SOS! Stop Over-Sitting!

While on book tour for Fight Fat after Forty, I was getting ready to be interviewed by an NPR station in the Carolina's when the anchor asked me an interesting question: "Hey, congratulations on your book. So, how many pounds did it cost you?" Surprised, I asked him what he meant. "Well, I'm a writer as well. For every book, I spend months sitting down hammering away on my computer and I always seem to gain weight. Some of it's just stress eating, but a load of it is sitting on my rear. Most of my books are worth about a 15 pound weight gain. It's a real pain to work it off once the book is done."

I definitely related to the stress and sitting. But curiously, I had unintentionally prevented weight gain due to my natural state of get-up-and-go. Knowing I'd be writing for hours, I followed two rules. The first was to start and end the day with a walk and/or run. This allowed me to launch the day feeling refreshed and energized, and finish the day rejuvenated. The second was to practice my self-made "assume the vertical for 5 minutes every hour while writing" rule. I set an alarm and every hour for five minutes I get up and walk around and stretch. It certainly helps my thinking while keeping me sane while I spend countless hours writing and rewriting manuscript. I shared this with the NPR anchor and he promised to give it a spin for his next book.

This got me thinking about the issue of sitting. I'm a member of a special group that's writing a National Physical Activity Plan for America. We're examining what level of activity is healthy and promotes wellness while preventing disease. Sedentary behavior is front and center. As it turns out, when you make sitting a second career, there are indeed health consequences.

Researchers who investigate the science of sitting are sending out a wake-up call. For example, a recent study published in Circulation noted that after scientists followed 8,800 Australians for 6 years, they discovered that every hour of TV watching (while sitting) was associated with an 18% increase in deaths by heart disease, and an 11% increase in deaths overall. Those folks who watched TV at least 4 hours every day were 80% more likely to die of heart disease, compared to those who watched less than 2 hours per day. Since Americans watch an average of 5 hours of TV per day, we're in trouble. Kind of takes the bite out of those day long marathons of House!

In another study of 17,000 Canadian adults, scientists found that people who spent excessive time sitting for any reason were more likely to die of heart disease within 12 years. But these results come with a twist. It didn't matter if you were slender or that you exercised regularly. In other words, if you're hitting the gym or taking that walk once a day or twice on weekends and then spend the rest of your life sitting, you're still increasing your risk for heart disease. The researchers concluded that sitting too much was not the same as not getting enough exercise. There seems to be preventive power in spending more time up and active every day of your life.

Meanwhile, in another study, when American researchers placed electrodes on people's bodies while they were engaged in prolonged sitting, they noted that the muscles stop moving, giving the scary appearance of what would look like a brain's flat line. In related research, rats were studied after prolonged bouts of sitting, and scientists discovered a significant decline in a special enzyme that decreases the amount of fat circulating in the bloodstream. This suggests that in people who sit too much, fat is more likely to get packed into arteries, thus increasing the risk for heart disease.

OK, so what's the bottom line here? Here's my take on this new science. In many cases, those people who tend to sit in front of the tube for at least 4-5 hours per day also tend to be less active and over-eat, especially processed foods. There may also be mental components, such as depression, in play that further contribute to shorter life spans. Therefore, it's no surprise that there's an increased risk for heart disease, as any one of these lifestyle behavior components can significantly contribute to health problems.

Well, how much sitting should you do? Researchers don't know the answer to this question as yet. What we do know is that, like a fine racing car, the human body was not meant to sit for prolonged periods of time. You know how you feel when you've been glued to your computer for hours on end? Your body becomes achy and you're almost pushed to get up and move. One visitation to the gym on the weekend doesn't, as we now know, neutralize the health consequences of all of this sitting time.

Since national experts haven't provided guidelines yet, I've gone ahead and created some of my own.

1. Keep it movin'. Do you know a Nervous Nellie or Ned in your life? Do you recall what they look like? They're usually up and moving and they tend to be reed thin. Nellie and Ned aren't running marathons, but their activities add up over time, like pennies in a piggy bank. Researchers have found that you can burn up to an extra 350-500 calories per day by accruing a whole host of lifestyle aerobic (walking) and strength (hauling fire wood, composting, carrying groceries) type activities in 24 hours. And this is gym free living. The National Institutes of Aging notes that you can prevent disease by simply increasing these "activities of daily living". Heck, just get up and move more.


2. 5 minutes of every hour, assume the vertical. So much of our professional and personal lives are spent sitting. It's so easy to lose track of time. With the advent of the computer, the tube and countless other high tech toys, we're clocking serious chair time. That's why I created this little rule. Set your alarm (a kitchen timer works) and just aim to get up for at least 5 mins every hour and move. Walk around, stretch, run in place, clean a little more of that closet, or hit some yoga poses (my faves include sun salutation and warrior pose). The key is to try not to let 60 minutes go by without gettin' vertical.


3. Try a Walk 'n Talk. Years ago, I began walking with many of my patients during their appointment. It was a revelation to see how much walking outdoors in the fresh air affected people's ability to open up and speak about the challenges in their lives. Not only was it great aerobic exercise, but it was enjoyable (elevated mood) and productive. Next time you want to meet up with a friend or colleague, why not schedule a walk 'n talk? This also includes talking on the phone. Don't just sit there. Get up and move while you're yapping away. Works like a charm.


4. Movin' and Tubin'. Hey, look I like my Law and Order episodes as much as the next person. Sometimes I'll watch them while I'm sitting. And, I may get up to do other things during the commercials. Or, I'll tape the show and play it back while I'm hitting my elliptical. That way I can zip through the commercials and spend less time on the tube for an optimal win win- staying active and vertical while enjoying the tube.

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Don't Self-Destruct! Adapt and Adjust!

Since you began your "I'm gonna get into better shape" journey, you've been learning how to integrate better nutrition and physical activity into your daily life. And I'll bet that you've come to realize that living healthfully in today's 24/7 grab-and-go world requires navigating countless minefields of tempting trash treats and hefty speed bumps every time you want to get in some physical activity. When men and women start a journey to improve their health, shed pounds, and become fit, the original enthusiasm begins to fade right around the fourth week of slugging it out. Red alert when you start to hear these words spill from your lips "I was doing just fine UNTIL ..." as you contemplate throwing in the towel. Go ahead and fill in the blank with the UNTIL___ stresses - my job has me traveling more; my boyfriend dumped me; I got a new micromanaging boss; I sprained my ankle; I'm suddenly financially strapped; I'm depressed and anxious about someone I'm care giving. The possibilities here are endless.

So the next step in your quest to become lean, healthier, and more fit is to learn how to manage these life stresses without reverting to old habits - eating your way through the stress, dropping the workouts, ceasing to do things that give you joy, and abandoning your self care.

When I wrote Fit to Live, I began the book with a quote from Charles Darwin. "It is not the strongest of the species who survives, nor the most intelligent that survives. It is the one that is the most adaptable to change." Scientists have known for years that survival is based upon the ability to be flexible, to modify habits as needed in response to life's ever changing environment. This is about regrouping when life throws you a curve ball and the two critical elements of regrouping involve the ability to adapt and adjust. I love to use them together as a verb I call "A²" or "A Squaring." The goal is to show that no matter what hits you in life, you can adapt and adjust without resorting to self destructive behaviors.

Adapt is a mental attitude that says "I'm facing a situation that I have to come to grips with." It's about accepting the situation - my boyfriend or girlfriend has left me - with as minimal negative effects on yourself - shame, guilt, anger, denial, dissociation, inertia, stress-eating - as possible. What you're doing is getting real and wrapping your head around whatever the stress is. You're accepting a new reality.

Adjust is the technical end of the regrouping equation. Now that you've mentally adapted to the new reality - I've gained 30 pounds - you're ready to map out a strategy to deal with this stress. It's about formulating a plan and implementing it.

Mastering the art of regrouping as soon as possible will affect everything you do in life, whether it's shedding weight and getting fit, or coping with a new baby, a change of career, or the loss of a loved one. Studies of the great centenarians have shown that a common characteristic of these amazing 100-year-olds is that they are "stress shedders." They fully experience a stress but don't allow it to paralyze and destroy them. They have an innate ability to A² fairly quickly and move on with life. You can, too.

Becoming a master of adapting and adjusting requires a lifetime of practice. Anything rewarding in life involves practice, from motherhood to great artistry. The great news is that it over time it does indeed become easier. For that matter, after a while, you can get pretty macho about this, and say "Go ahead, bring it on. I'll show you how I can adapt and adjust!" Upon returning from business travel that involved one delay after another, one of my patients proudly declared, "It didn't matter that I was stuck at that airport tired, hungry and surrounded by fast-food places. I just paid attention and made the right choices. For that matter, I even got up and walked around to get in some more steps for the day. It's a heck of a lot better than sitting on my butt at the gate!" Now, those are the words of someone who's mastering the A² mentality.

Now, let's go back to the "I was doing just fine UNTIL___" issue. Right now, make a list of your own unique "UNTIL's." Think back to the last 10 times you tried to shed some weight and get more fit and then it all fell apart when what happened? It's often an eye opener, as you start to see patterns. For instance, every holiday you blow it, or whenever you're in a hotel you become one with the mini bar, or you head to the fridge every time your boss criticizes your work. Once you identify the pattern, you can start building a strategy for dealing with that particular stressor so that you're prepared when it hits again.

Here are some easy steps for you to take the next time you hear yourself shouting "Oh no, incoming!" as these stresses start hitting you from every angle.

1. Acknowledge the new stress. Do not panic. Do not deny it. Let the reality sift through you. Take a deep breath and be with the new stress.


2. Adapt by wrapping your head around the new reality. For example, you hopped on the scale for the first time in six months and you're up 40 pounds. That's a reality. Let it sink in. Your cholesterol and blood sugars are up. Get the numbers. Take measurements. You'll need these to adjust to the reality.


3. Gather facts. As soon as the dust settles, make certain you have all the facts you need to address this new stress. This can be challenging so try not to get so emotional you become anxious and blind to reality.


4. Get support to help guide you. It often helps to find resources in your life to assist you as you begin to comprehend the new stress. Reach out and ask for help.


5. Adjust by formulating a strategy and plan. Once you can think more clearly and have accepted the new reality, hope is born from creating a way to manage and cope with the stress. That hope becomes your driving force.


6. Do not abandon your self care while learning how to adapt and adjust. You may have to shift your schedule and actions, but do not stop caring for yourself. You still have to nourish yourself and keep physically active, if not to just maintain your sanity while coping. For example, if you're spending time at a hospital supporting a friend or family member, you still eat healthy foods, and may find that some of your walks are around the hospital grounds instead of at the gym. That kind of flexibility is the foundation for optimal adapting and adjusting.

I will guarantee you that your ability to achieve your best body and healthiest lifestyle is based upon how well you can adapt and adjust to the stresses and challenges that threaten to derail your best efforts. Practice these simple steps every day and reap the benefits of an amazing transformational win win - your physical fitness and health transformation, as well as your transformation into a master of adapting and adjusting.

Think Small Lose Big

• Week 1: For Lasting Change, Start with a Power Mind
• Week 2: The Secret to Dropping Real Weight is to Eat Real Food
• Week 3: The Next Step is the Big Step
• Week 4: The Lifestyle Rx for Muffin Tops and Menopots
• Week 5: Don't Self-Destruct! Adapt and Adjust!

Who Said Fast Food's Getting Healthier?

I almost fell off my chair when I saw the first ads for Taco Bell's new Drive-Thru Diet campaign. I ran to my computer and decided to scope out the facts. There are 7 options of tacos and burritos. Good protein content, up to 8 grams of fat and 2.5 grams of saturated fat, and 150-340 calories per serving. Not bad until I saw the sodium content. That Taco Burrito Supreme Chicken has 1410 mg sodium. Fact: normal sodium consumption should be less than 2300 mg per day. You'll be bloating away with this option. There are a few 350-600 mg sodium options. Christine, Taco's pitchwoman, dropped over 50 pounds eating their Fresco Ranchero Chicken Soft Taco which has 4 grams of fat, 1.5 grams of saturated fat, 170 calories, 12 grams of protein, and 740 mg sodium. I hope that was one a day while she was exercising and eating whole foods otherwise.

Taco Bell's not alone. Dunkin' Donuts now sells egg-white veggie flatbread at 290 calories, 9 grams of fat, 4 grams of sat fat, 11 grams of protein, 680 mg of sodium and 39 grams of carb of which only 4 grams are sugar. This is a better alternative to the chocolate glazed cake donut at 280 calories, 15 grams of fat, 7 grams of sat fat, 33 grams of carb of which 16 are sugar, and only 3 grams of protein. Hey, I'm all for occasional treats, just not every day.

Quiznos now provides a 500-calorie-and-under menu with a"500" symbol to identify these items. There are 20 of the lower calorie options in all. That's the good news. The bad news is that the nutrition information has serious problems. Someone's trying to get away with murder. The descriptions include only the total calories, the sat fat (not the total fat), nothing about protein content, no breakdown on the carbs (how much is sugar) and three separate columns on trans fats all of which read "0" making it look as though you're eating no fat. It's misleading at the very least. The finally coups de grace was the sodium content. They must think we're idiots and we don't read these labels. The sodium ranges from 951 mg to close to 4000 mg! Until they put out more honest labeling and decrease the sodium big time, run!

McDonald's has a terrific website, chock full of complete nutrition information. There are plenty of options under salads, with a grilled chicken on a bed of greens at 320 calories, 9 grams of fat, 3 grams of sat fat, 30 grams of carb (11 gr sugar), 30 grams of protein and 960 mg of sodium. This is including the dressing they give you along with the croutons. Clearly you can cut the fat, sodium and carbs down by using just a small amount of the dressing. It's all about customizing to your needs.

I took a trip to the Starbucks website and encountered a challenge trying to find information about their new Panini sandwiches, touted to be 400 calories or less. The homepage has nothing about food. If you search "food" you hit a dead end. But, if you click on "coffee" and then "nutrition", voila the sandwiches show up. Someone's got to update that website so it's easier to navigate and scope out the food selections. The Starbucks Food page is brief and features the four varieties of the panini, as well as pictures of blueberries, raisins, oatmeal and muffins. However, in order to find out the nutritional information of any food, you have to choose which store you frequent as the preparation is "unique to each market". I selected one I often visit and, like finding the treasure at the end of a long hunt, I finally found the Santa Fe Chicken Panini: 380 calories, 10 grams fat, 5 grams sat fat, 47 grams carb, 2 grams sugar, 26 grams of protein and 870 mg of sodium. The other paninis' contents were roughly about the same. The chicken and vegetable wrap sounded like a better deal at 290 calories, 9 grams of fat, .5 grams of sat fat, 36 grams of carb, 3 grams of sugar, 19 grams of protein and 530 mg of sodium. The good news is that these are a heck of a lot better than chowing down on a mountain of scones with that latte.

Finally, there's Subway. We're all familiar with Jared and his big time weight loss purportedly eating Subway sandwiches. Actually, I've read he's putting it back on, which I hope is not true. The chain has enlisted Shay Sorrells, one of the contestants from Biggest Loser, who's dropped 161 pounds but has plateaued at 300 pounds. Subway's now offering her $1000 per pound for every pound she sheds until May. I'll be interested to see how she is as a spokesperson and how she integrates their food into her program. From the website, there are a number of lower fat 225-280 calorie 6" sub sandwich options. Again, watch out for that sodium content at 700-1200 mg per serving.

You've heard me harp about sodium throughout this blog. That's because most people pay little attention to it. The lower fat foods are heavily salted at fast food restaurants because it is supposed to make them tastier after the fat has been reduced. This is exactly the problem with other low fat items that are higher in sugar content to, once again, make up for the loss of fat tastiness. But watch out for that salt. The January 2010 issue of the New England Journal of Medicine noted that if people were to decrease their salt intake by just a little, they would lower the number of heart disease and stroke cases as much as if they'd dropped weight, lowered their cholesterol or stopped smoking. Some of the companies are experimenting with other ingredients and spices to reduce the salt load, but currently the majority of the fast food options are very heavily salted.

Finally, can you really believe the ingredient breakdown and nutrition information provided by these companies? The American Dietetic Association noted that in recent surveys, some chain restaurants and supermarkets were understating their nutritional information by a whopping 18 percent. It's hard to trust the data knowing you're getting such misleading information.

My bottom line is "buyer beware". I think that it's good the companies are at least offering better options relatively speaking. I'd buy something there if I had no other choice. And if you have to eat there, remember it's like walking into a mine field. Stay focused and don't be tempted by their typical high fat, high carb fare.

Instead, if you want to be healthy and drop those excess pounds, I would not recommend you rely upon regular use of any fast food restaurant. For crying out loud, just get to the grocery store and buy fresh produce, whole grains and lean protein. Do something wild and radical like make your lunch, eat a healthy breakfast and dinner, and bring along some fruit for snacks? When you can't trust others to nourish you, you can certainly trust yourself!

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The Lifestyle Rx for Muffin Tops and Menopots

Of all the anatomical parts in a woman's body, it's her middle that gives her the greatest amount of frustration and anxiety. If a woman is carrying an extra 10 or more pounds, she'll feel anguish over the muffin top she sees every time she pops into her jeans. Women over 40 have a greater tendency to pack on the belly weight as they course through their perimenopausal years and beyond. I call this belly fat the Menopot. All women will have a Menopot and the normal amount of fat is ideally no more than 5 pounds. However, most women are carrying double digit Menopots and too much Menopot leads to a major muffin top.

It's time to deal with this bountiful belly. It's time to change.

No one ever changes their behaviors without the presence of two factors. The first is a feeling of pain or angst about something in your life great enough to grab your attention and force you to want to change. For example, you look at yourself in a pair of jeans and what you see is a belly that's spilling over your waistband and a zipper that's ready to pop. Now, you may have been walking around like this for a while and you've been surviving by simply dissociating yourself from the problem. "Muffin top, what muffin top?" And then one day, something happens and you awaken from your dissociation and you realize you can't go on like this. You've reached rock bottom. You have to change and you're ready to do whatever it takes to resolve this girth control problem.

The second factor that must be present before meaningful and sustainable change takes place is a reward. People only change when they're transitioning from something unpleasant to a joyful rewarding place. What's the reward for all of the work it's going to take to reverse your bulging belly? Well, that's up to you. Some women dream of wearing a tucked-in blouse, belt, and jeans. Others are already suffering the medical consequences of too much inner belly fat and their reward is ditching the medications and living a longer life. The point is that everyone has to clearly identify their reward and use that as a motivator and a driver to make the changes necessary to achieve their goal.

I'm going to assume you really want to change and you're willing to get down to work right now. OK, before you get started, whip a tape measure around your waist across your belly button. Your goal is to be well below 35 inches. If you're 35 or greater, you have too much belly fat and that's associated with increased heart disease and diabetes. Keep this in mind as you begin your journey.

Here are the three belly-blasting steps to get you started and on your way to whittling your waist.

MIND:
Visualize your reward. Close your eyes and see yourself without the bigger belly. What do you look like? What are you wearing? How much lighter do you feel? How much more energy do you have? How proud will you be when your doctor marvels at your accomplishment and you can take fewer medications or perhaps get rid of them all! If you have any trouble with the reward, think about what gives you joy in life. Make a joy list. Are you holding back on any item because your belly's in the way? Feeling bad about your body and not going dancing? Can't bend over to do your gardening the way you like to because there's a belly in the way? Keep working at this until you can come up with a joy that can be turned into a reward that can power you through to your goal.

MOUTH:
Remember the big three. Pay attention to the quality and quantity of your foods, as well as the frequency of your meals and snacks. Quality means you're concentrating on consuming whole foods (veggies, fruits, whole grains, lean proteins). It also means you're eating real foods, and not processed science fair projects. Real foods also mean eating high quality fats, carbs, and proteins. Don't be afraid of healthy fats, or the monounsaturated fats (MUFAs) like olive and canola oil. They not only quell your appetite, but they leave you feeling full and satisfied. Nuts, pumpkin seeds, avocados, natural peanut or almond butter, edamame, semi-sweet chocolate chips, and olives are just a few examples of these terrific foods.

Also, research has shown that when you incorporate MUFAs in your diet, you'll decrease your belly fat load. Quantity is all about reining in those portions. Eat slower and stop before you're full and you'll notice you're eating about 400 to 500 calories per meal instead of 2,000! Bellies show up because we just plain eat too much. Frequency means you'll eat every three to four hours from breakfast through dinner. In the best of worlds, you'll lighten up dinner and finish by 8 p.m. or 8:30 p.m. at the latest. The later you eat, the easier it is to pack on the belly. Research shows that if you overeat at night, you'll gain twice the fat compared to the day time. Lighten it up and eat earlier. Wake up hungry and ready for your "breakfast"!

MUSCLE:
Work your body. The magic formula to blast your belly is a combination of cardio + weight lifting + core work. The trick with the cardio is to do intervals of intensity and try to burn 400 calories per workout. Or, break it up into 10 or 15 minute segments with intensity. Mix it up and cross train with other activities (treadmill, outdoors, elliptical, rower, biking indoors and outdoors, jump roping, brisk walking, hiking, etc). It's great to get in some kind of cardio every day, but just make sure to hit it hard no less than four to five times week. Weight training is vital if you want to see a real shape shifting in your body composition. Twice a week is all it takes and most plans don't require a gym. In both Fight Fat after Forty and Body for Life for Women, I made a point of showing you how to use your own body at home to get an effective whole-body workout. Finally, working your core does not mean countless crunches. Instead, I like to draw upon simple Pilates mat work and slower, more concentrated abdominal contractions to achieve a maximal benefit. Yoga and Pilates are terrific to integrate into your program to provide a terrific mind and body experience.

Here are three final belly-blasting rules.

1. What you do from 3 p.m. on will determine your girth size. This is the time of day when women start to lose it. Make sure you have a planned mid-afternoon snack (peanut butter on a WASA cracker with a dollop of jam; carrots and hummus; protein shake). This will control your appetite at dinner. Be careful not to overeat at dinner. Watch out for after dinner eating and don't be taking the boys (Ben and Jerry) into bed with you. It's the ménage a trois guaranteed to pack on the belly!


2. If you don't wake up hungry in the morning, you overate the night before. The key is to use your sleep as a semi fast time. You don't want food in your stomach during the two hours or more before you go to bed. If you do wake up hungry, I'll guarantee your belly will feel flatter in the morning.


3. For a flatter belly, get seven to eight hours of restful sleep. It's a fact that women who don't get enough sleep and/or their sleep is poor quality have larger bellies. They're less likely to be mindful of their mouthfuls and are much less likely to have the energy to work out. Get your zzz's!

Think Small Lose Big

• Week 1: For Lasting Change, Start with a Power Mind
• Week 2: The Secret to Dropping Real Weight is to Eat Real Food
• Week 3: The Next Step is the Big Step
• Week 4: The Lifestyle Rx for Muffin Tops and Menopots

Just What IS an Average Woman's Size Anymore?

The talented young actress Gabourey Sidibe, star of the widely acclaimed film Precious, graces the cover of the latest copy of V Magazine. It's a special "size issue" of the publication, showcasing plus-size models and challenging the notion that the only women who can wear cool clothes are rail thin toothpicks with a two foot gap between their thighs. Sidibe has noted in interviews that she's struggled with body image and excess weight for years, commencing with countless diets at the age of 6. At age 26, her present weight is estimated to be anywhere from 250-300 pounds, and it's no surprise her size has been a focal point of heated discussions emanating from the bone-hungry, skinny-obsessed Hollywood crowd . Sidibe comports herself with self confidence borne of a resolution she made at age 21 to love herself as she is.

This V Magazine edition is timely. First, designers are getting ready for the unveiling of their 2010 ready-to-wear collections, and the fashion world waits in eager anticipation, wondering if plus size clothes and models will finally be hitting the runways. Second, the First Lady has just launched her fight against childhood obesity and is leading by example with her active and fit lifestyle. This program will be her legacy and she's gearing up for an aggressive campaign encouraging the whole family to take themselves on, shed excess pounds and get fit and healthy. Third, as I had mentioned in a prior blog, the new Surgeon General, Dr. Regina Benjamin, is coordinating a national wellness program targeting obesity and physical inactivity in American's lives. This is a powerful convergence of the worlds of retail, government and the White House. And, it appears everyone is jockeying for position as beauty and health are redefined for the American woman.

It's no wonder that so many of you are scratching your heads and wondering just what are you supposed to be aiming for in this weight and size game. What size is "normal" - what is an average weight anymore?

To answer this question, let's look at some facts. The average starlet is wearing a size 2 or 4 which is the sample size designers are making presently. Today, the average American woman is 5'4", has a waist size of 34-35 inches and weighs between 140-150 lbs, with a dress size of 12-14. Fifty years ago, the average woman was 5'3-4" with a waist size of approximately 24-25", she weighed about 120 lbs and wore a size 8. Curiously, over the past twenty years, fashion model sizes have dropped from a size 8 to 0. Whenever I hear 0 I can't help but envision an invisible woman. It gets more interesting when you look at changes in women's bodies and dress sizes dating from the 1950's. There was actually a uniform sizing system for women's clothes until the US Department of Commerce dropped it in 1983 noting that the traditional sizes were no longer reflecting the size and shape of the average consumer. Today, in order to cater to women's vanity, as women have gotten larger, designers have manipulated sizes so that truly larger sizes are marked as smaller. A size 8 in the 1950's is now a size 4 or less today. Sizing from brand to brand is now so variable that most women fill their closets with at least two or three sizes.

My patients constantly ask me what size and weight they need to be in order to achieve their optimal fitness and wellness. I see this on my weight loss and fitness boards as well .. Who's calling the shots on the definition of beauty as well as health? The fashion industry with their emaciated models? The fitness folks with their flat-ab'd muscle mavens? Celebrities from size 0 to Sidibe-sized stars? Government professionals armed with charts, graphs and committee reports?

The answer is all of the above. Each group is helping shape women's perception of what is right for them. Women are turning their backs on the skin and bones coat hangers that have been the mainstay of the runway model. The '80's ushered in the fitness magazines and their meatier, curvier models. Women are starting to get smarter and realizing that reaching a jeans size with no fitness involved is an empty experience. Also, the fitter you are, the more you can weigh at a smaller size. Hey, sign me up! Most of us now roll our eyes at the weighty roller coaster antics of some celebrities (e.g., Kirstie Alley), and are saddened when others succumb to pills, depression and starvation. The First Lady bares her biceps and gets down and dirty planting an organic garden on the White House grounds. Women everywhere want those arms. And the Surgeon General takes herself on and personally as well as professionally commits to getting healthy and mentoring others as well. The Doctor in Chief is showing she's human and asking folks to work together to solve this obesity problem.

So, where does all of this lead us? I believe that women want to be able to see a range of possibilities in the media as well as in government recommendations. Skip the starving or frankly obese models, and show a spectrum of active, fit women of a variety of shapes and sizes. Plunk them all into great clothes and show the world that a real diversity of women can look and feel great. We want to celebrate a wide spectrum of health and fitness, and run from the old stringent, "skinny" definitions of beauty that have haunted us, leading to eating disorders, eroded self esteem and scale hopping, pill popping madness.

What's a healthy and appropriate size for you? The answer lies in this key list of health indicators:

1. Know your waist size. Take a tape measure to your waist, measuring across your belly button. Your goal is a waist circumference less than 35". More than that is unhealthy because it's associated with too much internal belly fat, and that's associated with heart disease and diabetes.


2. Identify your shape. Pull out that mirror and embrace your hour glass, pear or apple shape. This is where genetics plays a significant role. Your job is to optimize your genetics. So long as your waist size is less than 35 inches, you're OK. You apples need to be on red alert to rein that waist in for health's sake. Pears should celebrate the fact that lower body fat is not usually associated with disease.


3. Measure your body fat. You can buy a body fat scale or have a fitness professional perform a measurement at a health club. Average women should keep their body fat in the range of 20-29% until they become menopausal. After that time, body fat through age 60 can peak at about 32%. Too much body fat all over the body increases a woman's risk for breast cancer. Too much inner abdominal fat leads to heart disease and diabetes.


4. Calculate your BMI. Check out the BMI Calculator Plus on WebMD and plug in your weight and height for your BMI. It's best to keep this in the range of 20- 25. If it's greater, it's associated with the consequences of overweight and obesity. If it's less than that range, you may be too thin and headed for trouble. The only exceptions to the BMI rule are truly athletic and muscular people. That means their BMI may be higher than normal, but their body fat is usually lower than normal.


5. Live a healthy lifestyle. If you're eating a healthy diet and getting in at least 30 minutes of cardio activity 5 x week along with some form of strength training 2 x week, then you're living an optimal lifestyle. No one's perfect. The key is not to be sedentary all of the time, and eating trash 24/7. If you are, you're living an unhealthy lifestyle fraught with increased disease risk. Also, you'll never know your ideal clothing size or body shape unless you make better lifestyle choices. These healthy habits will correct the red zones you may be occupying right now in the other categories in this list.


6. Note your clothing size. Whip out a piece of clothing (jeans) that fits you perfectly. That's your current size. How do your other numbers look? If you find that you're in an unhealthy range, you'll need to shed some excess fat. Your clothing size will change with healthy lifestyle choices. Once you're no longer in the red zone for health risk, look at your clothing size and that's where you belong. The only way to continue to improve that size is to take it up a notch and add more intensity and exercise, while paring away excess calories.

The bottom line is that a healthy body (and body image) is nestled somewhere between the extremes of fashion's scary skeletons and frank obesity. Do the work it takes to become healthy. And while you're at it, define your own sense of beauty.

This is, after all, your life.

Planting the Seeds for Permanent Lifestyle Change

Photo: catlovers
CC BY-SA 2.0

Recently I received a unique gift. One of my colleagues knew I loved flowers and voila, there it was, an "easy to grow indoor plant bulb". The instructions promised a gorgeous fiery red Amaryllis as a just reward for my laboring over the pot. But wait, there's a catch. It takes 8-10 weeks before I see a bloom. You mean I have to wait? I can't just plop the bulb in the pot, water a few times and enjoy the bouquet? I was feeling the stirrings of impatience, and immediately called to mind an Oren Arnold quote, "Dear God, I pray for patience, and I want it Right Now!"

Then I had a moment of inspiration. So many of you are striving to improve your lifestyles and get in shape. Regardless what month it is, it's always a terrific time to regroup, renew and rejuvenate yourself. But the funny thing about change is that you want to see results right away. Who cares that it took you 5 years to pack on the pounds? You want them gone tomorrow. Once you've had an awakening, and you've broken through your own dissociation about your current state of health and fitness, suddenly you feel the pain and angst and you want it gone now. I hear you.

Photo: catlovers
CC BY-SA 2.0

So, why not go for a win-win and start on your journey while also learning how to practice that one virtue few of us have mastered - patience? Let's literally plant the seeds of permanent lifestyle change right now. I challenge you to go out and buy an indoor plant bulb and care for it until the blossoms appear. What a neat way to remind yourself of the patience you need to build a strong foundation for anything in your life, let alone your health.

While you're searching Google to find a great bulb place, let me share a few insights about patience. Countless times I have heard my patients cry out, "Why does it take so long to drop this weight or get fit?" Actually, most of these folks are doing just fine and don't recognize their achievement. "Yes I've dropped 10 pounds but I have so far to go. This is taking forever!" The "but" just negated the sweet success and progress already achieved. A more patient reply is "Yes I've dropped 10 pounds and I am well on my way to achieving my goal!". That simple substitution should leave you feeling empowered and in control of your destiny. That's the power of patience.

Photo: catlovers
CC BY-SA 2.0

The Merriam-Webster dictionary defines patience as "the capacity to endure hardship, difficulty, or inconvenience without complaint. Patience emphasizes calmness, self-control, and the willingness or ability to tolerate delay. It also connoted tolerance, understanding, persevering, being constant, and capable of calmly awaiting an outcome or result." Pay close attention to the last phrase. You need to be very clear about your goal. It's got to be front and center in your mind, fueled by determination and passion. I know what that Amaryllis is going to look like after 8 weeks. You may not know what your body will look like after 8 weeks of healthy choices, but you can be guaranteed it'll be better than it is now! So, keep your eyes on the prize. I love this quote from Margaret Thatcher, a heroine of mine, "I am extraordinarily patient, provided I get my own way in the end". You got that right! And you will get your own end when you carefully and patiently choose your lifestyle habits wisely every single day.

We all get angry and frustrated when it seems as though we're not progressing as fast as we want. The Dalai Lama says "Patience...is cultivated through the rational process of analysis...It is essential that we being our training in patience calmly, not while experiencing anger." So, calm down already. It's in that calm place that you'll find your most profound patience.

Want to hone your patience skills? Here are some great exercises:

1. When describing your healthy lifestyle program, concentrate on what you've accomplished. Stick with the "glass half full" attitude as that allows you to be positive which strengthens patience.


2. Acknowledge others for their patience toward you and the people around them. When you make it viral and spread the message that patience is a real gift, it reminds you to be patient which then helps empower you to achieve your wellness goals.


3. Eat patiently by taking at least as long to eat your meal as it took to cook it. This only works if you actually cracked open a pot, so do some real cooking!


4. Talk to yourself with patience and love. If you're not sure how to start, simply talk to yourself as though you were your best friend in need of help and support.


5. Control your use of stimulants (e.g. caffeine) and you'll be calmer and more patient throughout the day.

Every day, tend to yourself and your potted bulb. Practice patience as you visualize the beautiful flower and your healthy body emerging gradually over time. And when the going gets tough, recall these wise words from St. Francis de Sales: "Have patience with all things, but chiefly have patience with yourself... every day begin the task anew".

Photo: catlovers
CC BY-SA 2.0

OK, take your patience pill and get started today!

The Next Step is the Big Step

You're three weeks into our Think Small Lose Big 8 week program to create healthier, sustainable lifestyle habits. You've committed to making healthier choices by writing your pledge and posting it around the house. You've also learned that to shed real weight you have to eat real food.

The next step is the big step- literally! It's time to step it up and move your body. Hey, what goes in must come out. This means that what you eat has to be burned up by physical activity. The great news is that 2010 brings with it new fitness and activity trends to help you mobilize and keep it going. Erase any nightmarish thoughts about 4 AM gym workouts at some Olympic camp. Instead, this year we have plenty of inexpensive new, fun, and exciting ways to get up and get fit.

Take advantage of these new creative trends to move that marvelous body of yours, no matter how old you are or your current fitness level. Don't wait another day. Take your pick, mix it up and start today!

1. Look out for fitness bargains. Get a cheaper gym membership. The economy's still in rough shape and this is the time to bargain for lower dues as well as cost effective trainer packages. Find small, portable home based fitness equipment on sale and customized to you, the budget conscious consumer.


2. Train in a group. Instead of relying on more expensive one-on-one personal training sessions why not opt for a weight training class at the gym? Or, how about getting a small group together for a great personal training session. Many people benefit from the group support and camaraderie. You're less likely to blow off your workout when you know you're accountable to others.


3. Shorten your workouts while increasing their intensity. We're all time starved. In order to get the most out of your workout, you need to increase the intensity to burn the same number of calories in a shorter period of time. Boot camp style workouts can give you a quite a comprehensive experience, often combining intense cardio as well as weight lifting in an hour or less. Check out circuit training as well, as it can provide short bursts of endurance and resistance training for a great workout session in 30-45 minutes.


4. Get your game on. It's time for exer-gaming. Wii Sports, Wii Fit and Dancetown will no longer be only home-based. Heads up for their appearance at more health clubs throughout the year. These fitness-based video games change up the usual drudgery of the basic workout session, and add more fun and a chance to engage more muscle groups at one time. This is a great opportunity to get the whole family up and moving.


5. Blast through a Boomer workout. There are over 79 million Boomers out there demanding Boomer-specific exercise programs. This over-50 crowd has made the "exercise-disease prevention" connection and is showing up in larger numbers to get and stay fit. I'm predicting more mental aerobics will be offered with "cerebral gyms", where Boomers can challenge their memory and learning using computer based technology. Talk about a great mind-body experience!


6. Mind your body. In addition to whatever cardio and weight training programs you want to use, don't forget to explore yoga, Pilates, and the martial arts. Experiment and try a variety of classes. These movement modalities can provide ways to engage both mind and body for a unique inner self experience. Tai chi and yoga have been shown to reduce stress hormons, as well as produce other health benefits including reductions in blood pressure and depression. I highly recommend integrating some of these mind-body movements into your daily program.


7. Road Warriors Unite. I've got the travel miles to prove I'm a road warrior. One of our greatest challenges is trying to stay fit despite tough travel schedules. There are great products out there to help you stay on track. Whether it's rubber tubes or suspension devices, you can easily pack these lightweight products and put them to work on the run. I've used mine in the office, on a long plane flight (stretching in the galley while chatting with the flight attendants who always want to join in!), or in a hotel room. No matter where you are, we've got you covered!


8. Have fun with fusion classes. If you're bored to tears with the same old workout, it's time to try out the new dance and exercise classes popping up in every health club. How about hip hopping, pole dancing, hula hooping, Zumba and ethnic dancing? A great ball room dancing session will leave you clamoring for more. The bottom line is that moving your body can be loads of fun, guaranteeing you'll be back for more.


9. Geek it up to monitor progress. Thank heavens for the computer age and the gadgets galore you can choose from to keep you on your program. There are now simple to use tracking devices that help you monitor everything from the calories you burn to the steps you take. More mobile applications will become available that are downloadable to your iphones or similar technology. These apps will include online fitness plans, nutritional programs, and motivational tools. GoWearFit, FitBit and Training Peaks are just a few of the offerings for you to choose from.


10. Hire a certified fitness professional. You want and deserve the most credible fitness advice. That information will be provided by a certified fitness professional. Ask if your trainer belongs to an organization (e.g. American Council on Exercise, American College of Sports Medicine, National Strength and Conditioning Assn., etc) that is certified by the National Commission for Certifying Agency (NCCA). Your trainer also needs to maintain their credentials through continuing education courses. The goal is to deliver a safe, challenging program based upon cutting edge advances in fitness. A certified fitness professional can do just that.

Alright, it's time to do your homework. You have lots of options. While you're trying setting things up, don't waste time. Get up and walk more each day. Find excuses to increase your activities of daily living. Move more. Every step you take counts. These small steps are in reality the big steps you need to take to live long and live well.

Think Small Lose Big

• Week 1: For Lasting Change, Start with a Power Mind
• Week 2: The Secret to Dropping Real Weight is to Eat Real Food
• Week 3: The Next Step is the Big Step