Weight Management

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Weight Management

December 4, 2012
12:00 p.m. – 1:00 p.m. (EST)

Lillian Craggs-Dino, RD - Dietitian

Cleveland_Clinic_Florida_Host: Welcome to our Online Health Chat "Weight Management" with Lillian Craggs-Dino, RD. We are thrilled to have her here today for this chat. Let’s begin with the questions.

browna20: With so many different ways of eating/dieting how would someone know what is truly best for them or what will work? I know it's a lifestyle change and not simply a short-term diet but these days there are too many choices. Any opinions on the healthiest and most effective weight loss plan?

Lillian_Craggs_Dino_RD: This is a great question because you are right: long-term weight loss success is a lifestyle change that involves motivation, commitment, and dedication. Goal setting, support, and making small, daily changes is the way to accomplish your goals. One of the healthiest diets is one that incorporates variety and portion control. If we are too restrictive, sometimes, this leads to binge eating and sabotage. Also, we must monitor our intake. To change our eating and the foods we eat, we must first identify what we need to change. A food diary is an excellent tool to help with this and there are many online and computer apps that can assist you with that.

Brendybooks: After a slip-back in my weight control program, how do I keep from not throwing in the towel until AFTER the holidays?

Lillian_Craggs_Dino_RD: Great question. Just get back on track. Start with making a new set of goals, identify the problem areas and make small changes. It is never too late to start a healthy eating and exercise program. Literally: Women in early 40s start to take on weight that's harder to keep off. Regular exercise and not eating major meals (petite with good BMI and height/weight) does the trick but it vacillates of course. For someone in this age group who eats very well, does routine exercise, and just has some "tummy area" issues, with a cholesterol total of 218, what is a way to keep metabolism high during the holidays and year-round? The high cholesterol and "tummy" area is mostly due to cheese and wine. I have been substituting Kefir and yogurt for some dairy. Eating more legumes and "good" nuts. What else?

Lillian_Craggs_Dino_RD: This is a good question, and many women have similar challenges. I certainly would advise eliminating the alcohol since this adds unnecessary calories. Also, simple sugars tend to accumulate fat around the belly, so take a look at your intake and limit your simple sugar intake. If you are concerned with cholesterol, increase your fiber intake (fruits, veggies, whole grains) and this can help naturally lower cholesterol, help you feel full and you will eat less.

Brendybooks: Is spaghetti squash considered a vegetable or a starch?

Lillian_Craggs_Dino_RD: Spaghetti squash is a starchy veggie, but filled with excellent fiber, vitamins and minerals. Go for it.

Cleveland_Clinic_Florida_Host: We have already received some great questions! Lillian is being as thorough as possible in his answers. Thank you in advance for your patience. We will get through as many questions as possible.

yogacat: I am 70, and have not been able to exercise because of Disk and Scoliosis pain for the past several months. I have lost 3 lbs. Is this because I have lost muscle weight?

Lillian_Craggs_Dino_RD: Losing weight is a matter of calorie intake and output. I'm not sure what your intake is, but if you are losing weight, this can be loss of muscle, fat, water or a combination of all three. Are you able to do some strength exercises perhaps with resistance bands or light yoga stretches to keep flexible? Any kind of activity that you tolerate can help.

ls0505: What do you think when a woman about 50 years old already going through menopause, eats right, exercise, and cannot lose the extra pounds? She can only lose when she does a strict diet and after she stops it comes back?

Lillian_Craggs_Dino_RD: Yo-yo dieting is ineffective in the long term. You say you are eating right, but I would suggest you keep a food diary to double check yourself. Research shows we tend to underestimate our food intake by more than 15%. When you keep a diary, you may notice a trend of foods that you may want to alter or reduce. Weight gain is due to many factors, including calorie intake and types of foods.

kellykeal:What are your thoughts on the low-carb diets?

Lillian_Craggs_Dino_RD: There is a role for carbohydrates in the diet, so I would have to ask how much carb is one restricting? One challenge with the American diet is that we are over-eating simple carbohydrates such as low fiber starches and not enough whole grain, fruits and veggies. I would rather see someone restrict the calorie dense and nutrient poor carbs like simple sugars and white starch and make sensible substitutions. However, it is recommended that we consume 40-55% of our intake from carbohydrates. Unfortunately many diets are greater than 75% carb. Therefore, reducing carbs in this case would be better.

Brendybooks: My feeling is to restrict more, less calories, yet, for 18 months the food plan I was on worked great. Go back to it? Modify?

Lillian_Craggs_Dino_RD: I don't know what food plan you are on, but I hope it is one that incorporates variety and is calorie-controlled. Also, get a check up with your primary care doctor and nutritionist to help you determine a proper weight goal and assist you.

KLepley: What is the best route for someone who had a total hysterectomy at 39, battled the endless weight gain of hormone replacement therapy and weaned themselves off of the therapy and is now 55 and seems like nothing works when it comes to losing weight. Exercise is limited because she has fibromyalgia and arthritis in her feet but diet and she is not a lazy person! Any suggestions?

Lillian_Craggs_Dino_RD: I know that hormone therapy does lead to weight gain in some people. But now that you are no longer on them, you need to look at your calorie intake. Since exercise is limited for you, the one control you have is your food intake. If you are not losing weight, you are still in a calorie excess. Also, if you can do any form of exercise, this will keep your metabolism higher. Even with your fibromyalgia, perhaps you can do Pilates, yoga, or swimming. That would help tremendously.

KLepley: What is the best way to jumpstart you metabolism after having a TAH 16 years ago and not having any hormones?

Lillian_Craggs_Dino_RD: The best way to elevate your metabolism is to build muscle mass. Any form of exercise can help with that. While some foods temporarily increase metabolism (caffeine, hot peppers), these are temporary effects.

JudithP: What are the dietary advantages of acai?

Lillian_Craggs_Dino_RD: Acai is a fruit that does provide vitamins such as vitamin C and folic acid. Acai has antioxidant effects and also has fiber.

BjRush: What about digestive conditions causing weight retention and gain? What do you recommend for a person with a slow metabolism and possible IBD?

Lillian_Craggs_Dino_RD: When one has digestive disorders, it is best to look at the foods you can tolerate and then look at the portions that you are eating to reduce the calories. Also, doing some form of exercise is always a good thing to help elevate your metabolism.

Cleveland_Clinic_Florida_Host: For those now joining us, we are currently chatting with Lillian Craggs, Dino, RD who is taking your questions about Weight Management. To ask a question, type in the box below and then click 'Ask'

maxine: What is the best milk to drink? I recently switched from “regular” milk to almond milk, did I make the right choice?

Lillian_Craggs_Dino_RD: Good question. Milk is a good food just as almond and soy milk. They all have advantages. The trick is you want to reduce the fat and sugar. Whole milk has high total and saturated fat, so that was a good change you made. However, check the sugar content on the almond milk you are drinking to make sure it is under 10 grams per serving. Otherwise, you are drinking too much sugar.

bigntall: The BMI chart says that I am obese. I am 6’2 and 270 pounds, workout 7-days a week and don’t feel obese? How can I get a more accurate reading?

Lillian_Craggs_Dino_RD: Great question. One downfall of the BMI is that it does not measure body composition. You may measure as obese according to the BMI chart, but perhaps you have a high muscle weight, which is a good thing. Try getting a body composition measurement. You can use special scales that can measure your muscle/fat/water weight through bio-impedance. You can buy these scales at home appliance shops or common shopping website. Obesity is over-fatness, not just having too high of a body weight.

skrawberries: I am 4 months pregnant and I love fish and seafood. Is it safe for me to eat these?

Lillian_Craggs_Dino_RD: Seafood is a good food, however, for pregnant ladies you want to limit eating seafood to no more than 2-servings per week to avoid any mercury or other contaminants. Have a variety of foods such as whole grains, lean meats, fruits, veggies, dairy, and keep going for your checkups with your OB/GYN.

ralphallen: What should you eat before a workout and after a workout?

Lillian_Craggs_Dino_RD: This does depend on what your goals are and what type of exercise you do. Generally, you want to eat a mixed food before and after workout (within 1 hour before and after). A good food may be a glass of chocolate milk, a protein shake, banana with peanut butter, or a bowl of cereal. You always want to nourish before your workout and then replenish after your workout. And make sure you drink plenty of fluids.

lilac100: I have high blood pressure but I don’t have time to cook most nights so I get frozen dinners. Do you have any suggestions?

Lillian_Craggs_Dino_RD: One challenge with frozen meals is that they are high in sodium, which can lead to high blood pressure. You want to keep your sodium intake to no more than 1300 mg per day. So check those frozen dinners and try to pick meals that have less than 400 mg of sodium. They are out there. Just read those food labels.

kellykeal: How often is it recommended you see a nutritionist?

Lillian_Craggs_Dino_RD: That depends on what your goals are and if you have any nutritionally-related conditions. A licensed nutritionist can help with your food choices and changing your eating lifestyle. I recommend you see your physician for a referral to a dietitian/licensed nutritionist and then together, you can decide on how many visits are appropriate.

Cleveland_Clinic_Florida_Host: We have already received some great questions! Lillian is being as thorough as possible in his answers. Thank you in advance for your patience. We will get through as many questions as possible.

lindy: I am very confused on what the best sugar substitute is the best/healthiest? I drink coffee and tea almost everyday, what do you suggest?

Lillian_Craggs_Dino_RD: The FDA states that sugar substitutes are safe to consume. My suggestion is to limit the use of sugar substitutes and sugar in total. There are many sugar substitutes to choose from. One of the more natural sugar substitutes comes directly from the Stevia bush. This is a healthy option.

francois: What supplements do you recommend? Some researchers say that some have no affect (i.e. fish oil), what are effective daily supplements?

Lillian_Craggs_Dino_RD: Always visit your MD before starting any kind of vitamin, mineral or herbal supplement. Based on your dietary intake, mediation intake, health status, and presence of any illness will dictate if supplements and which ones may be appropriate for you.

Cleveland_Clinic_Florida_Host: We have approximately 15 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Brendybooks: I was on a road trip for two months and gained some weight back of the almost 70 I had lost. Yet, I followed my 1300 calorie diet and lifted weights (moderately). Could it be the lack of swimming, which I do 3x a week and/or the sodium from eating in restaurants?

Lillian_Craggs_Dino_RD: Weight gain is attributed to calorie intake or if you are changing your body composition. Perhaps the weight gain is from building muscle with your weight lifting, which is not a bad thing.

becky1: If you had to select a list of 10 foods to avoid, what would they be?

Lillian_Craggs_Dino_RD: That's a tough question because almost all foods can be incorporated into a healthy diet. But this is what I would avoid or at least limit:
1) Alcohol
2) Foods with trans fats
3) Foods high in saturated fat
4) Foods high in sodium
5) Foods low in fiber
6) Foods high in simple sugar
7) Foods/beverages with excess caffeine
8) Food high in artificial preservatives
9) Foods that are highly processed
10) Food with poor nutrient content

jbalding: What advice do you give on navigating the grocery store to make healthier food choices? Thanks.

Lillian_Craggs_Dino_RD:Typically, shop the perimeter of the stores because these are the healthier aisles. Avoid those buy-one-get-one-free gimmicks. Go with a shopping list and take your time to read food labels. Always go for the fresh or fresh frozen and try to avoid those highly processed snacks!

bridget199: Are there healthy alternatives at fast food restaurants?

Lillian_Craggs_Dino_RD: It is now a law that fast food restaurants must give you the calorie content of their foods. When you read some of the high calorie, high fat foods, try to avoid these. Read the menu and make healthier choices. There are healthier options at these restaurants. You just have to know what they are and then make the right choice.

Cleveland_Clinic_Florida_Host: We are getting ready to close for today. A large number of questions were received and we apologize if we did not get to your question. We will try to answer as many questions as possible in these last few minutes. If you have additional questions, please go to clevelandclinic.org/health/livepersonchat to chat online with a health educator.

chilloutdude: Is Greek yogurt healthier than regular yogurt?

Lillian_Craggs_Dino_RD: Greek yogurt tends to have a higher protein content than regular yogurt. But if you are picking the fruit flavors rather than the plain and adding your own fresh fruit, then you are consuming high sugars and calories. One of the best foods is plain yogurt (Greek or regular) to get protein, calcium and vitamins.

pbob4: Do you have any suggestions for free online weight management and tracking sites?

Lillian_Craggs_Dino_RD: Some sites are: Myfitnesspal.com; calorieking,com; caloirecounter.com; livestrong.com.

dannysmom: My son is very skinny and should put on some weight. Can you explain what ‘healthy’ fats are?

Lillian_Craggs_Dino_RD: We need fat in our diet for health. You want to keep total fat to no more than 30% of your total calories. Good fats are those that are not saturated or trans. Good fats are unsaturated like those you find in nuts, seeds, fish, and whole grains. If your son needs to gain weight you need to look at his total calorie intake, not just his fat intake.

bevparks: In your list, you mention foods high in a specific type. What is too high or too low in each of those categories?

Lillian_Craggs_Dino_RD:Keep trans fat to as close to 0 as possible; keep saturated fat to no more than 10% per your total calorie intake; keep simple sugars to less than 10%; keep sodium to no more than 1300 mg.

Cleveland_Clinic_Florida_Host: I'm sorry to say that our time with Lillian Craggs-Dino, RD is now over. Thank you again, Lillian for taking the time to answer our questions today about Weight Management. To make an appointment with Lillian, or any other specialist at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.