Online Health Chat with Maxine Smith, RD, LD
February 8, 2010
Cleveland_Clinic_Host: Nearly ½ of adults set New Year’s resolutions to lose weight and start exercising or to break other unhealthy habits.
Making a commitment to lose weight is a commendable first step in achieving a weight loss goal. You have moved into the action stage and have a better chance of making your goal a reality. Possibly you have even started to lose some weight, but are at a plateau or have hit a few bumps in the road. This is a natural part of the weight loss journey and it is important to continue to persevere!
Weight loss requires a commitment to lifestyle changes – some of which may be challenging - but the benefits may be life-altering. Some of the advantages of weight loss include decreased risk of heart disease, diabetes and high blood pressure, less joint pain and increased energy and self-esteem.
Research has identified tried and true methods to increase your chances of meeting your goal while still enjoying a variety of foods. We will have the opportunity to discuss some of these interventions that can promote your success.
Maxine Smith has more than 20 years of experience as a registered, clinical dietitian and currently works in the department of Nutrition Therapy. Areas of special interest include weight, lipid and diabetes management and disease prevention. She provides nutrition services to patients in the Preventive Medicine and the Outpatient Nutrition areas.
Ms. Smith earned her dietetics degree from the University of Akron, Akron Ohio and completed an internship at Metro Health Medical Center. She is a member of and is certified in adult weight management through the American Dietetic Association.
When not counseling patients, she enjoys creating patient education materials, giving lectures and contributing nutrition expertise to the media.
To make an appointment with Maxine Smith, RD, LD or any of the other specialists in Nutrition Services at Cleveland Clinic, call 216.444.3046. You can also visit us online at www.clevelandclinic.org/nutrition
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Maxine Smith, R.D., L.D. We are thrilled to have her here today for this chat. Let’s begin with the questions.
Resolving to Lose Weight
dehlia: I feel that I can never keep my weight loss resolutions; Am I alone?
Speaker_-_Maxine_Smith: According to a University of Washington survey, 63 percent of the people questioned were still keeping their number one 1997 New Year's resolution after two months. Most of these were health related resolutions. Those that are more successful have certain things in common including:
- They have a strong initial commitment to make a change.
- Have coping strategies to deal with problems that will come up, and
- They keep track of your progress. The more monitoring you do and feedback you get, the better you will do.
JackP: I have met my goal of 20# weight loss by January 15th but I am afraid that I will gain it back like I always do. Is there anything that I can do to help keep this weight off for good?
Speaker_-_Maxine_Smith: The National Weight Control Registry has been used to identify what factors help maintain a weight loss. The participants in the ongoing registry have lost a minimum of 30# and have maintained it for a year.
Certain behaviors have been identified that are associated with weight maintenance. Some of these include: 45 min. plus of exercise most days of the week, following a low-fat, calorie controlled plan, eating similar to your regular eating plan on special occasions such as holidays/vacations, self-monitoring such as weighing yourself regularly and keeping a food diary and support from others.
kels1780: My 15 year old daughter is trying to lose some weight, what would be the best way for her to start this process?
Speaker_-_Maxine_Smith: You want to emphasize "health" and shedding a few pounds to be healthy. Bone and muscle mass should be considered as many teens want to look like their petite peers, but that would be unrealistic and possibly unhealthy.
It would be best to see a dietitian who specializes in pediatrics who could measure her body fat percent so that she can aim for a realistic goal. If she is not exercising regularly, she should start, upon physician clearance.
moconnel: I'm 52 and going through menopause. It's very hard to lose weight. Any suggestions for jumpstarting my metabolism?
Speaker_-_Maxine_Smith: There are only a few factors that affect metabolic rate significantly. First, upon physician clearance, start a resistance training program to build lean muscle which will help increase metabolism. Also, avoid skipping meals (particularly breakfast).
jenjen: How can I stick to my weight loss resolutions when I have relatives and co-workers that are always pushing food on me? It seems that it gets worse when I tell them that I am on a diet!
Speaker_-_Maxine_Smith: Many people get a sense of pride in their cooking and when you reject their food, they may feel slightly rejected. Typically this will be temporary and they will learn that you are serious about your efforts and act differently the next time. Other times, someone may want to sabotage your efforts, either consciously or unconsciously; they may be jealous of you and of your ability to succeed. You need to stay focused on your goal and what YOU need.
Consider possible retorts ahead of time such as:
“I’m following a particular eating plan for my health” (vs. I’m on a diet)
“It looks delicious, but I just ate… Could I take a piece home to enjoy later?”
Remind yourself that you are giving yourself a gift of weight loss (and all the benefits that are associated with it) and NO-ONE can take that away from you.
sugarbee: Why does it get so much harder to lose weight after the first 5-10 pounds? It seems like your “magic number” drops way down, and you really have to cut calories a lot to lose any more weight.
Speaker_-_Maxine_Smith: Initially, one will lose an abundant amount of fluid. When you start losing weight, you will lose storage carbohydrates (or glycogen) which attaches itself to 6 times it's weight in fluid. Also, as you get closer to your ideal weight, hormones such as ghrelin will increase in attempt to fill your fat stores. Also, as you lose weight you will need less calories (as you have less mass to feed), so you may need a caloric reduction.
rudy: Now that the 'New Year's resolution stage' is over, what motivational tips can you give to keep my exercise program on track?
Speaker_-_Maxine_Smith: Continue to remind yourself of your personal advantages for exercise. Also, be sure to carve out a specific time each day to exercise so that this becomes routine. Plan ahead!
50_and_counting: In order to lose 10 lbs in 12 weeks - what calorie intake should I be looking at? I understand that I need to exercise also, but I don't know what to eat and what not to eat. Thanks.
Speaker_-_Maxine_Smith: This will be individualized. However, you can estimate calorie need to lose weight by multiplying your weight in pounds by 10 to maintain weight. Subtract from this 500 calories for every pound you want to lose per week. This 500 calorie deficit could come from cutting back on food and/or exercise.
bigandtall: According to BMI, I am obese ( I am 6"2" and weigh 270"). I work out 7 days a week. How do I know where I stand?
Speaker_-_Maxine_Smith: It would be a good idea to get your body fat% measured. You can do this at a dietitian’s office and it may be offered by a health club. You want to make sure, however, that the machine can be used in an “athletic mode”; otherwise the results may not be accurate.
A healthy body fat% is typically ~ 8-18% for males and 18-26% for females.
rudy: Does the BMI index allow for any adjustment for more athletic bodies -- ie, muscle weighs more than fat?
Speaker_-_Maxine_Smith: No. BMI serves only as a guide to determine body fatness. To accurately determine if you have excess body fat, you would need to have your body fat% measured.
Weight Loss Goals
rudy: When you are just moderately overweight, what weekly or monthly weight loss goals would be appropriate to shoot for? (for a woman)
Speaker_-_Maxine_Smith: You may not want to hear this, as everyone would love to lose 5-10# a week; however, realistically aiming for and average of 1/2-1# per week is realistic. Don't get discouraged, however, if some weeks you do not lose weight, as one experiences fluid and hormonal changes that may affect weight. You may lose twice as much a week or two down the road.
Causes of Weight Gain
petcare: How can a patient lose or maintain her weight when one of the medicines she takes has the side effect of weight gain? Consequently, she has an increased appetite and is gaining about 2 pounds a week?
Speaker_-_Maxine_Smith: Discuss your concerns with your physician. There may be an alternate medication that he/she can prescribe that will cause less weight gain. Try to divert attention away from food. Setting a timer for 15 minutes or so and going and doing something else may help. If the weight gain is temporary fluid retention, your weight will decrease. If the weight is fluid, sometimes a sodium restriction will help - but discuss this with your physician first.
AJCanton: What about digestive issues causing weight retention and gain? What do you recommend for a person with a slow metabolism (underactive thyroid) and possibly irritable bowel?
Speaker_-_Maxine_Smith: Digestive issues may result in bloating and fluid retention, but should not cause weight gain (remember it is all calories in vs. calories out). If your thyroid is low, seek medical advise as this may inhibit weight loss.
Food Choices and Diets
chelsea: Should you strictly diet when trying to lose weight and then eat a balanced one to maintain your weight?
Speaker_-_Maxine_Smith: A healthy weight loss diet should not eliminate any food groups. Portion sizes however, may need to be closely regulated. There are some instances when particular food groups may be eliminated. However, these diets should be supervised by a doctor/dietitian.
blanken: Is there any type of diet that will help me lose weight better than another?
Speaker_-_Maxine_Smith: Researchers at the Harvard School of Public Health and the Pennington Biomedical Research Center put participants in the study on four popular diets -- high carb, high fat, low-fat and high protein -- to test to see which of the regimens resulted in more weight-loss success. All groups lost similar weight after 2 years.
About 80 percent of them lost at least eight pounds after two years. And 15 percent of the participants lost at least 10 percent of their body weight. Ultimately it comes down to calories; you need to put less fuel (food) in your body than it needs so that your body will have to go to it’s reserve fuel tank – or your fat stores.
rudy: If you had to select 10 foods. . . what 10 would you avoid completely when trying to lose weight?
Speaker_-_Maxine_Smith: Foods that are of high caloric density (many calories for the weight of that foods). Full-fat cheese, Full-fat ice-cream, pastries, butter, fried foods, candy, refined pasta, rice and bread, sugar sweetened beverages, chips.
ShuShu: What about snacking? I am in my 50's, perimenopausal and I want to eat anything sweet that is not nailed down! Also - the recommended serving size portions don't fill me up. Any suggestions?
Speaker_-_Maxine_Smith: First, are you having a healthy snack between meals? 4-6 small meals a day are associated with maintaining a healthy weight and can help satisfy you till the next meal. Try having something with fiber and protein between meals such as a few nuts which will help with satiety.
kels1780: I need to increase my fiber, what are the best foods to eat??
Speaker_-_Maxine_Smith: Fiber is the non-digestible portion of plant foods. Therefore increasing plant foods is the way to go. Whole grains, vegetables (particularly legumes or starchy beans), fruits and nuts and seeds are all good sources of fiber.
newtonm: Do you agree with a diet plan that says to eat nothing after a certain hour (say 7:00), not even a snack? I see nothing wrong with eating something in the evening. I seem to do better when I plan a snack, hopefully preventing “binging” because I am hungry.
Speaker_-_Maxine_Smith: Its a myth that eating late at night will cause weight gain. Yes, it can prevent binging. Eating late can be a problem with people who do not eat enough during the day and then go home to a huge meal and then continue to snack all night. The total calories in per day is what counts.
busybee: I work 10 hour days (when lucky) and eat dinner about 8 pm. I have no control over my work schedule and seem doomed to gain weight. What can I do?
Speaker_-_Maxine_Smith: In your case, you might be better off having a “mini-meal” at about 4 or 5 p.m. If your inter-meal period is too long, you are setting yourself up for disaster. You may then be out of control, eat too quickly and too much and wind up regretting it later.
If you have someone else that has prepared your food, you may ask them to plate up a healthy portion of food and put the rest away in foil or in the freezer so that it is easier to limit your portions. Also, try to relax and wind down before you eat.
newyear: My goal is not weight loss but to feed my family a healthier diet. What are the best foods to buy in the grocery?
Speaker_-_Maxine_Smith: Shop around the perimeter of the store. The least processed foods are typically the healthiest. Fresh fruits, vegetables, whole grain breads, lean poultry, fish and meats and low-fat dairy products are the way to go. If you are not reading labels, start comparing similar products. Shy away from those containing trans fat, more than a couple of grams of saturated fat and that have sugar or forms of sugar in the first few ingredients.
proudmom: I eat chocolate when I get home from work. I also eat ice cream as a treat because I feel I deserve it! How do I change this habit? I depend on it. I am a hard working person, thus feel it is my reward!
Speaker_-_Maxine_Smith: You need to make a choice: Do you want to reward yourself with chocolate and gain weight or do you want to be healthy and lose weight?
Focus on the long-term gratification that eating healthy will bring you, such as feeling looser clothes or whatever it may be. You deserve reward and pleasure, just brainstorm non-food ways to meet your need. Also, do something calming before you get home, get the junk food out of the house and direct yourself to do something else immediately when you get home.
225hip: Is increasing fluid intake (especially water) good to suppress hunger and lower food intake?
Speaker_-_Maxine_Smith: The researcher, Dr. Barbara Rolls, identified that the weight of food affects satiety. Water can be filling because it has significant weight. Also, some eat when they are truly thirsty. Fluids between meals and prior to meals may suppress hunger.
rudy: Do organic foods provide ANY weight-loss benefits compared to non-organic foods?
Speaker_-_Maxine_Smith: Absolutely not.
sugarbee: What do you think of fasting? What are the benefits and consequences of long and short-term fasting? Does it help with weight management?
Speaker_-_Maxine_Smith: It depends on what type of fast you are talking about. Juice fast? Fasting at any particular meal? Fasting can slow metabolic rate which means your body burns less calories to do the same task. There was a recent study that identified that doing an alternate fast (one day ~ 600 calories and the next a more "regular" diet) helped preserve metabolic rate and the participants were able to stay on this type of program for a period of time.
kels1780: What's your opinion on deli meats? Are they healthy to consume or would you prefer to eliminate from diets?
Speaker_-_Maxine_Smith: The American Institute of Cancer Research recommends avoiding processed meats. Some stores will sell turkey breast fresh off the bone. Try cooking extra fresh meat at dinner and freezing it in small portions for sandwiches. There are also a few companies the sell "unprocessed" deli meats such as Applegate Farms.
newtonm: What are your views on using SlimFast products? They have been around for a very long time. Does that mean they are safe and effective?
Speaker_-_Maxine_Smith: According to the American Dietetic Association, meal replacements such as Slimfast can effectively promote weight loss. It can help simplify one's eating plan and help them to decrease attention on food. However, one needs to learn calorie amounts of commonly consumed foods and learn to limit portions for long-term success.
newtonm: How effective are herbal supplements in aiding weight loss? How about Acai? I hear so much about it.
Speaker_-_Maxine_Smith: There is no research to recommend any supplements for weight loss at this time. Some of these may be dangerous, so if considering, also check with your physician.
The Acai berry may serve as a good antioxidant to help prevent your cells from disease. However, there is no association with weight loss. Don't count on one fruit, however, to meet your antioxidant needs; a variety of colors of fruits and vegetables within any particular day is the disease preventive route.
ctm02: Are there any tools that you can recommend that will help me to stay motivated to stay on my eating plan?
Speaker_-_Maxine_Smith: These are a few that I have found quite helpful for my patients:
- Continue to remind yourself of the benefits of reaching your goal. It may be looking good in those summer shorts or having more energy to keep up with your kids. Put up notes to remind yourself if necessary.
- Weigh yourself weekly and give yourself a NON-FOOD reward. It doesn’t have to be expensive. It could be giving yourself a candle-lit bubble bath or a back-rub from your spouse. Get creative!!
- Continue to focus on health and wellness. Read books and articles that are motivating. Also, avoid environmental triggers that stir up your cravings such as watching food-related T.V. shows, meeting your friends at your favorite pastry shop, etc.
- Keep graphic records of your accomplishments! Watching that line on your weight graph go down or the line on your exercise graph go up can be quite motivating!
chillout: I have been avoiding the restaurants while trying to lose weight but I am starting to get bored and feel left out but I am afraid that I will lose control. What do you suggest?
Speaker_-_Maxine_Smith: Plan, Plan, Plan! You can get something healthy and low in caloric-density at pretty much any restaurant; however, you want to be in control and not succumb to all of the sensory triggers of the restaurant.
For chain-restaurants, check out their nutrition information on their web-site ahead of time. You can request that a restaurant fax you a menu. Some restaurants also have calorie information on their sites which are particularly helpful. You can also check out healthydiningfinder.com for leads to healthy dining options in your area.
Also, do not go to a restaurant overly hungry (just as you should not go to a grocery store overly hungry). Have a small snack a half hour before your dining experience to take the edge off your hunger.
kathleen0909: Any suggestions for free online tools as motivation and for tracking weight loss?
Speaker_-_Maxine_Smith: There are many. Sometimes joining an online support group/chat can help. Support is important and encouragement is important for success. I like MyPyramid.gov., Sparkpeople.com, Livestrong.com, Fitday.com
Pbob2: One of my motivators to eat a healthier diet is that my dad was recently diagnosed with colon cancer and I don't want to get this disease". Do you think changing my diet will make a difference?
Speaker_-_Maxine_Smith: I am sorry to hear about your Dad. From a nutritional perspective, you can help decrease your risk by eating a high plant-based diet, avoiding processed/deli meats, limit red meat to 18 oz. a week, increasing fiber and limiting alcohol. To determine your colon cancer risk, visit clevelandclinic.org/score to take a quick and easy online survey.
pjburtnett: As part of the goFit group, I feel stronger and clothes fit better - thanks to increased exercise, but I have only lost a few pounds and its disappointing. I have not altered my diet, including not eating any more. Shouldn't I have seen more actual weight loss?
Speaker_-_Maxine_Smith: Actually, there has been much about this in the research. Exercise is great, but many overestimate the calories that you are burning. It is easy to eat the 150 calories that one may burn in 1/2 hour of walking in a piece of buttered toast. Keep exercising but seek to also decrease calories by a couple of hundred per week. Measure your food portions.
Should You See a Dietician?
gollygee: I have tried to lose weight on my own and have not had much luck. I am thinking about seeing a dietitian. What are the benefits of a nutrition consult?
Speaker_-_Maxine_Smith: You are not alone. According to the research, those attempting weight loss, who had better attendance in the sessions with a dietitian and/or other support groups, had stronger weight-loss results. A dietitian can help you incorporate your favorite foods into a diet plan that will promote weight loss.
She will also consider your lifestyle and tailor your eating plan to realistically work in your situation. She will help you identify obstacles (which will undoubtedly arise) and provide you with strategies to work through them. The dietitian will also serve as an accountability partner and a coach to encourage you on.
proud_mom: Will Medicare and Health Insurance help with any aspect of losing weight?
Speaker_-_Maxine_Smith: Unfortunately, Medicare will only reimburse for diabetes and renal failure at this time. However, there are health care costs to provide health. Just as one's car insurance does not cover routine maintenance, health insurance does not cover all health needs. Consider trading a manicure or a trip to the hair salon for a health visit.
Keeping Weight On
JudyK: I weigh 96 pounds at age 68. I love to exercise and am very active in Silver Sneakers and the local health club. I do yoga class twice a week, Silver Sneakers twice a week, a 30 minute elliptical a few times a week, and a few machines several times a week. Question: With no hormones left at this stage of life to develop much muscle, and eating a healthy low fat diet, how can I maintain weight or even gain a little?
Speaker_-_Maxine_Smith: It is great to see that you are so active. The resistance exercise should help you maintain muscle mass. Fats are calorically dense, so adding a bit more of "healthy fats" such as peanut butter, olive oil, avocado or nuts to your diet could help to maintain weight or gain a few pounds.
Cleveland_Clinic_Host: I'm sorry to say that our time with Maxine Smith, R.D., L.D is now over. Thank you again Maxine for taking the time to answer our questions about Keeping Your New Year's Weight Loss Resolution.
Speaker_-_Maxine_Smith: I enjoyed chatting with you and helping to answer your great questions. Recommit to your healthy eating goals for the rest of the year and you will be proud of what you can achieve.
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