Step three: Track what you eat

In a tiny town in Eastern Idaho, there is a famous little restaurant called Big Juds. They are famous because you can get some very large burgers: a 1 lb classic Big Jud or a 2 lb Double Big Jud. Both come with a large fry and large drink of course. If you can eat the entire meal by yourself, you get your picture up on the wall and get your meal free (you have to buy a T-shirt commemorating your accomplishment though.)

They are good burgers and it's a fun novelty. But I wonder--how many calories would you have eaten if you ate an entire classic big Jud or a double big Jud? There isn't any nutrition information available online, so pretending you didn't even eat any fries  (impossible, I know) or drink soda, we could make a guesstimate using McDonalds quarter pounder with cheese that weighs 7 oz (520 calories) to extrapolate and guess that the classic Big Jud is about 1200 calories and the Double Big Judd must be about 2400 calories.

These numbers could be way off, but the sake of making a point, knowledge about what and how much you are eating are critical in being successful in maintaining or losing weight. It isn't magic, it's math and we need to know or have good estimates of the numbers to make this work.

Step Three: Track what you eat

Before I track anything, I like to make a meal plan for the day where I allot calories for each meal. This way, you don't have to keep track of total calories for the entire day necessarily, you just need to make sure you aren't going over per meal.

Example Meal Plan for 1800 calorie diet

Breakfast: 350 calories
AM Snack: 100 calories
Lunch: 450 calories
Dinner: 600 calories
PM Snack/Treat: 300 calories

Personalize your meal plan to your own preferences and tendencies for eating--do you like a small breakfast? Do you always get hungry for a snack around 10 am? do you have to have something sweet in the evenings? Are you pregnant and have to eat every 2 hours? Jot down a plan and don't be afraid to change it if you feel like you've given yourself too much for one meal and not enough for another.


I'm about to say some dirty words. Forgive me. It's time to talk about calorie counting. Calorie counting is a bad word to many people because it for sure can be tedious and for sure difficult depending on what you eat (determining calories in grandma's homemade hamburger casserole will be a challenge).

I wouldn't even suggest calorie counting if the benefits didn't far, far outweigh the inconvenience. Here is a list of the good things that come from calorie counting:

1. Form healthy habits. As you go through the process of reading labels and counting calories, you will learn and will make better choices in what foods you eat and how you prepare food. Over time these changes will become habit.
2. Being conscious of what you are eating. Ever eat potato chips straight out of the bag? How about ice cream straight out of the container? I have. Ignorance is bliss. This would be the opposite of conscious eating. (Unconscious eating doesn't sound right.) When you write down what you are eating, how much, and how many calories, you will naturally self-regulate what you eat. If you have trouble binging, this should be your go-to method of stopping it. It's painful to write down that you've just eaten 800 calories worth of Nutella.
3. Nutrition Education. There is nothing that can educate you quicker and better about food and their nutritional quality than having to read labels. We get so many recommendations--eat more fruit and vegetables, eat lean meats like chicken, avoid added sugars and highly processed foods--reading labels and counting calories will teach you in a very real way why there are those recommendations. Example: It's recommended that we eat nonfat dairy. You read the labels and see that a 6 oz. cup of original Yoplait yogurt has 170 calories, but the same amount of Light Yoplait yogurt (nonfat) only has 90 calories. A calorie difference of 80 calories for such a small amount of food is a big deal.
4.  Being able to eye quantities of food. After measuring a cup of rice out on to a plate several times, you'll be able to serve yourself a cup of rice without a measuring cup. Not only will this help with not over-serving yourself,  this will also help with not overeating. Example: Wow, this big plate of pasta at the restaurant is probably 3 cups worth noodles (doing quick math in your head 3 cups of pasta = about 600 calories) plus the sauce, meat and cheese on top--I better only eat half. 
5. Making the math work. If you are going to make the math of weight loss work for you, you have got to have a firm grasp on how many calories you are eating. We don't want to be eating too much and not losing any weight or eating too little and starving ourselves and dooming our weight-loss ambitions. Counting is simply the best way to know where you stand. 

 

There are a few tools that you need on hand to start counting calories.  

1. Measuring cups. Go to a dollar store and get multiple sets of measuring cups and measuring spoons. You'll be glad to have lots on hand because you'll dirty several of them throughout the day. You can also use a measuring cups/spoons and see how much your own dishes hold--my smaller spoons are 1 tbsp and the larger ones are 2 tbsp.
2. A kitchen scale. Some foods are often measured by weight (like meat or cheese) and you'll be happy to have a scale to measure out 1 oz of cheese than trying to figure out how many ounces are in a cup of cheese and then do the conversion. My scale was $20 at Walmart--it's come in handy for baking and weighing envelopes/packages too.
3. Calculator. Get a little calculator to keep on hand so you can quickly do the math on a food. You'll be less annoyed having to find the calculator function on your phone or computer. 
4. A place to record what you eat. If you like the physical act of writing things down, get a notebook. I usually end up scribbling calories on spare scraps of paper (I'm not that fancy.). You can also use computer programs (word, excel) or websites or apps to keep track of what you are eating. This is a great option if you want to take some of the work out of  it and to be able to track your calories over a long period of time. There are some great free websites with food journals (They also have food databases and weight trackers, which I'll talk about that in the next sections) that make it very easy to keep track of your foods. I've used Fitday before and liked it fine. I'm sure there are others--if you have a favorite, leave a comment with the name of the app/website. 

My last list for you is probably the most important--where are you going to find the nutritional information for food? 

1. The label on the food. This is the first place you look and the most accurate. For foods that don't have a nutrition facts label (fruits and vegetables, foods packaged by the store, restaurant foods, foods you prepare from a recipe) you'll need to look the information up in the places listed next. 
2. A book. When I want to calorie count or look up lots of other useful nutrition information, I use "Bowes & Church's Food values of Portions Commonly Used". I got the book in college for my dietetics classes and I'd say it's one of the only books I still use on a regular basis. The book is very complete source of nutrition information on almost any food you can think of. The book can be expensive (especially if you get the newest edition with CD rom) but it would be worth a little effort to find a used or older edition copy. Note: If you ever have a health condition where you are trying to limit certain nutrients (i.e carbohydrates in diabetes, or certain electrolytes during renal problems) this book would be beyond helpful. 
3. The internet. There are many websites and apps that have databases of foods and their nutritional information. You can use the databases in websites like Fitday or you can just google "calories in a banana" and come up with lots of information. Warning: because there is so much variation in foods (sizes, ingredients, etc) you will find some big discrepancies between calories listed online. It helps to look at multiple sites to get a feel for which information is most likely accurate. The more practice you get, the more you'll know what phrases to use to search for foods and about the quantities used.
4. The menu. Because of legislation in the past few years, more restaurants and even vending machines are being required to display calories for their menu items. Research say people don't look at these, but you can and should if you are watching what you eat--you can still eat fast food and lose weight if the math adds up.
5. The recipe. It's more and more common for recipes found online or even in printed cookbooks to include the nutrition information. Make sure to account for any deviations to the recipe (did you use skim milk when the recipe required whole?).
6. Calculate. One of the hardest calorie counting tasks is to calculate how many calories are in something you've prepared. An example is fried rice--fried rice is a favorite at my house. I could google "calories in fried rice" but there are so many ways to make fried rice, I really doubt anyone else's fried rice is like mine. To calculate how many calories in my fried rice, I find the total calories for the entire dish then determine how many servings or cups are in the dish. I have to read of the label or look up the calories for each individual ingredient: (1) 8 cups of cooked rice 1860 calories (2) 16 oz bag of frozen peas/carrots 300 calories (3) 4 cups of broccoli (raw) 100 calories (4) 1 cup onion 61 calories (5) about 9 oz of ham 485 caloires (6) seasoning 10 calories (7) 4 tsp soy sauce 25 calories (8) 4 tbsp oil 480 calories for a grand total of 3460 calories and a yield of 13 cups of fried rice. I know that 1 cup of my fried rice is about 266 calories. Tedious? Yes! But if I keep records of my recipes and mostly stick to the same way of preparing them, I should only have to calculate calories once. 

Two question you may be asking are "do I have to be exactly accurate?" and "do I have to measure my food and count calories forever?" The answer is no and no. If it's taking too much of your time, don't get caught up in being exactly accurate--just the act of being conscious of what you are eating and doing your best to guess how many calories you are eating is huge. As per counting forever, this process will help you take control and form good habits, but I doubt anyone that could do it forever. However, if you find after reaching your goal, your habits are slipping and the quantities of food you eat growing larger and larger, it's smart to start doing this again to relearn portion sizes and reestablish good habits. 

This was a lot of information to digest. I hope I've given some helpful information/tools, but feel free to ask me questions. My next post in this series will be Step 4: Tracking your exercise

Step Two: Make a Plan

 I have mixed feelings about the show "The Biggest Loser". On the one hand, I like anything that motivates and encourages people to make healthier choices--the dramatic changes in these people is astonishing. On the other hand, I think the show gives people unrealistic expectations about how quickly they can make changes to their body.

When you aren't working out eight hours a day, have professional help constantly at your disposal, and a $250,000 incentive, it's simply unrealistic to expect such huge weight loss numbers. Not only that, I'm not convinced it's healthy or effective. Many of the contestants gain the weight back because I believe they haven't truly learned to deal with the issues that have lead to their weight gain.

Step Two: Set goals and a timetable for weight loss, then make a plan for how you will get there. 

A reasonable and safe weight loss is no more than 1-2 lbs per week. Half a lb weight loss a week is even a reasonable goal. If you lose weight slow and steady, you are much less likely to bounce back and gain the weight. Yo-yo dieting is a dangerous practice and results from diets that are too restrictive.

If you have a large amount of weight to lose, say over 20 lbs. It is helpful to break that weight loss down into periods, including break periods where you are trying to just maintain your new weight. This ensures that you are forming life-long healthy habits and aren't going to go back to old habits that got you in trouble the first place. Remember, we aren't trying to go on a diet, we're trying to make life-long changes.

Example:

Current Weight: 190 lbs
Ideal Body Weight/Goal Weight: 150 lbs

Goal:

Months 1-2: Lose 10 lbs
Month 3: Maintain weight
Month 4-5: Lose 10 lbs
Month 6: Maintain weight
Month 7-8: Lose 10 lbs
Month 9: Maintain weight
Month 10-11: Lose 10 lbs
Month 12 and forever: Maintain weight

Check your goal to see what your weekly weight loss would be. In the above example, it would be a weight loss of about 1.1 lbs per week. This isn't as dramatic as hopping on the scale and losing 10 lbs in a single week, but the end result is still losing the 40 lbs over the course of a year.

Using the magic number of 1lb of fat = 3500 calories, we can calculate how many calories deficit we need each day to lose this kind of weight.

Desired weight loss per week x 3500 calories = calories per week 

 Example:   1.1 lbs/week x 3500 calories = 3850 calories/week

Now divide that by 7 days to get the daily calorie deficit. 

Example:   3850 calories/week  ÷ 7 = 550 calories/day

In this example, a person would need to have a calorie deficit of 550 calories a day to lose 1.1 lbs per week.

The deficit can come from (1) burning more calories through exercise or (2) eating fewer calories or, my favorite, (3) a combination of both. Personally, restricting calories is much more difficult and less enjoyable than getting out and exercising. Using your baseline calorie needs you calculated in the last post, make a plan for how many calories you are going to eat each day and/or how many calories you are going to burn each day through exercise.


Example:

Baseline: 1920 calories
Daily deficit needed to lose 1 lb per week: 500
Plan: (1) burn 300 calories in exercise each day (this is about 45 min- 1 hour of exercise depending on the activity)
(2) eat 200 calories fewer or about 1720 calories each day

If your goal is to maintain your weight, use your baseline calories and then make sure to eat more calories if you've exercised.

Example:

Baseline calories: 1920
Ran 3 miles and burned 350 calories
Need to eat 2270 calories to maintain weight.


If you are pregnant and want to calculate your calorie needs, use your pre-pregnancy weight to calculate your baseline like we did in the last post. Then, depending on how far along you are, add the following amount of calories to your baseline.



1st trimester          0 extra calories
2nd trimester    340 extra calories
3rd trimester    452 extra calories 


Depending on how much exercise you are getting, you may need to eat even more--I'd check the scale first to see if you are gaining the recommended 1-2 lbs/week.

If you are nursing and want to factor that into weight loss or maintenance, add the following amount of calories to your baseline.

First 6 months              330 extra calories
Second 6 months          400 extra calories

In the next post, I'll talk about step 3: Coming up with a meal plan.

In the News: American Medical Association recognizes obesity as a disease

This article in the NY TIMES talks about the American Medical Association's (AMA) decision to officially recognize obesity as a disease. This decision has created a stir similar to when Alcoholism was classified as a disease.

If you go by what the AMA is saying, 1/3 of our population has a disease. I know how personal people take their weight and I know this is going to offend many people. But I think that's the point.

I think the reason the AMA did this is to underline, bold and italic how serious the obesity problem is in our country. I think they want doctors, health insurance companies, politicians, the general public to stop looking at obesity as an unfortunate cosmetic issue, but  as the serious public health concern and burden that it is. Medical professionals see people with obesity as a ticking time bomb for a long list of other diseases.

While the AMA has no legal power, this decision could potentially have big ramifications when we talk about how obesity is treated and who pays for it.

The counsel on Science and Public health praised the move saying that it would help remove some of the stigma of obesity as people sometimes oversimplify it as "that person eats too much." Obese people have such a difficult time losing weight because it's just not that simple--another post we'll discuss the hormonal changes that work against an obese person losing weight.

Ironically, the "Fat Activists" are demanding that the AMA change this back because they claim it adds to the stigma of being overweight. I have very little patience for the "Fat is Beautiful" activists and that mentality. I feel like they do much more harm than good. They keep the focus on appearance and this debate should sit squarely on the shoulders of health. I feel strongly that we need to be caring about what our bodies can do and significantly less about what our bodies look like.
 
The other question is about if insurance companies and by default, all of us are going to be paying for other people's obesity. As I listened to the talk show host this morning talk about this, she was concerned about having to start paying for other people's obesity.  I yelled at my radio "WE ALREADY ARE!"

We already are paying for, what we call comorbidities of obesity. We are paying for people's quadruple bypass surgeries, and for their type 2 diabetes, and for their dialysis when their kidneys fail, for their cancer treatments (obesity significantly increases the risk for cancer) and for all the medical conditions that come hand in hand with obesity.

I promise you, the cost of preventative care, of helping someone lose weight, is way less than the cost of treating renal failure, CVD, type 2 diabetes, and Cancer.

As the rates of obesity is rising in the country, it seems we are getting used to it and it's becoming the new normal. This move by the AMA will hopefully remind people that we should be caring about this and should be taking action. At least it has people talking.

High Fructose Corn Syrup

High Fructose Corn Syrup (HFCS) has ended up on the naughty list, right next to trans-fat. HFCS is supposed to be extra scary because it’s in almost everything.

 What is HFCS?

Before I explain what HFCS is, we need to review sugar. A Monosaccharide is the big fancy word for the simplest structure of sugar. There are different kinds of monosaccharides—glucose, fructose, galactose, xylose and ribose.  We mostly care about only about glucose, fructose and galactose. These sugars are found in different combinations in the foods we eat. For example, the table sugar is glucose/fructose combination. The sugar found in milk is glucose/galactose.

To get HFCS, we start with corn syrup which is made up of fructose/glucose, the same basic building blocks as table sugar, but a little bit different.  The corn syrup is enzymatically changed  so that it has a higher ratio of fructose to glucose than normal corn syrup. The end result is something very similar chemically to honey.

Why is HFCS in everything?

HFCS is in everything because it’s cheap. I don’t understand agricultural law, but there are tarrifs on sugar and subsidies for corn in the United States. The end result is that sugar is much more expensive in the United States than any other part of the world. And Corn is cheaper. The process to make HFCS is to make the corn syrup sweeter so they don’t have to use as much of it, again making it cheaper.

What’s the fear?

As the use of HFCS increases, the rate of obesity, type 2 diabetes and CVD has also been increasing. This leads many to believe that HFCS is the cause. 

(Another branch of fear of HFCS is related to the use of genetically modified corn (GMO’s). That’s a topic all in itself, so we will just focus on if HFCS is what is making us fat.)

What we need to know is that if the body reacts differently to HFCS than to regular sugar and if that is, in any way, what is contributing to rampant obesity.


Research Says

As I began to dig into the research of HFCS, I found several problems with the research. First, many studies were funded by either parties that would profit from HFCS being tarnished (sugar companies) and parties that would profit from HFCS being exonerated. 

Second, most studies are of a correlative nature. Meaning, lets look at the statistics and see if they somehow make sense. And what's the number one rule of statistics? "Correlation does not imply causation." I was not finding any good controlled studies, the kind that show cause and affect. (As a personal preference, I don't count rat studies.) I summed up a few of the articles I found below. 

The resounding message I got from the research was that HFCS is just as bad as regular sugar. Both are, simply put, extra calories. Extra calories lead to obesity, diabetes, and cardiovascular disease. I will submit that there needs to be better and more research with controlled studies on HFCS just to make sure there isn't something we're missing.

Take Home Message

As we feed ourselves and our families, we need to think about the added sugar/calories we and they are getting. I suggest that if we are going to avoid HFCS, we need to do it not because were scared of HFCS, but because were scared of added sugars. Here are some other added sugars to be aware of: 

• Anything that ends in "ose" dextrose, glucose, fructose
• cane syrup, cane juice
• fruit juice concentrates, nectars
• honey (there's no nutritional advantage to honey over other sugars)
• malt syrup
• molasses 

 Here are some tips for cutting back on foods with added sugar. 

• Remember that ingredients in foods are listed by weight. The higher up on the list a food is, the more of it is in that food. If an added sugar is high on the list, then you know that food is high in added sugar. If it's near the end of the list, you don't need to worry about it as much.
• Stop buying soda or juices. If you are frequenting a fast food place, get your kids the milk (even chocolate) or water option. Be mindful of the times you or your child is getting a soda or other sugary drink--you may be unaware of just how often that is.
• Put smaller portions of ketchup on your child's plate. If you have a ketchup-loving kid that wants it on everything, tell them that you can only give them ketchup for specific foods (i.e. ketchup is only for hotdogs and fries). 
• Limit meals eaten out at restaurants--they add sugar to make it taste better. Don't add sugar to your own cooking.
• Opt for a less sugary cereal.  Here is a list of breakfast cereals and the amount of added sugar by weight. I suggest you find the cereals you usually eat, see how much added sugar is in it and then find a few options that have less added sugar in it.            

Research and some other sources of info

The American Medical Association wanted to know how HFCS measured up against other sweeteners. They looked at the research others had done on HFCS (not quite a meta-study) and concluded that the composition and the way the body absorbs HFCS is so similar to table sugar, it is unlikely that HFCS is contributing more to obesity than table sugar. They do say that more research needs to be done. 

This article published in the American Journal of Clinical Nutrition looks at global statistics of HFCS and other sweetener use and obesity rates. The author concludes that   the hypothesis of a HFCS-Obesity link is not supported by these statistics. He says that the increase of calories (and increase of obesity) starting in the 1970s was due to an increase of all nutrients, fats included. 

This study found an increased correlation between type 2 diabetes and the use of HFCS within a country. In countries where HFCS was prevelant, there was a 20% increased liklihood of type 2 diabetes. 


Mayo Clinic "What is high fructose corn syrup? What are the health concerns?"


 Princeton university research showed that rats fed HFCS gained more weight than rats fed other sugars, but had a similar caloric intake.

 Harvard University  "High Fructose Syrup and Health"