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February 21, 2008

Expert offers advice to those seeking health balance

With Pitt’s 12-week MyHealth Weight Race in full swing, some 260 teams across the five Pitt campuses are striving to meet their weight-loss goals (and maybe win some prize money).

(See Feb. 7 University Times.)

But an expert in weight control cautioned that weight race participants should de-emphasize the competition part of the race and focus instead on meeting individual goals.

“This shouldn’t be about the chemists blowing away the geologists in a competition,” said Madelyn Fernstrom, founder and director of the UPMC Weight Management Center and associate director of the UPMC Center for Nutrition. “There’s nothing wrong — and a lot right — with a team approach, especially when it gives real support, but losing weight and managing weight are struggles of the individual. My motto is: When it comes to weight loss, one size does not fit all,” she said.

“Sure, there are certain fundamentals — you have to have fewer calories, you have to be more active and you have to monitor your eating behaviors. People also need to tailor a balance between diet and exercise to their particular situation. But how you do that will be different for each person,” Fernstrom said.

For example, an overweight person might suffer from joint pain that inhibits the ability to walk and exercise. “That person may first need physical therapy to correct that, so they can exercise,” she said. “Or weight gain may be related to a medical condition or to the medication a person is on, or the amount of stress the person is under, more than diet. Like everything in human life, weight management involves both biology and behavior,” she added.

Although being overweight does not guarantee dire health consequences, she said, “research shows that maintaining a body mass index (BMI) of 20-24 does have what we call value-added effects, such as stress release, living medication-free, being at less risk for diabetes and heart disease, having a better self-image. So, maintaining a healthy weight is an end in itself. This should be about a healthy lifestyle, not about going on a diet, which you can then go right off of.”

Maintaining a healthy BMI takes a lot of work, she said, especially as people get into their 40s and 50s, when naturally they are susceptible to “weight creep.” “It only takes an additional 100 calories a day to gain 10 pounds in a year. I tell people, the achievement of not gaining weight is a huge positive,” Fernstrom said. “Weight is a barometer of life. If you have a positive attitude, if you are active, if you have good balance in your life, you have more control of your life.”

Creating a structure contributes to the sense of control, she said. “It’s coffee break time. Instead of grabbing that doughnut, take a walk. If it’s too cold out, walk the halls or the stairs in your building. If you get sleepy in the afternoon, take a little stretch. Those types of activities on a regular basis decrease stress and increase energy, and they are habit-forming,” she said.

“If on the other hand you find yourself stressed out all the time, and you’re stress-eating as result, or you’re too mentally fatigued to exercise, you need to look at yourself in the mirror and say: What is the root cause of that stress? Why am I so tired all the time?”

Included in the advice Fernstrom offers to those with weight-loss goals are:

• Making “friends” with your scale. “You have to weigh yourself at least once a week and as much as once a day to track your progress,” she said.

• Keeping a diet diary. “We gain and lose weight like we’re on a flight of stairs: You go down, then you level off, or you go up, then you level off,” Fernstrom said. “So there are week-to-week small changes, and it’s useful to know if that two pounds you gained was just water-weight or is it because you went to that wedding reception and out to dinner three times that week.”

• Being patient. “If you should gain a half-pound to two pounds in a week, don’t try to make up for that the next week,” she said. “With modest weight gain, don’t panic, keep working at it.”

• Establishing realistic goals. “Don’t say, ‘I’m only going to eat salad for the rest of my life.’ Stay away from ads that promise you’ll lose 30 pounds in 30 days. Easy off is also easy on,” she warned. “Keep your expectations realistic.”

• Being motivated. “I know people with two, three, four sets of clothes. They say, ‘I gained weight, no problem, I’ll just buy a bigger suit.’ That’s the time when you should say, ‘No, I’m not going to buy bigger clothes, I’m going to get to where I fit in my old clothes,’” Fernstrom said.

• Eating more fruits and vegetables. Many fruits and vegetables contain nutrients that contribute to disease prevention, such as the cruciferous vegetables broccoli, cauliflower, brussel sprouts and cabbage, she said.

• Consulting with your doctor. “I’ve heard people say, ‘I don’t want to see my doctor. I’m fat and the doctor will just tell me to lose weight. He doesn’t care.’

“Your doctor does care. What he’ll ask you is what efforts you’re making to lose or maintain weight,” Fernstrom said. “If you go in and say, ‘I’ve been holding my calories to 1,500 a day and I walk for 20 minutes,’ those should be more effective. If that’s not effective, your doctor can look into other medical issues.”

There are plenty of web-based resources and dozens of weight-loss studies and programs at the University where motivated people can go for help, she noted, including her Weight Management Center, which covers all aspects of nutrition and weight control. “The bottom line is that a diet rich in lean protein, fruits and vegetables, and fiber-rich starches is going to be heart-healthy and brain-healthy. When you add physical activity and stress management, you have a healthy lifestyle.”

Fernstrom applauded the participants in the MyHealth Weight Race. “Often, it’s the individual making the effort that’s the most important and hardest step,” she said.

—Peter Hart

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