if the disease is present, patients and their families can get proper treatment.
(Narrator) After genetic testing, which is a simple blood draw, Amber found she did not
have the gene. That means her kids don’t have it either.
For Mayo Clinic News Network, I’m Vivien Williams.
We’re out of time for this week’s edition of Being Well. Thanks for watching and we’ll
hope you’ll join us again next week.