Everyday Fitness with Dr. Pam Peeke

The Weigh to Show Gratitude

noreply@blogger.com (Dr. Pam Peeke) — Tue, 24 Nov 2009 00:00:00 +0000

OK, so I'm playing with words here. I'm trying to help you connect your current weight management issues with the power of gratitude. Why? The holiday season is now in full sway, and it's a good time to sit down and be grateful for all that you have, as well as the opportunities that await you to do even better. So many folks out there may be stirring up the usual holiday anxiety about weight gain, loss of control over one's time and the usual over commitments and obligations. Stop, and take a deep breath. You'll be fine. Let's show you the weigh.

First, adjust your expectations about holiday goals and self care. Travel, family events and work can make it difficult to commit to the usual amount of time for exercise and planning for healthy nutrition. The answer lies in adapting and adjusting by doing what you can and moving on. Avoid perfectionism and being extreme or rigid. Second, don't fall into the abyss of feeling helpless, hopeless and defeated because your self care schedule is different. Make a new goal. You could do what I like to call "tread weight" during the holidays. You'll do what it takes to hold your own weight during the holiday season, correcting for any backsliding. Be grateful that by the end of the 24/7 running around, you're the same weight. When things calm down, you can regroup and aim for more progress.

Being grateful puts you in a self supportive mood, one of self love and nurturing. This calm can help drown out the voices of self criticism that plague so many of you as you try to eat well and stay as active as you can. So what if you couldn't get to the gym? Try to walk more throughout the day and bump up your activities of daily living. Be grateful you have a body that works well enough to do this in the first place. There's that gratitude again.

Want to exercise those gratitude muscles to keep you mentally centered all day? If you do, you'll be more likely to stay mindful of what you eat and how you move your body. Hey, it's great for relieving anxiety and thus reducing the risk of stress overeating. Take these simple steps:

Focus on what's right in your life and quit obsessing about what you think is wrong. Go back to your list of gratitude.

Say just one thing at any meal time for which you are grateful. If you're eating with others, get everyone on board to do the same. Doing so creates a magical moment for all.

Tell people in your life "thank you" as often as you can. The return on your investment is feeling terrific, which helps you stay on track with your self care.

Draw upon your gratitude during times when people you know and love are annoying and irritating. It keeps things in perspective so that you don't keep heading for the fridge to numb your frustrations.

Watch out so you don't lose yourself in others through envy or jealousy. Don't keep saying how much you want to look like someone else. Concentrate on and be grateful for your unique talents and strengths.

Be thankful you're still alert and vertical! Hey, so your thighs are larger than you like. Well, be happy your legs can still support you as you take a joyful walk. Celebrate a mind that can still be mindful of every bite you take to nourish yourself.

Find the lesson when challenges hit you. Be grateful for the opportunity to continue to learn something new and grow from a life challenge.

We're Eating Too Much

noreply@blogger.com (Dr. Pam Peeke) — Fri, 20 Nov 2009 13:56:00 +0000

Look around you and you'll see that America's putting on weight. Is it lack of physical activity or are we just plain eating too much? Well, it's a combination of both, but the European Congress on Obesity has proclaimed that increased food intake is the main culprit. You need to stay physically active to be fit and strong, keep body fat reined in, and have an optimal body shape.
But it's how much you're eating (healthy or junk food), that's really packin' on the pounds.

Actually, the scientists predicted that Americans would be about 24 pounds heavier than thirty years ago. But, instead, on average Americans carry an extra 19 pounds. The difference is that some people have picked up more physical activity which makes a real difference over time. Interestingly, if we want to get back to the slimmer weights of the 1970's, researchers recommend decreasing 350 calories per day for kids (a serving of French fries) and 500 calories for adults (a large burger). How do we accomplish this? If we used physical activity alone, children would have to walk 150 minutes per day and adults 110 minutes. Who's got that kind of time? Instead, how about just eliminating the fries and burger and bumping up the physical activity a little as well? The bottom line is that you need both.

Here's a recent posting from LadyPilot1998 on my weight management message board:

"Hi, I need some real HELP! I need to lose weight in order to keep my joints from hurting. I just have not been able to get this going and the several times I have got going... I just poop out. I live in hot, humid South Florida and need exercises that someone with limited range of motion can do inside. Frustration with myself is building and I am now at a real loss as to what to do. I would love to get any advice that could get me on the road to success. Thanks."

The road to success is paved with both healthy nutrition and physical activity. The key is not to launch into heavy duty running or lifting, especially if you have disabilities and perhaps have been sedentary for a long time. You'll get injured and, as LadyPilot noted, "poop out". When people want to drop weight, for many it's suddenly a crisis, and out of desperation, folks try to go too far too fast. There are better options.

For those with physical disabilities, there's nothing like water aerobics as well as strength training. The water carries your weight and your joints are protected so that you can engage in water based exercise classes. Good grief, there has to be a pool somewhere in LadyPilot's Florida locale. In addition, restorative yoga is wonderful. This movement therapy helps to build strength and flexibility. Walking to tolerance is a great exercise. The elliptical is kind to knees, while a recumbent bike is great for those with back issues. Tai Chi is a weight bearing movement that is gentle on the joints yet helps you with balance and flexibility. There are indeed many options. You also have to be realistic. If you cannot do intense training, it will take you longer to achieve your fitness goals. Time to take your patience pill.

The key to relieving those joints and getting into better shape is smart eating. Pay attention to quality- stick with whole foods, veggies, fruits, whole grains, lean proteins. Eliminate processed foods and refined sugars. Next up, be mindful of quantity. Even if you're eating whole foods, eating mountains of them still packs on pounds. While to remove excess fat, most women do well sticking to about 1300-1500 calories a day. Read labels carefully and stick to serving sizes. And last up, frequency of meals and snacks is critical. Eating roughly every 3-4 hours from breakfast through dinner is the way to go. If you eat appropriate servings of balanced meals and snacks (lean proteins with high quality fat and carbohydrates), your hunger is better controlled, which helps you rein in your appetite as well.

LadyPilot and everyone out there needs to whip out a journal and keep track of what, when and how much you eat for just a week. It's usually an eye opener to see how much you're actually consuming. Clean it up and add creative ways to move your body and you've got the winning combination to get this weight removal journey going.

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Blast Your Back Fat: Part Two

noreply@blogger.com (Dr. Pam Peeke) — Mon, 16 Nov 2009 23:00:00 +0000

Two weeks ago I wrote the Blast Your Back Fat blog post and heard back from lots of you. Many of you wanted to know more about the role of exercise in getting rid of your fat. For instance, does spot reducing work? In my original post, I made it clear that in order to drop those love handles, you needed to activate my three M's: Mind (get that stress under control so you don't stress overeat), Mouth (rein in the calories and eat smaller meals of high quality foods more frequently throughout the day), and Muscle (combine intensity intervals of cardio along with weight training, and don't forget cross training). It takes an integrative approach to minimize fat anywhere on your body.

So, do spot reducing exercises work? No, they don't. It's hard not to look at one part of your body that's stubbornly holding onto extra fat, and not to want to hammer on it endlessly. But that doesn't work. Spot reduction is a myth. You can't work a specific muscle group and hope to drop the fat around it. You'll strengthen the muscle, but the exercises will result in removing fat throughout the body. Look around the gym at guys and gals crunching away on ab balls, but they never seem to drop weight there. Well, it's because they're probably going home and overeating. The great news is that underneath their belly fat, their abs are strong. You just can't see them. As the abs go, so goes the back.

Are there any exercises you can do to tone and shape your back muscles so that as you adhere to a better nutritional program and remove fat, you can look more firm and fit? There sure are. Here are a few of my favorites. You can look in my book Body for Life for Women for specifics for many of these, which you can do at home as well as the gym. For instance, I use tubing (inexpensive and you can buy at any sports goods store) for home and travel workouts. Give them a whirl while also remembering to do your cardio no less than 5 x week, trying to burn 400 caloriess (you can accrue over the day), and using intervals of intensity (see my blog post on Vitamin I - Intensity).

Seated Rows:

Gym machine: Sitting on the apparatus with back straight and holding a handle from the cable in each hand. Slowly bend forward keeping the back straight and let the weight of the cable pull you forward, and then draw back to a straight back sitting position. It's like using both hands to row a boat.

Home: Or, take your tubing and wrap it around the leg of a table, bed or heavy sturdy object. Sit on the floor far enough away from the leg so that there is plenty of tension on the tubing, and grab one handle in each hand. Again, with a straight back, allow the tension to pull you forward and then pull back to a full upright sitting position. You should feel a stretch throughout your back. 10-12 reps in 3 sets.

One-Arm Rows:

Gym: using a workout bench, place one hand on the bench and the other hand is holding a moderately heavy (you should feel fatigue around the 8-10th rep) hand weight, letting the arm hang straight down. Bend forward at your hips, suck in your stomach, while your back and head are parallel to the floor. Now, retracting your shoulder blade, bend your elbow and pull the weight up until you feel your hand touch your body midway between your breast and pelvic bone. Hold, and then slowly lower your arm down. Repeat 10-12 times, then switch sides. Do this for three sets.

Home: If you don't have a bench, you can do all of this simply using a sturdy chair, whereby you put your free hand on the seat of the chair for stability. It helps to have a mirror so that you can watch alignment.

Rear Delt Fly:

Home or gym: Sitting on the edge of a chair or bench, grab a lighter weight in each hand and position hand behind each leg. Now, lean forward from the hips with your back flat. Tuck your chin into your chest. Raise your arms to the sides, gradually bending your elbows as they come up. Squeeze your shoulder blades together. Pause at the top of the extension and then slowly lower your arms. In my book I call this the Prone Fly, which can be done lying on your stomach on a bench with arms hanging to each side. Gym: Many gyms have a rear delt machine that's easy to use.

Opposite Arm and Leg Rises:

Home or gym:Lie flat on your stomach with your arms extended over your head and your legs straight. Either rest your forehead on the floor or turn your head to one side. Slowly and simultaneously raise your right arm and left leg until it's difficult to keep your pelvis and chest flat on the floor. Lower and repeat with the opposite arm and leg combination. Don't twist or rock your body to make this easier. Stop if you feel pain.

Shake Up Your Fat Cells at Any Age with "Vitamin I"

noreply@blogger.com (Dr. Pam Peeke) — Thu, 12 Nov 2009 18:02:00 +0000

I just returned from Arizona where I led a women's health and fitness retreat. Most of the participants were frustrated and wanted to know why, despite regular exercise and healthy nutrition; they weren't seeing their body fat change. After observing them work out, I concluded that they were "Vitamin I" deficient. What does that mean? I made it up when I wrote Body for Life for Women. Vitamin I is intensity. Without using intervals of intensity on a regular basis, those feminine fat cells won't give up that fat fuel and let you slip into a smaller pair of jeans.

Intensity:

Helps you burn calories more efficiently during and after your workout;

Increases the fun of exercise while cutting the boredom of endless hours on workout equipment at the same slower pace;

Increases your aerobic capacity and endurance while promoting fat loss;

Reshapes your body, redistributing fat and toning muscle for the fittest look;

Results in more fat loss in a shorter workout time than women who maintained the same moderate exercise level;

Applies to both cardio as well as weight training.

Research has shown that women who train with intensity look like it. They've got more toned muscle and less fat, resulting in a leaner, fit-looking body. Intensity also helps override the powerful innate programming in a woman's body to store fat that is so specific to a woman's body. Adrenalin and growth hormone help to stimulate fat release. As women age, fat cell breakdown is more of a challenge. Intervals of intensity will get the fat release ball rolling.

Here's what you need to know to start to incorporate intensity intervals into your training. First, here are the precautions:

Anyone who is over the age of 40 and/or has any medical condition that may be affected by intensity (e.g. heart, lung, muscle/joint injury, etc) must first clear any such training through their physician. Moderate levels of exercise are perfectly fine and yield terrific results for health and wellness. Sometimes higher levels of intensity simply cannot be used.

It is absolutely imperative and required that everyone who engages in interval training must first warm up at a low and then moderate intensity for no less than 10 minutes prior to starting an intensity interval.

For people who are presently unfit (e.g. not regular exercisers and/or overweight or obese), it is essential that you begin very gradually. This means you engage in low and moderate levels of intensity for no less than 6-8 weeks prior to initiating intensity intervals. A fitness professional will help get you started.

Intensity intervals in weight lifting must be initially supervised by a fitness professional. I will not address high intensity weight training techniques as this should always be created and guided by a professional.

The elliptical trainer and stationary bike are the safest ways to practice intensity intervals. The treadmill requires more pounding and stress on weight bearing joints and the back, but is fine is the individual is already trained and comfortable with brisk walking and running.

Actual high intensity interval training used by athletes is pretty grueling. It involves first the warm up, then going all out at 100% of effort for 30 seconds, then resting at a low level of intensity for 4 minutes, repeating this cycle 4-8 times. I do my own adaptation of this which involves a much more gradual increase in intensity suited for beginners and non-athletes.

Do a 10 minute warm up gradually moving from a baseline of lower intensity to moderate intensity;

For the first interval, increase the intensity one level up by increasing the speed, resistance, or incline for 30-60 seconds;

Bring down to your baseline moderate level of intensity for 3 minutes;

Repeat the intensity interval and rest period again;

If you feel that the increase of one level up doesn't feel hard enough to cause you to sweat, increase one more level up (now you're up 2 levels of intensity);

Repeat this 3:1 interval cycle just twice for starters. Add another cycle every week or so until you're comfortable with between 4-8 cycles.

You need to do cardio no less than five times per week. Try the interval training once per week as a start, working up to doing it three to four times per week. You may notice that over time, your baseline warm up levels may increase and your intensity levels will be higher. That means you're achieving the training effect and improving strength and endurance. Take body size measurements before you begin your intensity interval training and watch the reshaping and toning take place. Get your body fat percentage measured and pay attention to that number, not just your weight. We're talking about changing the quality of your body, not just the quantity.

Start today and reap the rewards of shaking up your fat cells with Vitamin I.

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Why Fat Doesn't Disappear Where You Want It To

noreply@blogger.com (Dr. Pam Peeke) — Wed, 11 Nov 2009 01:56:00 +0000

Go figure. You're working diligently to achieve a healthier weight, and the fat you want to keep (e.g. your breasts) is the first to disappear, and the fat you want to shed (fill in body part here: stomach, thigh, butt, arm, chest, back) is the hardest to remove. From a recent posting on my weight management message board, dmarchi says,

"Hi, I'm 23 and for the past year I have been dieting and exercising on a regular basis. I try to work out 3-4 times a week. This includes spin classes, running, and step classes. I try to keep my calories at or below 1500 calories a day. I do not count carbs, but I am thinking I might have to. I have lost about 25lbs so far. The problem is I haven't dropped a pant size! It seems like the weight I have lost has come off of places other than my stomach and hips. This is the area I am really wanting to lose weight from. I don't know what to do anymore, I am becoming discouraged and on top of it, I have hit a plateau. Does anyone have any recommendations on how or what I can try doing to improve my weight loss around the stomach and hip area? I would love to lose at least 10 more pounds. I am not sure if I need to change my diet or exercise. Thanks!"

Sound familiar? Let's demystify what goes on with your body fat when you're dropping that excess fat. Here are some rules of the "where the fat's going" road:

Genetics. Look at the other people in your family. Your body shape will often appear similar to someone in your family line. Sometimes the similarities are striking - - apple or pear shaped with nuances involving short/long legs, tiny waist or no waist line at all. J Lo can try all she wants to drop weight, but she will always have that famous behind. The same applies to Beyonce's behind and thighs. Your job is to optimize your body shape as best you can, and then live with what genetics endowed.

Age and Gender. Throughout their life, men tend to store fat in the abdominal area and they'll note that any excess body fat in their extremities will shed first and the belly is last to go. Most women (there are exceptions) tend to store most of their fat in the hips, thighs and buttocks prior to age 40. Weight reduction classically decreases waist and breasts first, followed by the lower half of the body. After 40, due to declining levels of sex hormones, it is easier to store fat in the belly area as well. In addition, other hard to reduce fat deposits appear in the back, upper abdomen under the breasts, as well as arm pit areas. Weight reduction after 40 often results in removal of fat in the breasts and lower part of the body, followed by the waist and the back - - the exact opposite of the pre-40 years. Again, there's wide variation and we're talking about general patterns.

Medical Conditions. Things happen in people's lives. Pregnancy is one example. Many women develop the postpartum "jelly belly" which can be a challenge to manage. The more pregnancies, the tougher it is to shed all of subcutaneous fat that has accumulated. Again, the goal is to minimize this fat, as it's impossible to completely eliminate it in most cases. Polycystic ovarian syndrome (PCOS) can give rise to an increase in belly fat at any age in women. Treatment of the syndrome can help manage this problem. The long term use of prednisone related medications make it difficult to remove abdominal fat. These are a few examples of conditions and medications that can complicate the weight management experience.

Plastic Surgery. Many people have gone under the knife and had liposuction, body sculpting and abdominal skin tightening. If weight is gained after liposuction, you may note that fat accumulates in other locations not touched by the procedure and sometimes these regions (back) can be tough to reduce. That's fair warning for those who are considering lipo. If you do it, stick with the program and don't gain weight.

Lifestyle Program. A balance of good nutrition and physical activity are the foundation upon which all healthy weight management is based. Cardio and weight training are essential to minimize fat and optimize body shape and muscular tone.

Let's look at dmarchi's comments. She's young and has done a great job removing 25 pounds of fat using a balance of exercise and good nutrition. She's dropped the weight in other places and is frustrated with her hips and stomach. She's also complaining about the plateau in her weight. I'd recommend getting a body composition analysis and finding out what her current body fat percentage is. She's looking to be somewhere between 20-25%, unless she's very athletic. She needs to look at her own genetic pool and she'll probably find that women in her family line have relatively speaking heavier hips and thicker waistlines. Her goal is to optimize her body composition and see where she settles.

To shake things up, I'd recommend introducing more cross training and lots of intensity intervals. She should change up cardio routines every six weeks. I notice she said nothing about weight training. Of all the thing she could do to reshape her body, lifting weight 2-3 times per week will enhance muscularity and minimize body fat.

And finally, she needs to take a patience pill. If indeed she really needs to drop that "last 10 pounds", it's always the slowest to go. Consistency in lifestyle habits is key. When each of us reaches a point where we have done all we can reasonably do to optimize our lifestyle, we'll smile and simply learn to be proud and content with our marvelous, amazing and fit bodies.

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Diet Program Dilemmas

noreply@blogger.com (Dr. Pam Peeke) — Wed, 04 Nov 2009 13:55:00 +0000

Let's just say you've been thinking about shedding your extra pounds. Then, one day you decide to finally take action. But, suddenly you're confronted with the dilemma of which way to turn. You do a little homework, whip through some magazines, watch TV commercials and call a few friends. Somehow you make your decision and then wonder if you did the right thing. Read what Detwaa sent me on my weight management board recently:

"I just signed up for a weight loss program where you have to follow a routine diet, drink and eat certain foods they offer, exercise, and check in several times per week to see progress. Is that something you'd advice, is it effective? The shakes are incredibly expensive and I'm supposedly required to have them in order to lose 60 pounds in 15 weeks. Did I make a big mistake? Was this something I could have done simply on my own? I have an option to buy the shakes one at a time as I go, or buy them all at once for a discounted price, and I just want to know if I can still lose weight if I don't drink them. This is a healthy low fat, hight protein, calorie restrictive diet."

I'll bet a few folks out there can relate to her angst. The good news is that there is a terrific book written by the Institute of Medicine called Weighing the Options: Criteria for Evaluating Weight Management Programs. The book is unbiased and written by academic experts who prioritize the consumer's health and welfare above any commercial interests. I'd highly recommend this to anyone considering a program. Meanwhile, here are a few helpful tips.

Beware programs that:

Promise you the moon. Watch out for programs that guarantee big weight reductions in a short period of time. Most people can safely remove up to 2 pounds per week on a healthy weight management program. Detwaa's program is promising to deliver double that number.

Cost you an arm and a leg. I'm not happy when I read "incredibly expensive shakes". Heck, you can buy cheap whey protein powder, add water or skim milk and perhaps fresh or frozen fruit and make your own for pennies. Commercial programs make their money by selling products (e.g. shakes, meals, supplements). Watch out for programs that require you to purchase these products.

Are run by people with questionable backgrounds. How long as the organization been around? Always ask many questions about who owns and runs a program. What certifications and qualifications in the field of weight management do these people have? What are the staff qualifications? What is included in your initial assessment? It should be comprehensive and ideally this group would be teaming with your own doctor to achieve optimal results. Did your doctor refer you to this program? What about success rates, and comments and references from other clients? Programs should be supervised by physicians and medical professionals who can answer questions related to each person's unique medical status, as that would change over time with appropriate weight reduction. Also be on red alert for programs offering pills, potions and injections for weight reduction. You absolutely must be fully informed about the professionals and staff involved as well as study thoroughly any materials related to these services and products. Programs operated by hospitals, medical centers, researchers and academics in the field (e.g. University of Colorado's "Colorado Weigh Program") can usually be counted on to deliver the most updated, credible and comprehensive programs.

Stress weight loss and not maintenance. The best programs have a strong emphasis on both phases, and provide an excellent maintenance element. Watch out for programs that spend 90 percent of their efforts on shedding weight, and offer only a cursory coverage of any long term maintenance.

The best program for weight reduction involves an interplay between my favorite three elements: Mind, Mouth and Muscle.

Mind: Research has clearly shown that when you have a strong mental health component, you'll achieve your best program success. That means there should be a qualified counselor for ongoing help and guidance in person, on the phone and/or through email communications. People need coaching and encouragement as well as answers to ongoing questions involving how to navigate life's stresses while also maintaining an optimal nutrition and exercise program. These experts help people learn behavior skills that will assure not just weight reduction, but maintenance for life.

Mouth: It's necessary to have qualified registered dietitians to supervise any program and to customize plans for people's unique needs. In the best of worlds, you're eating whole foods, an appropriate number of calories in balanced meals and snacks, as well as a minimum of commercial (and especially processed) products.

Muscle: All programs need to have a reasonable and appropriate physical activity component. It should be based upon established standards like those of the American College of Sports Medicine. Many offer a network of health club facilities as well as fitness professionals who will help guide you as you become more physically active.

So, for Detwaa and other men and women seeking weight management program advice, get serious and do a thorough job of studying your options. Your reward will be a safe and credible path towards sustainable weight reduction and a lifetime of optimal wellness.

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It's Not Just About the Scale

noreply@blogger.com (Dr. Pam Peeke) — Mon, 02 Nov 2009 21:55:00 +0000

Lee Carson /
CC BY-SA 2.0

While filming the National Body Challenge series for Discovery Health TV, I recall the humorous antics that occurred while I was being taped weighing each of the show's participants. The scale I used was actually a body composition analyzer. In addition to body fat and muscle mass, it also showed overall weight. That was enough to strike fear in the hearts of the women, but not the men. Fully clothed, guys would merrily hop up on the equipment, chuckle at the numbers (which weren't pretty), and high five each other laughing about who had the highest body fat.

By contrast, the women would start to peel every bit of clothing they could get away with on a family rated show, tossing off sweat shirts, rings, watches, bracelets and even earrings, before tentatively stepping on the analyzer. Several pleaded with us for a moment to hit the women's room and empty that bladder. Once on the apparatus, some women would squeeze their eyes shut and not look, a few just looked straight ahead never peering down to check out the numbers, and one even stepped on backwards to avoid looking at anything. No doubt about it. This is Scale Scare at its worst. Many people have lived a life of fearing the number that could mean the difference between having a great day, or the moody blues.

I'd like to help you by setting the record straight. Scale weight alone tells you nothing about what's really happening in your body or your health. Instead, you need to pay attention to other factors: body composition, Body Mass Index (BMI) and waistline measurement.

Scale weight is made up of the interplay between your basic body composition elements (bone, muscle, fat). Since bone doesn't change dramatically in the short term, your weight is all about the relationship between muscle and fat. The more muscle you have and the less fat, the smaller your size.Body composition is about not just the quantity but quality of your body. Also, don't confuse body fat with Body Mass Index (BMI). Your BMI is your weight divided by your height in meter squared and is a number that is used by doctors to assess your risk for medical conditions like heart disease and diabetes.

Also, don't forget your waistline! It's not just how fat you are, it's where the fat is at. If you have too much fat inside your abdomen, you're at high risk for disease. Measure your girth crossing your belly button. Guys need to keep that number below 40 inches, and women below 35 inches.

So you have four main numbers to keep in mind:

Scale Weight = Bone + Muscle + Fat

Body Mass Index = Weight/Height m2

Body Fat Percentage = Total Fat/Total Weight x 100

Waist size = tape measurement across belly button

Here's a great recent posting from Saginovi30 on my weight management board that makes the point about body composition:

"I'm 5'8", wear a size 4 jeans, but I weigh 145 lbs. Usually women my height and pants size weigh 120 or less. I exercise regularly, but I don't understand why on the outside I look 120 pounds, but in reality, I weigh 25 pounds more. Is it true that muscle weighs more than fat?"

My answer to her is that I can have five women who are all the same age, height and weight, and I will show you five different dress sizes, from a 4 to a 12. That's because the total amount of fat you carry on your body will determine your dress size. Fat occupies more space than muscle. When you're trying to zip up those jeans, that ain't muscle getting in the way! In this woman's case, there is no doubt that she has a low body fat (below 20%) and a higher muscle mass. This is the result of genetics and exercise.

The bottom line is please toss your scale and go out and get a body fat analyzer. They range from simple, inexpensive models that will provide just your weight and body fat percentage, to fancier scales that will show you how many pounds of muscle and fat you carry. To achieve your optimal body composition, it is absolutely necessary to do regular physical activity. If you simply starve yourself all the time to achieve some mythical scale weight, your muscle mass will fall and you'll actually end up with a higher body fat percentage. Instead, your goal is to maximize your muscle and minimize your body fat.

Here are some guidelines for average (non elite athletes or naturally thin people) height men and women:

Average adult men need to keep their body fat percentage between 18-25% for their lifetime.

Average women should aim to keep their body fat percentage about 20-25% until age 45-50, when the range can increase to 28%, and after the age of 65, up to 32% due to the age related decline in muscle mass after the seventh decade of life.

Aim for a BMI below 25.

Waist measurements should be less than 40 inches for men, and less than 35 inches for women.

I hope by now you see that scale weight alone is just one element of a more complex picture of your body and overall health.

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Blast Your Back Fat

noreply@blogger.com (Dr. Pam Peeke) — Fri, 30 Oct 2009 00:55:00 +0000

Back fat, muffin top, love handles, fat roll or spare tire - call it what you want, but it all adds up to that rather not-so-lovely vision of extra rolls of fat popping up all over your back, from your bra line to your belt line. It's the kind of fat that makes you rethink buying a skimpy top where the whole world can revel in your rolls. Have a look in the mirror at your back while wearing a form fitting blouse or sweater. There's that back fat poking out along your bra strap lines. And how about the rolls at your armpits, and the back fat shelf line above your waist? Not a pretty picture. And, as opposed to the menopot which is seen primarily after age 40 (see my blog post "Minimize Your Menopot"), back fat can occur at any age in men and women, but is worse after the age of 40. So where does it come from?

Back fat is an accumulation of excess fat that occurs due to one or any combination of factors including:

Being overweight or obese at any age (over eating and lack of physical activity);

Genetics in which even some slender people tend to distribute more of their fat to the back area;

Ethnicity plays a roll (pun intended) in which some groups tend to pack on back fat more than others;

Lack of weight training to bring down body fat and increase muscle tone;

Being over the age of 40 in which the decline of sex hormones affects distribution of fat throughout the body.

So what can you do about Back Fat? Plenty. Here are the "Rules of the Roll" to blast your back fat:

Make an Action Plan. Sit down and write out your goals. Take measurements throughout your body so you know where you're starting. Take pictures for the visual impact. Create realistic goals and expectations (dropping ½-2 pounds per week is the normal range). The heavier you are to start, the more excess fat you'll be removing. Write down your commitment to change. Journal your progress. Develop a support system to help guide you - like our wonderful weight management board on WebMD.

Be patient. Back fat is often one of those stubborn places that sometimes takes longer to reduce. Be persistent.

Get real. If you're over the age of 40, you may not be able to completely eliminate all of your back fat, but, like the menopot, your mission is to minimize back fat.

Hide it while you remove it. Let's not invite trouble in the form of super tight spandex tops. While you're shedding pounds and getting more fit, try to wear looser, comfortable clothes and toss the muffin topping skinny jeans. There are also great elasticized undergarments that help smooth out the rolls.

You must do both weight training and cardio to blast back fat. Don't think you can do this with cardio alone. You'll drop some weight, but you need to reshape and redistribute fat and only a combination of weight training and cardio will do that. Lift 2-3 x week and concentrate on building strength and perhaps boosting your muscle mass a bit. Check out my MUSCLE section in Body for Life for Women for easy ways to do this at home gym-free. Check out the WebMD fitness sites for creative ways to strengthen and tone.

Eat a back fat blasting diet. Physical activity is key, and equally so is what you put in your mouth. There is no one food or beverage that will magically remove Back Fat. Instead it's all about eating a variety of healthy foods every day. Quality: whole foods and lean proteins build the foundation for removing Back Fat. Quantity: watch your portion size. Almost everyone out there is eating too much relative to their age and gender. If you eat too much, you wear it. Read the USDA label and know what a serving size looks like. Frequency: eat every 3-4 hours from breakfast through dinner. Stop eating 2 hours before going to bed. Try to eat your dinner no later than 8-8:30 PM, and keep it lean (veggies, lean protein). Wake up in the morning feeling truly hungry. Check out my MOUTH section in Body for Life for Women for healthy, easy nutrition options. Scroll onto WebMD's wonderful nutrition sites for endless suggestions and recipes.

Get creative and cross train. No one specific exercise is the ultimate back fat cure. You need to draw from a variety of back strengthening and toning modalities. Mix and change it up every 6 weeks to keep it fresh and challenging. Have some fun and get adventuresome. Take up belly dancing, hip hop or twirl around a ballroom. Ballet is a terrific way to pinpoint back flexibility and strength. Don't forget martial arts, yoga and Pilates. Each uniquely singles out the back for a fat blaster workout.

Enjoy a win - win. The stronger the back the stronger the abs, and vice versa. You're working the core of the body and what you do for one, helps the other.

Back fat is a fact of life. Don't waste another moment fretting about it. Take action. And remember, here at WebMD, we've got your back!

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What do Veggies Have to Do with Weight Loss? Everything!

noreply@blogger.com (Dr. Pam Peeke) — Tue, 20 Oct 2009 22:54:00 +0000

Natalie Maynor / CC BY 2.0

If you're looking to drop excess weight, look no further than the produce section of your grocer. Cruise around the fresh vegetable section and ask yourself, "Am I getting at least 3 servings of veggies every day?" If you answered "no", sadly you're not alone. According to a recent report by the Centers for Disease Control and Prevention (CDC), only 27% of adults meet that basic requirement, and just 33% eat at least two servings of fruit every day. It also depends upon your age. Veggie consumption begins to increase after the age of 45 as people start to make the veggie/fruit-better health connection. Just 14% of American adults meet both requirements. What's up with Americans not eating veggies? Here are the top four reasons you're not gobbling the broccoli:

Not everyone in the family likes the same veggies making it mission impossible to cook for the crowd and please everyone;

Many fruits and veggies are expensive, compared to buying a bag of chips or a cookie;

Fresh veggies are a pain to prepare and cook, making microwave or fast food more attractive;

Restaurants and fast food eateries don't offer enough veggie options.

Alright, it's a challenge to strive for five (3 servings of veggies and 2 fruits) every day, but come on, we can be more assertive and creative. This is your health we're talking about. If you do, you'll be rewarded with a slimmer and more fit body, as well as enhanced health. Here are some facts.

A candy bar or cookie does not fill you up. Veggies do. This is especially true if you combine them with some form of protein. That's why reduced fat peanut butter and celery is a hit, or an apple with a serving of low fat cheese. Or just eat a heap of steamed or grilled veggies. That's a low fat and fiber rich guarantee to help you feel full and satisfied. That protein-fiber combo kills carb cravings as well. Whether it's breakfast, lunch, snacks or dinner, make sure you're adding veggies. That whole wheat pitta and turkey burger needs greens in the pitta pocket. Your omelet can be more filling with mushrooms, peppers and tomato. Start your dinner out with a big salad topped with a serving of shredded low fat cheese. Carrots and hummus make a terrific snack. How about a side of edamame to give you satisfying protein as well as fiber?

Don't forget that veggies and fruits are nature's medicine cabinet. You'll find vitamins, minerals and other nutrients that will boost immune function and help to prevent diseases such as cancer, heart disease and diabetes. For that matter, the Harvard Nurses' Study combined with the Health Professionals Study concluded that the higher your daily intake of fruits and vegetables, the lower your risk of developing heart disease. Those men and women who averaged 8 or more servings daily were 30 percent less likely to have a heart attack or stroke, compared to those folks who ate only 1.5 servings daily. Again, you're not only lower disease risk, but you're dropping weight as well.

What veggies seem to be the best options? Well, any fruit or veggie is great, but don't forget to include: deep green lettuce, spinach, Swiss chard, and mustard greens; cruciferous vegetables such as broccoli, cauliflower, cabbage, Brussels sprouts, bok choy, and kale; and citrus fruits such as oranges, lemons, limes, and grapefruit. You'll notice that white potatoes aren't included as they are considered starches. However, sweet potato is chock full of vitamin A and carotenes so go ahead and have a serving. Learn more by clicking onto www.fruitsandveggiesmatter.gov.

And, since veggies are so low in sodium, you'll drop that water weight you hold from eating so many salt-ridden processed foods. And, don't think that water weight is trivial. It can be up to five pounds in some individuals.

Make your lifestyle veggie and fruit centric. Here are some easy starters:

David Penny / CC BY-SA 2.0
Get out a beautiful fruit bowl and keep it filled each week. If it's front and center in the kitchen, you'll see it and use it.

Be constantly mindful of the need for them in your daily life. As you plan every meal and snack, always ask "where are the veggies and fruit?"

Strive for five colors of veggies and fruits in your daily diet. The deeper the color, the higher the level of antioxidants. Butter lettuce, squash, tomato, spinach and blueberries will get you there!

Find a farmer's market and experiment with local and a diverse selection of fruits and veggies.

Just remember that when you fill up on produce, you don't fill out. And the bonus is a leaner, healthier you.

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This Is Not A Diet

noreply@blogger.com (Dr. Pam Peeke) — Wed, 14 Oct 2009 20:56:00 +0000

Whenever I read the postings on my weight management board, inevitably there's one from someone who has had an awakening and is desperately seeking help to reverse obesity. Here's one I received recently from offby40:

"I HAVE JUST SIGNED UP FOR THIS IN HOPES OF FINDING SUPPORT IN STARTING A NEW DIET. I HAVE TRIED MANY DIETS BUT I HAVE A PROBLEM WITH COMPLETING THE DIETS. NOW I AM GOING TO FOCUS ON CALORIE INTAKE AND EXERCISE. I AM 300 LBS AND ABOUT 5FT9 AND MY BMI IS REGISTERING AT SEVERELY OBESE. IS THERE ANYONE THAT CAN GIVE ME SOME POINTERS ON HOW TO GET STARTED, AND HOW TO KEEP IT GOING. I REALLY NEED HELP."

First, I congratulate her for taking herself on to begin the journey to achieve health and wellness. Second, I want to set the record straight for everyone. Throughout this posting, the theme seemed to be "diet"- starting one, failed diets. This is not a diet! Instead, I suggest you say "I'm going to clean up my lifestyle, get healthy and become more mentally and physically fit." This is about healthy living, and developing better lifestyle habits. When you do, you'll find it so much easier to shed excess body fat, feel energized and increase your sense of self esteem. You want to be fit to live your life to the fullest. That's why I called my most recent book Fit to Live.

I'll bet many of you are in the same place as the person who posted this on the board. OK, here's how you start out. First, remember that WebMD has so many wonderful resources throughout our lifestyle channel to help with calorie counting, fitness tips and recipe suggestions. Next, if you're going to change lifestyle habits, that means everything from mental and nutritional behaviors, to financial (is health a priority in your spending), physical activity and environmental (clutter, lack of organization, getting outdoors) components. No need to feel overwhelmed. In my book, I address the key pillars of lifestyle: Mind, Mouth, Muscle, Money and Macrocosm (the environment).

Always start with low hanging fruit- the simplest, smallest steps you can take to get the ball rolling. Before beginning any program, please consult your physician and medical team. Know what your baseline health status is and if there are any restrictions on your program. Here are tips and tools to get started:

MIND: Get a clear vision of why you want to change your lifestyle. It has to be powerful enough to get you through challenging times when you're tempted to revert to old habits. Being fit enough to play with your kids or grandkids? Healthy and attractive enough to get out there and find a partner in life or new friends? Becoming a runner, biker, hiker and hanging out with like-minded folks? Want to prevent or reverse medical conditions that plague you? Anything goes here. Sit down and really think this out. Come up with a mantra to remind you why you need to stay on track- "Sick and tired versus Fit and Fab." Say to yourself "I choose fit and fab." This is a conscious, mindful, deliberate choice. Finally, create realistic expectations. Progress, not perfection, will get you there.

MOUTH: Quality, quantity and frequency are key. Whole foods, lean proteins, and whole grains become the staple of your nutrition. Read the USDA labels on all foods to know what a true serving size is. When in doubt at restaurants, eat ½ of what's in front of you. Eat smaller meals and snacks every 3-4 hours beginning with breakfast and ending with dinner. Remember to include protein and fiber throughout the day, as that combo will curb carb cravings as well as increase your sense of fullness. Try to finish dinner no later than 8:00 - 8:30 PM and leave 2 hours without eating before you sleep.

MUSCLE: Get up and move more throughout the day. Buy a pedometer and crank out 10,000 steps (roughly 4 miles) per day walking. Work up to this goal. Be creative about finding ways to move more. At 300 pounds, you need to protect your knees so avoid any jumping, running, squats or lunges.

MONEY: Invest in a great pair of sneakers with plenty of cushion. Get socks that do the same. If you're a gym type, scope out a good deal on a membership where you can cross train on different cardio equipment (ellipticals are knee friendly and burn calories efficiently) and where you can learn to begin safe and guided weight training, stretching and core work.

MACROCOSM: Look around at your living and working spaces. Does it look like a bomb went off? How can you develop a new healthier lifestyle when you're buried under miles of piles? You need to clean up your environment and get organized. You can't take a walk if you can't find your sneakers and you can't pay for that jazzersize class if you can't locate your checkbook. Be patient, and schedule an hour here and there over time to get this done. Also, get outdoors more. Walking, biking, and hiking in nature are such wonderful, healing experiences. Do it alone, with a friend or in a group. Just do it.

Whip out a journal and keep track of your daily progress. You don't have to write the great American novel. Just monitor what counts- your baseline lifestyle elements, challenges and triumphs. You'll need your starting status: medical issues (what you want to change like blood pressure, blood sugar, any medical conditions); make a note of overall weight, body fat percentage, BMI and waist size (across the belly button); and, clothing size including jeans, pants, dress, belt.

Finally, don't forget to create a support system. This could be your mother, best friend, a mentor, or your dog. It includes keeping up with us on the WebMD weight management board for online support, as well as any helpful books or DVD's that resonate with you. You're assembling your "A" team to help you through thick and thin (ahem!).

OK, there's your foundation. Now hop to it and don't call this a diet!

Rules for Reinventing Your Body After Forty

noreply@blogger.com (Dr. Pam Peeke) — Fri, 09 Oct 2009 13:34:00 +0000

On October 5th, I was the health and fitness keynoter for More magazine's annual "Reinvention Convention" in New York City. Five hundred women showed up to explore how to reinvent their lives once they crossed that 40 year old milestone. From new careers, financial challenges, to broken relationships and physical shape shifting, women came to the conference to get help understand it all and to regroup. In my packed session, women were anxious and enthusiastic, eagerly jotting down every tip, tool and technique I could offer. I decided to make this easy by creating a simple acronym- AFTER FORTY - to help women remember 10 important tips to help them optimize their bodies after the age of forty.

A: Adapt and adjust to life's constant daily stresses and challenges. Charles Darwin said that it isn't the smartest or strongest who survive, but those who can adapt. Throughout my book Body for Life for Women, I emphasize the fact that women need to practice how to become mentally flexible and rise up to the occasion when life throws you curve balls. After the age of forty, your mind and body begin to change significantly. Women often feel helpless, hopeless and defeated when weight packs on and you forget where you put your keys. Don't go there. Regroup and optimize your mental and physical well-being and you'll navigate these changing waters well.

F: Fight for the right to take care of yourself. No one is going to show up and schedule time in your day for self care. Only you can do that. Be assertive and get used to saying "I'm sorry, but I am busy at that time" when people try to erode the special moments you've set aside to have a healthy meal, to take that walk or to soak in the tub. This is one of the most important appointments you'll make for yourself each day.

T: Try lean protein to increase a sense of fullness and satiety, to rein in appetite, to curb carb cravings, and to maintain muscles. Women tend to under eat this wonderful macronutrient. Lean poultry, skim or low fat dairy, or vegetarian options will all help to quell hunger, rein in runaway appetites and keep your muscles in top form.

E: Exercise regularly, do it with intensity and make sure to cross train. Too many women are doing the same old cardio and weight lifting and are mystified as to why they stopped seeing real positive changes in their bodies. Come on ladies, get a fitness professional to mix it up in both your cardio and lifting for you so you can use more muscles and shake them out of complacency. As well, you need to ramp it up with intervals of intensity to keep your muscles challenged. Most importantly, this will help you release more fat fuel efficiently so that you can shed that extra fat. Try integrating some yoga, Pilates and even martial arts. How about dancing? Get outdoors and challenge yourself with fun and enjoyment. Just get up and move more throughout the day. This is what it takes to keep your over forty body alive and powerful.

R: Redefine normal. You aren't 20 or 30 anymore. Your body is undergoing significant changes, from fading eyesight to widening waistline. Stop looking backwards and obsessing about what doesn't work anymore. Instead, wake up every day and celebrate what does work. Hey, you're still here and you'll make do with whatever anatomical parts you can use to propel you through each day. This is integral to adapting and adjusting.

F: Fat, not weight, needs to be monitored. Buy a body fat scale and aim to get your body fat in the range of 20-28%, with a good average being 25%. If you're postmenopausal and over the age of 60, body fat ranges can increase to 32% due to aging related loss of muscle (especially true after the seventh decade of life).

O: Organize and plan your self care routines. If you fail to plan, you plan to fail. Sit down and make a plan. Whether it's stress management classes, gym memberships or shopping for healthier options, You need a strategy that meets your needs. If you want to drop body fat and increase muscle strength and mass, get together the team that you need to make this happen. WebMD's got your back with endless information about how to get the ball rolling. Check out my weight management board to share your experiences and ask questions with other like minded folks.

R: Rein in evening eating. After the age of forty, you don't need the same number of calories as you did when you were younger and more physically active and metabolically hotter. Most women don't realize that they are over eating throughout the day. But, the evening is a real problem. So many women kick back and consider this their time to reward and relax. Unfortunately, this includes plowing through sweets and grazing until bedtime. If you want to remove that excess belly fat, you need to eat smarter. Eat every 3-4 hours throughout the day through dinner, try to finish dinner (veggies and lean protein) no later than 8-8:30 PM, and try not to have anything to eat for 2 hours prior to retiring. You'll wake up hungry and feeling lighter, and ready to break that fast: breakfast.

T: Take time to just "be". Try to stop "doing" and take time for "being". Find a quiet place to read, close your eyes, listen to music, take a walk, say a prayer, or do some yoga stretches. Your mind needs these mental recesses. You have to practice mental aerobics to stop the deluge of thoughts - the incessant "to do's" that inhabit our feminine brains. Visualize a stop sign. Then, move into a peaceful place. This is a precious gift you give yourself.

Y: You deserve joy, happiness and fulfillment. Go ahead and feel entitled to be all of these things and more. Live, love and laugh every day. Embrace every waking moment with exuberance. Feel powerful. Choose to do this for yourself. Your reward is having the mind and body you deserve, to help you realize your dreams.

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What Women Really Want

noreply@blogger.com (Dr. Pam Peeke) — Thu, 08 Oct 2009 17:34:00 +0000

Every now and then I'll pick up a book that I want to share with others. I've got one for you. It's called Women Want More by Michael Silverstein and Kate Sayre, two experts from the Boston Consulting Group. When I read this book, I said "Finally, someone's asking women today what's important in their lives, from beauty to health".

Before I plunged into the chapter on weight and fitness, I scoped out what's really important to women in general. Overall, a woman is "stressed, time-pressured and money-tight". I know, I'm wiping the shock off my face. Let's see what women in the survey said about what the most important values to them were:

Love - 77 percent

Health - 58 percent

Honesty - 51 percent

Emotional Well-being - 48 percent

Frankly, I try not to separate the mind (#4) from the body (#2), but suffice it to say, that love and connections with others happily trump all. Here are some other highlights from the book's findings. Guess what makes women extremely happy? Well, sex and food figured in there, but at the top of the list were pets, followed by sex, food, and shopping. Go figure. Fido's nonjudgmental, honest to a fault, and is a ball of never-ending love. Sex never had a chance.

Now for another reality blast about women and their bodies: 68 percent of you believe you're significantly or slightly higher than your ideal body weight. Twice as many women think they're overweight as actually are. Only 25 percent of these women think they're extremely or very attractive. 26 percent note they rarely ever or never feel beautiful. 44 percent rarely or never feel powerful, and 32 percent of you walk around feeling frustrated most of the time.

Speaking of frustration, let's turn to nutrition and fitness. Expectations speak loudly. Most women still aspire to be thin (there's that word again), but they also want to be healthy. Women are going to a much more holistic place and many are now opting out of crazy diets and looking for a more reasonable and healthy approach to achieving their best bodies. Women also want to be fit but not buff. They want to be able to keep up with the kids but not compete in the next Miss Olympia. For that matter, women specifically noted that they wanted to become fit without bodybuilding. The survey made it very clear that to most women, trying to find time to keep up their fitness often feels like mission impossible. It gets wedged into tightly packed days and many women live in a state of perpetual frustration trying to get in that walk or yoga class.

When the subject of nutrition came up, women were loud and clear. Preparing healthy whole foods has to become easier and more convenient. Companies with healthier meal replacement products are becoming more popular. Along with the fitness and nutritional components, women crave a network of support. Men can be terrific supporters. But, women also want to commiserate with other women just like them. Many women love to bond with kindred spirits for the big win win - supporting one another to achieve and maintain success in health and fitness. I call it assembling your own estrogen squad.

And here's a terrific end note. Despite being time starved, anxious, frustrated and up to their ovaries in care giving everyone who comes within 100 feet of them, women are optimistic. The majority of the women surveyed truly believe that life will be better in five years. Hooray for giving our attitudes a lot of altitude to be able to adapt and adjust to life's challenges. Women are beautiful, powerful and are now becoming more assertive about taking care of themselves. We're gradually getting there...with a little help from Fido and the squad.

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Make the Weight-Clutter Connection

noreply@blogger.com (Dr. Pam Peeke) — Wed, 30 Sep 2009 13:00:00 +0000

The ongoing recession is making us all rethink how much "stuff" we really need in our lives. Not sure if you're living in a junk jungle? I'll give you a hint. If you've got miles of piles everywhere and you're tripping over it, you've got too much. So, let's use this recession as a perfect time to regroup and learn to live our lives more effectively. It's time to de-clutter and get healthier. You heard me right. Your health will improve - and so will your waistline.

I'll bet lots of you live cluttered lives. And you wonder if there's a link between clutter and weight. Well, there is. The more disorganized and cluttered your life is, the more difficult it is to shed that weight. What do I mean? When you want to steam your veggies and you can't find the steamer, you get frustrated and angry and just throw in the towel and you're on the phone ordering a pizza. Or, when you're trying to find your workout clothes and they're buried in the pile at the base of your closet, I guess you're not hitting the gym that day. See the clutter-weight connection?

Everybody needs an environment to live in that is conducive to practicing healthy living habits. You can't take a walk if you can't find your sneakers, and you can't eat well if your fridge and cabinets are filled with trash. You can't pay that gym membership or for that health magazine subscription if you can't find your checkbook.

How can you feel calm and peaceful when you're walking around with angst, shame, and guilt, and also surrounded by chaos? It's enough to make anyone head for the fridge and bury their head in a carton of Jamocha Almond Fudge. Cluttered environment, cluttered belly. Make that connection, and you'll start shedding excess body and house weight, for that matter.

Just like we've ballooned physically, so have our home environments. We're not only mindlessly eating too much food, we're binging on too much stuff. In my book Fit to Live, I reveal several stories of patients and friends who get the Mouth-Mess connection; something finally clicks in their heads that shows them that if they get rid of the clutter, their lives turn around. When I was filming the National Body Challenge for Discovery TV, I visited people's homes and tripped over clutter everywhere. Garages were scary places where that bike or weight set was buried under tons of Christmas tree lights, broken appliances and deflated basketballs.

So how do we clean our personal environment? Here are 5 principles to de-clutter your world:

Your external environment is a reflection of your internal world
Start by going out and looking at your car. What do you see? Dust and dirt; candy wrappers and crumpled soda cans on the floor? What do your friends say when they get in and take a drive with you? It's the same with your home.

Your home should support what is most precious to you
Does your home reflect what you cherish? Organize so you can enjoy what is most important to you: family, friends, gardening, or even writing that novel... whatever gives you meaning and joy. And hey, your health is the most precious of all! Organize your gym clothes, put your sneakers near the front door ready to walk in, and fill your kitchen with delicious whole foods.

Think of Carrot Cake
When you're trimming closet fat, treat it like eating carrot cake: take small slices. If you try to do the whole house at once, you'll end up with a bigger mess. Slice it off one spot at a time: your desk, that closet, the living room, the set of kitchen cabinets. Aim for small steps, and your motivation and momentum will grow.

Use the 12-Month Rule
If you haven't used it, pitch it! If you're not using it now, or will definitely not use it in the next 12 months, get rid of it! Unless it's your tax returns, or important personal documents, think about why you are keeping those stacks of papers. You can sell your stuff on e-Bay, toss them out, or best of all, give them away to people or groups in need such as the Salvation Army, or even your local library or church.

Be Consistent, Not Perfect
Alright, maybe you've de-cluttered your home, but your workspace looks like a bomb just went off. Be consistent, and remove attic weight, basement, bookshelf and car weight.

Now go get those sneakers you just found at the bottom of your closet, and get outside for that life giving walk you so deserve.

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Night Shifts and Your Weight

noreply@blogger.com (Dr. Pam Peeke) — Mon, 28 Sep 2009 13:33:00 +0000

On September 10th, I wrote a blog entitled "If You Eat Late, You'll Gain Weight." Boy, did I hit a nerve. There are lots of you doing the nocturnal foraging in your fridge. A number of the postings on my weight management board came from frustrated folks from the night shift crowd. Here's an example from gangstakitty:

"After reading your blog, what you say makes sense. But what advice do you have to someone (me) who works nights (7p-7a) 3 days a week? On my days off (the other 4) I often find myself wanting to eat at the same times I get a chance to eat at work. Since I work in a hospital, sometimes when I eat "dinner" varies with my workload, but I usually a snack to hold me over around 5pm and don't eat anything substantial until 1am. At home I find myself doing the same thing which can't be good, but I can't seem to break the habit."

This reminds me of the alternating night shifts I spent during my years in training. It is a definite challenge to keep regrouping every time you start or end a series of night shift work hours. Let's look at how night shift work affects your health and weight, and some tips on how you can address this challenge.

First, if you're a night shift worker, you're in good company. Over 8.6 million Americans work outside of the standard 9AM-5PM work hours including police, fire fighters, nurses, pilots, factory workers and truck drivers. What impact do these late night working hours have on your health? Typically, night shift workers have long complained about fatigue and sleep problems. Medical problems that have been noted include an increased risk of: colds, cancers of the breast and prostate, higher cholesterol levels; heart attacks; and, obesity. Investigators have suggested that there might be an association between night shifts and changes in stress hormone (cortisol), weight regulation hormones (leptin, ghrelin, insulin) as well as melatonin (regulates sleep and affects immune function) leading to an overall increased risk for disease.

Harvard sleep researcher Dr. Frank Scheer published a March 2, 2009 study in the Proceedings of the National Academy of Sciences in which he found that working night shifts can cause hormonal and metabolic changes that can lead to an increased risk of obesity, heart disease and diabetes. The reason for these alterations is that your innate sleep-wake clock, known as your circadian rhythm, is taking a hammering from the constant change up in your schedule. Scheer and his colleagues found that alternating night shift schedules cause what he refers to as a "circadian misalignment" resulting in:

Plummeting levels of the hormone leptin which regulates body weight;

Increased day time blood pressures;

Decreased insulin sensitivity and impaired glucose tolerance;

Increased blood sugar levels.

The researchers were very careful to note that their study involved only 10 people (5 men and women), and was done as a controlled in-lab experiment. The results of this limited study are important, but clearly more research in a real time and life environment is needed to fully understand which night shift workers are at highest risk. Also, I'll wager that these findings also apply to other groups of people, including people who suffer from poor sleep (e.g. sleep apnea), as well as those who travel for extensive periods (e.g. overnight to Europe, Asia, Africa).

Here are suggestions to help you stay healthy and manage your weight if you're a night shift worker:

Become a smart sleeper. Don't dally around. Get right to sleep when you get home. When you do sleep, make it the best sleep possible. Because you're sleeping during daylight, make sure the room is as dark as possible (blackout drapes work well); a sleep eye mask can help; sound proof your room (ear plugs and white noise machines are options); control the temperature (65 degrees); and, make sure family and friends don't interrupt your sleep for any reason other than an emergency.

Include a nap if you can. Fire fighters sitting around waiting for a call can nap, but most people don't have the kind of job where that's possible. However, if you're tired and you have an opportunity to take a 15-20 minute snooze, do it. It can refresh and energize you.

Don't drink alcohol or caffeine before going to bed. Both disrupt normal your sleep rhythm and decrease the quality of your sleep. You might try drinking tea during your night shift. It has about a fourth of the caffeine found in coffee but it still packs a punch. As well, you'll also get an antioxidant benefit from tea's bioflavinoids. Stop drinking the tea or any caffeine at least 4 hours prior to sleep.

Stay active. Physical activity helps improve the quality of your sleep. Slip it in during your shift whenever you can. Once you've slept at home, make sure to get in some kind of exercise before you have to get to the next shift. If you're coming off nights, exercise helps to tire you out, making it easier to get to sleep. Clearly, it's great to keep manage weight as well.

Stick to an eating plan. Eat every 3-4 hours from breakfast through dinner. Eat a healthy, balanced meal of lean protein, veggies and whole grains before you start work. Then, bring with you healthy snacks that you'll have every 3-4 hours. Some are portable and easy to grab (12 nuts in a 2 oz ziplock). How about an apple and a serving of low fat cheese? One of my favorites (kept me going throughout my residency training) is reduced fat peanut butter on a multigrain cracker. Doesn't require the fridge and it occupied a small area in a desk drawer. A key to eating on the night shift is to keep it lean and light. Soup and salad with protein works. Lean protein with veggies is great. Minimize any heavy complex carbs (bread, pasta, rice, potato) unless you've got a job that requires lots of physical challenge (construction or factory work). Finally, don't eat a big meal right before going to sleep.

Steer clear of refined sugars and fats. Sweets and munchies are all over the place- vending machines, the cafeteria and employee kitchen as well as candy jars on people's desks. Remember the stress-fat connection (see my books Fight Fat after Forty or Body for Life for Women). Night shift work can be stressful, ramping up your appetite for something to numb you. Take a breath and realize you're not hungry but just overwhelmed. Remember that boredom is a form of stress and leads to mindless eating. Get up and stretch or move around. If it's time to eat, grab the food you brought. Just stay away from the sugar-fat combo that will throw your precious hormones into chaos and pack on the pounds. Here's where having a plan and bringing your own food is a life saver.

The bottom line is that night shift work is a real biological challenge. Some people have this down to a fine science and do quite well. Through trial and error, along with patience and focus, you too can succeed.

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Why Are You Eating When You're Tired?

noreply@blogger.com (Dr. Pam Peeke) — Thu, 24 Sep 2009 15:32:00 +0000

You know the scenario. It's about 3 or 4 o'clock in the afternoon, and you're weary. You started the day off with the best of intentions - a healthy breakfast and lunch, and perhaps a mid-morning snack. You were doing so well. Then mid-afternoon hits. Your cell phone's ringing incessantly, you're overdue on a critical project deadline, a friend or colleague interrupts you to over share about an impending divorce, and your Blackberry just crashed. Forget it. You're not weary. You're overwhelmed, drained and exhausted. And you would give anything for some energy to get you through it all. What do so many of you do? Yep, reach for sugar because you think that will help. Instead, it only makes things worse.

I vividly recall seeing an old advertisement from a 1950 edition of McCall's magazine. In it, there's a manicured hand holding a silver spoon heaped with refined sugar, and a caption reads "Need a quick afternoon pick me up? Try Sugar!" Flash forward almost sixty years and we're still running for the white stuff when we're tired. It's time to change it up. When you're dragging, the last thing you want to do is plow through a mountain of refined sugar and fat. It zips right through you playing havoc with your blood sugar levels and increasing your appetite. So, what else can you do? Here are some great options:

Get enough sleep. That means 7-8 hours of quality ZZZ's. If you begin the day sleep deprived, you're more likely to be mindlessly reaching for all the wrong foods, and I'll guarantee you won't be racing to the gym to exercise.

Start your day out right. Make sure you're eating balanced meals and snacks every 3-4 hours. If you've skipped or skimped on breakfast or lunch, both your appetite and hunger will be skyrocketing and by mid afternoon you'll chow down on anything around you. Lean protein, veggies, fruits and whole grains are the way to go all day through dinner.

Eat a mid afternoon snack that contains lean protein, fiber and healthy fat. Try a serving of low fat cheese along with an apple, or low fat peanut butter on a multigrain cracker. Heck, grab a 2-3 oz. piece of chicken or turkey in a small whole wheat pita pocket with lettuce. The body's enzyme systems take a long time to break down the chemical bonds in these foods, so the snack stays in your stomach longer giving you a fuller feeling than if you ingested lots of refined sugar (candy bar). When protein is broken down, some of the amino acids, like tyrosine, help to increase the secretion of neurotransmitters like dopamine, which can help you energize and cope better. Also, complex carbohydrates like whole wheat and multigrain products produce a steady slow release of glucose, as opposed to refined carbs (white sugar) that produce a rapid rise and fall in blood sugar, which can ramp up your appetite.

Drink up! Clearly make sure you're always well hydrated with water. And, it's actually fine to have a caffeinated beverage like a cup (not a pot!) of coffee or tea, but no later than 4PM. Make sure to keep the coffee calories in check by using skim or low fat milk and avoiding sugars and fats from the fancy coffee bar drinks.

Get up and move. There's nothing more energizing than moving around. Make a habit of doing this on a frequent basis throughout the day. I call it my 5 minute per hour rule. Every hour, try to accrue 5 minutes when you get up and take a walk and stretch. It's amazing how this little intervention can fight off afternoon sleepiness.

Take a mini chill. That's my term for closing your door, sitting back in your chair and just closing your eyes for a several minutes. No need to light candles or pal up with a Tibetan monk. You just need to practice what Dr. Herbert Benson of the Harvard Mind Body Institute calls the "relaxation response". You simply practice turning off all incoming messages and just "be". He uses everything from mantras to prayer to help you get there. I have captured his meditation for you to practice in Fight Fat after Forty, and Body for Life for Women. In the best of all worlds, take mini chills throughout the day, starting before you rise from bed in the morning. It helps you be present and mindful in your daily life.

Nap if you're really tired. An optimal nap is about 20 minutes. Too little and you're not rested, too much and you feel groggy.

Experiment and find out what works best for you and then make a plan and be prepared. I'll guarantee you'll be energized!

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Don't Relapse, Just Regroup

noreply@blogger.com (Dr. Pam Peeke) — Fri, 18 Sep 2009 13:11:00 +0000

Getting fit and healthy is not a destination. It's a journey filled with trials that test our abilities to live healthfully. Both turbulent and joyous, it's one that everyone has to come to embrace by learning the fine art of regrouping. Let's look at this posting from Blueeyes23 on my weight management board:

"I am trying to get back to my diet of eating healthy foods. I used to weigh 250 lbs. I started exercising and running. My diet consisted of counting calories and eating lots of veggies, pasta and some chicken or tuna (I don't normally eat meat). I stayed with this diet as well as counting the calories and staying within that limit. I started running from a couple miles to 5 miles now I'm up to 7 miles a day, 3 to 4 days a week. I went from 250lbs to 197 (currently). My goal is to be 175 which is where I need to be. Well, I went on vacation for a week and treated myself to "splurging" as I was soo good dieting and losing weight. That was in July. I am now eating more unhealthy food (donuts, candy bars, Pizza Hut pizza) and my body will sometimes just super crave sweets. I try my best to watch what I eat but it's hard. I still run 7 miles a day up to 4 days a week. Any suggestions, tricks that I could use or what I need to do to get back on track with my diet?"

Does this sound familiar to anyone out there? You bet it does. Here are some tips and tools to help manage this problem.

Don't use the word relapse. I don't like it because it's too negative. It leads to guilt and shame and ultimately to self destruction. Instead, look at these kinds of events as opportunities to learn how to take better care of yourself. That's the essence of learning how to regroup. Take a breath, examine what happened, see the patterns, adapt and adjust, and then move on.

Avoid "vacation mind"- where you let it all go and revert back to your old habits, thinking you can just pop right back into healthy eating after "splurging" for a week. Nope, that doesn't work. This is a lifelong journey and you're now mentally and physically different than the 250 person who started this. Chowing down on heavy calories for seven days is what got Blueeyes to 250 pounds. She can still go on vacation and have a great time, but with a brand new mindset- the mind of someone who shed over 50 pounds and needs to sustain that. Having some treats in appropriate servings is what someone who is healthier and more fit now does.

Beware awakening the refined sugar addiction demons. Apparently she's got the sweet tooth and carb craving demons on board. The solution is to immediately clean up her work and home environment, get rid of all of these foods, and to go into a 72 hour cold turkey on all of this. It really works. The key is not to over think this, but to just do it. Get right back to fresh, whole foods and don't look back. Keep physically active, avoid places that may tempt you (pizza parlors, the candy aisle at the grocers) and get to bed early. Trust me, this works.

Realize that exercising can NOT cancel out all of your over eating. Thank heavens she is still active or she would have gained a lot of weight back. Both reining in the calories and keeping physically active is the way to go.

Become a master at regrouping. Expect many challenges to your healthy lifestyle. Come up with Plan A and B all the way to Z if that's what it takes to learn how to adapt, adjust and regroup when life changes up on you. Get macho about it. "Go ahead and kick another challenge my way. Watch me regroup!" Now, that's a winning attitude!

So, if you're like Bueeyes, don't waste another moment stressing. Instead, celebrate the fact that you turned this speed bump into a valuable lesson that you're going to run with, starting right now.

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Genetics May Load the Obesity Gun, but Environment Pulls the Trigger

noreply@blogger.com (Dr. Pam Peeke) — Thu, 17 Sep 2009 18:05:00 +0000

Ever wonder how powerful genetics are when it comes to your chance of becoming obese? Take a moment and look at your own family tree. Going back as far as you can, think about the people in your family who might have been obese. You're obese if you have a Body Mass Index (your weight relative to your height) of 30 or more. BMI is closely correlated with body fat, with the following two exceptions: 1) a true very muscular athlete where body fat is overestimated; and, 2) the elderly where body fat is underestimated due to their loss of muscle. Check out the WebMD BMI calculator to see what your BMI is.

Many people can see some clear patterns of obesity in the family. Does it appear obesity is your genetic destiny? As it turns out, the answer is more hopeful than you might have originally thought. There is indeed a well known obesity gene, the FTO gene that is associated with increased intake of food, especially fat. It's been thought that people who carry the gene just don't feel as full and satisfied after eating normal portions of fat. There seems to be a fat-satiety disconnect. If you carry double copies of this obesity gene (one from each of your parents) your risk of becoming obese is 2.5 times higher than someone who doesn't. 17 percent of the general population has double obesity genes, and another 40 percent have a single copy. Don't despair. Your genetics will only activate if you give them a comfortable environment to do so - like eating a high fat diet and being sedentary. That's the perfect recipe for the obesity genes to emerge and wreak havoc with your body as well as your life.

New research has shown that a low fat diet can keep the obesity gene under control. Physical activity seals the deal. So, the deal breaker here is not your genetic legacy, but what you eat. The researchers compiled comprehensive data on the eating habits of people who do have the double gene copies. Only when the men and women were eating a high fat diet did you see the expected obesity. How much fat is acceptable? It's higher than you think. The actual number was 41% fat in the diet. Obesity was less common in those who ate less than that. It's recommended that you try to keep your fat intake in the range of 20-30% for optimal nutrition.

Whether you carry this gene or not, all of you - from over-eaters of fat to sugaraholics - need to pay attention to what you're eating. This medical study provides an important and a very positive and hopeful lesson. You don't have to be a prisoner of your own genes. Create a lifestyle of healthy eating and activity, and you'll keep harmful genes at bay. I've always said that genetics may load the gun, but environment pulls the trigger. Take a moment and study your own living and working places. What can you do right now to clean up and reorganize these spaces so that everything - from the food you keep in your fridge and cabinets to your walking or running shoes you keep by the front door - is all there to support your healthy lifestyle and keep you out of harm's way? Get rid of the junk food and choose the produce section of your grocery store over the pastry aisle. Hang out with like-minded people as well. Doing all of this will guarantee you'll be pulling that lifestyle trigger your way.

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Believe, Achieve and Succeed

noreply@blogger.com (Dr. Pam Peeke) — Fri, 11 Sep 2009 20:04:00 +0000

This week I watched with fascination as a 5'6" Georgia teen, ranked 70th in the world, triumphed over her six foot Russian opponent at the US Open Tennis event. That was the fourth top seeded Russian she's summarily dismissed since her debut at Wimbledon this year. Known as the Georgia "spark plug", Melanie Oudin is a wonder to watch. But what caught my eye were her shoes. It wasn't the neon rainbow colors, but the area on the side of her shoe at her heel that grabbed my attention. On each shoe, she had one word printed like a billboard of motivation -"Believe". When questioned about it, she simply declared, "I know I can succeed because I really believe it." Observing her is a lesson in what it takes to succeed. She's not perfect and actually capitalizes on that. Actually, her other title is "the comeback kid". She will often lose fairly miserably in the first set, and then come storming back. She notes the first set gives her time to learn the feel of her opponent. She appears impervious to any emotion of defeat or frustration. She learns, adapts, adjusts and moves on to success.

How does this apply to all of you who are seriously trying to improve your lifestyle habits? Here's the lesson - all success starts with the mind. Not some diet craze or exercise boot camp. This laser focus mindset is something I call The Power Mind, which I describe in detail in Body for Life for Women and Fit to Live. One of the biggest mistakes I have observed when men and women embark on their journey to shed excess fat and get more fit, is that without really thinking about it, they hop onto the next "diet" or fitness craze thinking they've found the answer to their girth control problems. You know the drill. It's always short lived and then you're either back to square one or you really blow it and end up in worse shape.

The problem is that you can't just approach your eating and exercise as though you're a robot implementing technical commands. Your mind drives you. You need your head screwed on right to start with. So many people just launch into their well intentioned programs without being very clear about why they need to do this in the first place. Getting to the bottom of that "why" is often tougher than you think. Saying you just want to be "healthy" doesn't work. Go deep and get personal about what drives you. You need to have a very clear vision, passion, strategy, accountability and measurable outcomes. Once you identify the meaning behind your desire to change, then you work on believing you can achieve your healthy lifestyle goal.

The great Olympic sprinter Florence Joyner ("Flo Jo") once noted she used three words to power her through grueling training and competition: "Believe. Achieve. Succeed". Watching Oudin I can see that put into action. How about you? I love those three words and regularly use them in my writing and teaching. If you believe then you lay down the path to be able to achieve and thus succeed. Stop right now and say to yourself "I believe I can patiently and persistently create a healthier lifestyle". Write it down and keep copies of that one line commitment everywhere to get you through tough and challenging times. Be your own best coach and say it to yourself throughout the day. You can do this. Believe it!

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If You Eat Late, You'll Gain Weight

noreply@blogger.com (Dr. Pam Peeke) — Thu, 10 Sep 2009 14:49:00 +0000

Long ago, while writing my first book, Fight Fat after Forty, I wrote a silly little poem to drive home the point that eating too late and too much each night can contribute to weight gain - "If you eat after eight, you'll gain a lot of weight". OK, so there's no real magic with eight o'clock per se, but it rhymed with weight so I went with it. I was just trying to emphasize that meals need to be carefully spread out over the day, and that it was optimal not to eat at least 1-2 hours before going to bed. Also, it was my clinical observation that when people overate, the evening hours were more potent in packing on the pounds in comparison to the daytime hours. Over the years, studies have supported my experience. Happily, a new study from a Northwestern University team has added further fuel to the fire by showing that overeating in the nighttime does indeed appear to significantly increase your risk for putting on the weight.

Specifically, these researchers found that the time of day you eat is a powerful predictor for weight gain. In a novel experiment, two groups of mice were fed the same high fat diet, which was deliberately intended to cause weight gain. One group of mice ate the diet during the night hours when rodents tend to naturally forage for food. The other group was only allowed access to the food during the daytime hours, when mice classically rested and slept. Extrapolating to humans, this is analogous to overeating the same number of high fat calories either before or after 6:00 PM. The investigators were shocked by the remarkable difference in weight gain between the two groups of mice. The group that simply overate during their typical eating schedule had a 20% weight gain. But the mice who overate the same number of calories during what would have been their sleep time, had a whopping 48% increase in weight. That's over twice the weight gain of the other group. This is an eye opening discovery.

Now for the $60,000 question - why does it matter when you eat those calories? Scientists are just beginning to piece together this puzzle. Many of us agree that part of the answer lies in understanding how this overeating interacts with a disruption of the normal sleep-wake cycle. During this cycle, it's believed that there is a complex interplay of brain and body hormones and chemicals that maintain a delicate balance of appetite, hunger and satiety. These, as well as other factors involving daily changes in core body temperature, energy levels and sleep, also play integral roles in metabolism and storage of the food we eat. It doesn't take a rocket scientist to realize how much 21st century living has disrupted normal sleep-wake cycles. Electricity prolonged our awake hours, and what I refer to as our "weapons of mass distraction" - TV, phone, computers, blackberries - are obliterating any attempts to rest or sleep. You see the problem. Our normal nocturnal biology has been thrown into chaos. And we're wearing the consequences of these nighttime trips to the fridge.

There are two patterns of nighttime overeating. The first involves "saving up" your calories by skipping meals and snacks and eating the majority of your calories in the evening. The second is to eat above and beyond your calorie budget (with either healthy and/or unhealthy foods) and to do this primarily in the evening. This can take place in a number of ways - grazing all the way to bedtime; eating a large dinner with or without after dinner grazing; eating an average dinner and then overeating after dinner. Do any of these patterns sound familiar? Regardless how you do it, the end result is weight gain.

What's the solution? For either pattern, the blueprint is the same. Starting with breakfast, eat every 3-4 hours through dinner. Try not to finish dinner later than 8:30PM. I know, life's challenging, so just do the best you can. Try not to eat anything for at least an hour (ideally two) before going to bed. If you ate dinner early (e.g. 6:00 PM) and you're not going to bed until 11:00 PM, have a 100-150 healthy snack (e.g. yogurt) say around 9:00 PM, which leaves two hours before you go to bed. Or, you can opt to have a treat at this time (e.g. 100 calorie chocolate mousse bar), understanding that it doesn't contain much protein and may not be as filling. Use trial and error to see what works best. You can mix them up throughout the week.

If you're coming home late, just remember that you need to keep up with your healthy snacks to tide you over (grab those nuts you packed in your purse or brief case) so you don't overeat when you do have dinner. Here's another one of my sayings: "The later you eat, the lighter you eat". If you're stuck eating later, opt for lots of filling veggies and 4 (women) -6-8 (men) ounces of lean protein. That'll satisfy you and not pack on extra weight. The key is to try not to let more than 4 hours go by without having a balanced meal or snack. Timing is so important in helping you stave off raging hunger and appetite.

Hey, and don't forget to get enough sleep! Studies show that folks who don't get 7-8 hours of sleep tend to have much more difficulty eating and exercising appropriately. Do whatever you can to get those zzz's.

The bottom line is that excellent nutrition is about quality, quantity and frequency of eating. Now we have new respect for the power of those evening hours to either make or break our attempts to finally shed that weight... and keep it off.

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Eating Like the Folks You Hang Out With

noreply@blogger.com (Dr. Pam Peeke) — Wed, 26 Aug 2009 20:21:00 +0000

Photo: Phillie Casablanca / CC BY 2.0

Have you ever wondered if your eating habits are truly affected by the people in your life? Well, wonder no more. Researchers from the State University of New York at Buffalo have found that kids and teens tend to eat more when they are having a meal or snack with someone they know, rather than with a stranger. That makes sense as people are more self-conscious around someone they don't know. But, check this out. The study also found that overweight kids will eat much more with another overweight friend than with an average-weighted friend. For that matter, the difference is over 300 calories. This study, published in the American Journal of Clinical Nutrition, shows how folks you eat with can affect your overall weight management.

If you're overweight or obese and you're eating with someone else who is the same, and especially if they're a friend, you'll eat more than if you were dining or snacking with a thinner person. The researchers call this "permission giving". That means that eating more than is necessary is the acceptable norm. What's interesting to note is that in studies of children, a normal-weighted kid consumes on average about 500 calories and it doesn't matter if the child he's eating with is a normal-weighted or an overweight friend. It's the overweight kids who are most influenced by the presence of a "permission giver" (another overweight kid).

Studies of adults have found that when men and women are followed for three decades, people tended to put on more weight if their same-sex friends were overweight or obese. This is the power of the social network. It's viral. The people you live, play and work with can indeed exert a powerful influence on your lifestyle habits.

Here's the good news. It's viral both ways. If you want to improve your current eating or exercise habits, start hanging out with people who are already doing that. Let them infect you with their good habits. Choose your mentors and do what it takes to be with like-minded individuals. Join a walking, hiking or biking club. It really works. This is true whether you're trying to quit smoking, drinking alcohol or over eating. Take a moment and think about who you tend to be with throughout the day.

A rule of thumb when you want to change any lifestyle habit is that you need to change the environment to support your new habit. Part of that environment is not just where you're living or working, but who you're doing that with. Everyone is on their own life journey, and they're also in various states of readiness to make change. There are plenty of people in your life who may not be ready for change and are still living an unhealthy lifestyle. That's OK. Just balance time you spend with them, with time being with more fit and healthy folks. It can often be a tricky balance, but keep working at it.

The bottom line is that if you want to become healthier, find other people who support that through their own lifestyle habits and hang out with them and learn and enjoy their encouragement. Then, one day, after you've succeeded in doing well, guess what? Someone's going to eyeball you and say "Wow, I want to be like you. Can we hang out together?" You see? It's a wonderful, viral process. So, what are you waiting for? Seek out your mentors and get started today.

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The Post Workout Burn

noreply@blogger.com (Dr. Pam Peeke) — Mon, 24 Aug 2009 16:58:00 +0000

I'll bet most of you have heard about the "post workout burn". These are calories you keep on burning even though you're done with the workout. I got to thinking about it again when I got this email from "afdw" on my weight management message board:

"Firstly, if you work out does it increase your metabolism for the upcoming hours? Then since sleep slows down metabolism, will it ruin your metabolism increase? Because now I wonder if I should workout in the morning or at 9pm. I normally workout at 9pm-9.30pm then I sleep at around 11-12. I am curious if this will slow down my metabolism and will I not get the optimal results I should have if I sleep a few hours after my workout. If i do workout in the morning, will it benefit me more? Please give me advice."

Alright, we'll start with the timing issue. What time is best to work out and how do you schedule that relative to your sleep? My easy answer for the workout time is any time that works for you.

First, at the very least, try to stay as active as possible throughout your day by increasing your activities of daily living. Every calorie you burn counts and also stokes your metabolic fire.

Second, do your deliberate workout at a time of day when you know you will have the least chance of being interrupted. If you're a mother, you work around the kids' schedules. And since most people work, it's about being creative and flexible with the nuances of work schedules as well. Hopefully your workout times coincide with your natural biorhythm - some of you are larks (early risers) and others are owls (late to bed). Also, about 50% of people can sleep perfectly fine after an evening bout of exercise. You won't know if you're one of those until you've experimented, so give it a whirl.

Finally, as you try to integrate physical activity into your busy schedule, it's so important to remember those two words I keep repeating: adapt and adjust. If Plan A doesn't work, get going on Plan B. Keep workin' it until you get a baseline schedule of exercise that works for you. Those who do, look, feel and live like it.

Now, onto the issue of the post workout burn. The calories that you expend after you finish up your exercise are known as the "after-burn". Exercise scientists call it EPOC, or excess post-exercise oxygen consumption. After you've worked out, especially if you did an intense workout, your body spends time getting your oxygen, body temperature and blood circulation back to its normal state. Muscles are repairing themselves and restocking their glucose fuel. You may notice your heart and respiratory rate are elevated for a while, and your nervous system remains somewhat activated as adrenalin and cortisol (stress hormone) levels slowly settle down to pre-exercise levels.

This adjustment period can take anywhere from 15 minutes to 48 hours. A rule of thumb is that during this period, your body will continue to burn between 10-15 calories for every 100 calories you burned during your workout. The more intense the workout, the more calories you burn. For instance, in studies comparing low and high intensity workouts in which the same number of calories was burned (500 calories), the high intensity EPOC burned 45 vs 24 calories for the low intensity exercise following each workout. Long, low intense exercise (1.5-2 hours) also raises EPOC to optimal levels. Think of hiking or walking.

New science has shown that if you're looking for a maximal EPOC, don't forget to do both weight lifting as well as cardio. Colorado State researchers compared moderately intense weight lifting and aerobic exercise (cardio) to see if there was a difference in EPOC. It took the weight lifters 100 minutes of lifting versus 60 minutes of cycling to achieve the same 600 calories of exercise expended during exercise. The strength training produced an extra 24 calories of after-burn (total EPOC 51 calories) compared to the same level of intense aerobic exercise, cycling (total EPOC 27 calories). Let's do a little math. The EPOC from cardio done 5 x week would equate to an extra 7000 calories per year above and beyond the calories already spent during the exercise sessions. The EPOC from weight lifting 2 x week would be equal to 5000 calories of extra calorie burn per year. Combining the two, that's a grand total of 12, 000 calories or (dividing by 3,500 calories/pound) almost 3.5 pounds of fat removed as a benefit of the after-burn. Not bad for after-burn!

The bottom line is it doesn't matter when you work out, but what counts is the intensity. If you haven't yet tried intervals of intensity, gradually increase speed and resistance under the supervision of an expert. Ask a fitness professional at your gym or community center for direction, and check out WebMD's fitness resources to get started safely. Start racking up those bonus calories today!

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Cooking Calories While You Sleep

noreply@blogger.com (Dr. Pam Peeke) — Thu, 20 Aug 2009 18:25:00 +0000

Alyssa L. Miller / CC BY-SA 2.0

Today a patient of mine told me she's having difficulty focusing on her new healthy lifestyle habits because she feels so sleep deprived. On average, she's been trying to live on 4-6 hours of sleep per night. She looked at me and asked how important sleep was to her weight loss efforts. I'll share with you what I told her. First, we'll start with what happens to your body's calorie burning engine while you sleep.

Have you ever wondered how many calories your body burns while you sleep? Here are some fascinating facts. Please keep in mind the usual variances here - while sleeping, Shaquille O'Neil burns a tad more than Lance Armstrong. During sleep, an average individual burns the equivalent of 77 calories per hour. 20% of the time you're sleeping (90 minutes), you're dreaming which means you're spending roughly 115 calories in dreamland (e.g. the rough equivalent of running .8 miles). Generally, a 160 pound individual will burn roughly 549 calories over 8 hours of sleep. A pound of muscle burns about 6 calories at rest and a pound of fat 2 calories. Clearly, those people with more muscle, and especially if it's well trained (our pals Shaquille and Lance), are at an advantage for cooking a few more calories than the average guy while they get their nightly shuteye. Just another argument for staying physically active.

But wait, there's more. There's new research showing that the quantity as well as quality of your sleep directly influences weight loss. A lot of focus has been on the appetite hormones leptin and ghrelin. These two hormones are the reason why after a bad night's sleep nothing you eat seems to fill or satisfy you. Ghrelin, produced in the GI tract, stimulates appetite while leptin, produced by fat cells, is supposed to send a signal to your brain that you're full. Clearly, many factors influence the secretion and regulation of these hormones including genetics, stress and lifestyle. When you don't get enough sleep, and/or it's poor quality sleep, ghrelin levels skyrocket and leptin's plummets. Appetite is out of control and here comes overeating. Other studies showed that the less sleep you get, the more body fat you carry.

The bottom line is you want to do everything you possibly can to get 7-8 hours of sleep every night. My patient typically took her laptop to bed, pounding away on the computer trying to finish deadlines, and then collapsed in a heap. She wonders why her sleep time and quality are so poor. Optimizing the quality of sleep means creating a sleep-friendly atmosphere (e.g. no laptops, don't watch a horror show or getting into a shouting match with your better half before hitting the sack). Try to get on a regular schedule of going to bed at a specific reasonable hour. Do sleep inducing activities before going to bed - read a book, meditate, cuddle with your partner, listen to relaxing music. Finally, remember that your goal is to let your body's natural and powerful chemistry work for you. Don't confuse your hormones with a crazy sleep schedule. Team up with your body for the best win win.

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Exercise Does Help You Shed Your Weight

noreply@blogger.com (Dr. Pam Peeke) — Mon, 17 Aug 2009 17:41:00 +0000

I couldn't believe my eyes. I'd just gotten my current issue of Time magazine and after reading the cover, my jaw dropped - actually clanked on the floor. The cover story read "The Myth of Exercise: Why Exercise Won't Make You Thin". The cover photo portrayed a young woman running on a treadmill and dangling in front of her was the real reason she was sweating - her mental fantasy of a cup cake. Trying to be objective, I methodically read the article. It's written by a good writer who typically doesn't work with this kind of subject matter. His premise was that exercise, especially intense activity, increases your appetite and you end up eating more and actually gaining weight. Further, he noted that people want a food reward - their favorite treat - after every workout session. He also shared his own struggle - he's not obese - with that male gut issue. But there's a cynical, biased edge to his writing, as though to say "Why should I work out if my gut's not disappearing?" I've got a news flash for Mr. Cloud. An over 40-year-old man has decreasing male sex hormones that directly contribute to more fat distributed to his belly. He's not as metabolically efficient at burning fat. Relative to his age, he's eating too much, thus the gut.

Who said that the main reason we work out is so we can chow down on pastries? I asked my good friend and gym mate Newsweek's Eleanor Clift what she thought of this and she posted on her blog:

"...exercise has kept my blood pressure down near astronaut levels, and the endorphins released during exercise help keep me sane...I happen to believe that exercise is the closest thing we've got to a fountain of youth."

I loved this quote because it stresses that activity is a mind and body experience. Heck, so many of my patients over the years have said to me that they began doing more activity to drop weight, but actually continued it because it was so good for their heads - calmed them down, reduced their anxiety and depression, and helped them to cope with the stresses of life so much better. There's also the pride in performing better, from sports to activities of daily living. Doing more activity and watching what you eat does allows you to be able to metabolize that occasional treat without weight gain. I don't know anyone who workouts out so they can plow through a box of doughnuts afterward. There are people out there who fool themselves into thinking exercise will somehow cancel out indiscretions like that, but after jumping on the scale a few times post over eating, reality sets in.

And what about that roaring increase in appetite sending us all racing to a post workout Crispy Crème binge? Read the research. A recent study from University of Pittsburgh found that overweight and obese women didn't need any more calories when exercising regularly than when they were sedentary. So let's set the record straight. Of course you're going to have a greater appetite if you engage in intense exercise. So, you just make sure to keep healthy foods (especially fruits and veggies) around and be mindful of your calories. The basic energy balance equation says that to maintain your current overall weight, you need to take in the same amount of fuel (food) and you burn each day. Ideally, to drop weight you reduce the total number of calories you take in, and you increase the calories your burn.

So, I put it out there on my weight management message board to see what all of you thought about the exercise-weight loss connection. Here are your voices:

"I wondered what research was used for such headlines. I am 60 years old and have never lost weight with a calorie restrictive diet. I cannot starve myself enough. Yet when I added aerobic exercise my entire body improved and I lost 5 dress sizes. I begin in May of 2002 and didn't really notice much the first two months as muscle does weigh more than fat; but by the time school began in the Fall I needed an entirely new wardrobe. From August to November that year I lost one size per month before reaching a plateau. It is not until I hit a bit of depression six years later and stopped exercising that I needed to buy larger sized clothing. I begin my exercise program with a stationary bike and 20 minutes. Eventually I worked up to 70 minutes a day on the elliptical. I ate a healthy diet at that time using WebMD's food intake program (before it got all of the bells and whistles) - I was never hungry or deprived of my favorite foods. With "diets" having such a rebound issue of regaining the lost weight plus 5 to 10 pounds, I just can't believe that diet alone is the key. Exercise improves multiple body functions keeping your metabolism up much better than the loss of muscle associated with weight-loss alone." 1949Rose

"Weight loss is a simple equation: you either decrease the calories you take in by diet modification, increase the calories you burn by exercise, or DO BOTH! Personally, I have had great success with the third option (down over 93 pounds
in 2-1/2 years)." Dukeof Earle

"There is probably some truth that you can lose weight without exercise, I lost several pounds without exercise when I first started. The problem I have is that this article will further convince people that they don't need exercise which I firmly believe to be false! I have no doubt I could have lost a decent amount of weight without exercise but I also know that I could not have dropped the 90 pounds I have lost and kept off without exercise! Exercise is responsible for firming up my muscles, it is responsible for giving my body the shape it had lost but even more than that, exercise has given me more self-confidence then I ever had before - enough so that I trained for a ran a 25k race. My body does require more fuel because I exercise 7 days a week (no not everyone needs to exercise that much but I enjoy my workouts) but the food I eat is healthy and I count my calories so I am not in the position to gain weight. I guess the bottom line for me is exercise is not only good for the body but the mind and soul as well." Redwingfan

Finally, I'm going to put on my hat as the American College of Sports Medicine's spokesperson for their global Exercise IS Medicine campaign. Here are the facts.

Physical activity is one of the most important behavioral factors in weight maintenance and improving long-term weight loss outcomes. In fact, participation in an exercise program has proven to be the very best predictor of maintaining weight that was lost.
Exercise and physical activity have been proven to help prevent chronic conditions such as heart disease, osteoporosis, anxiety, depression, obesity and diabetes.
Studies show that when students are more active (through physical education, classroom activity, play, etc.) they improve test scores and attendance and experience fewer discipline problems and sick days.
Simple activities like walking, accumulated in 10-minute bouts, can have significant benefits.

So, get on out there and live in balance. Pay attention to your eating and your moving. They're both life giving vital signs.

Related Topics:

Minimize Your Menopot

noreply@blogger.com (Dr. Pam Peeke) — Wed, 12 Aug 2009 12:49:00 +0000

Alright, raise your hand if you're a woman trying to navigate the treacherous waters of the perimenopausal (40-52) or menopause years (cessation of all menses, usually by age 52-54)? Yep, just as I thought. There are about 78 million baby boomers and over half of them are women, so you're in good company. Can you relate to this post I received on my weight management board?

"I am 57 years old and am postmenopausel. I work out at least one hour 5 days per week. I eat less than 1000 calories every day, and I CAN'T LOSE ANY WEIGHT! My current weight is 165 pounds. I have had my thyroid checked, and blood drawn, everything is normal. help!" from dmlevins

OK, for dmlevins and all the rest of you who feel her pain, here are some tips and tools. I spent many years in my laboratory at the National Institutes of Health, as well as clinical years working with women over 40, studying what the heck was going on with their ever expanding tummies. Lo and behold, I published Fight Fat after Forty which described why we start having such girth control problems, and I named the extra fat collecting around the middle the "Menopot". All women get this fat accumulation. On average it can be in the range of 3-6 pounds. It should not be double digits. And, you can't completely get rid of it. Your goal is to minimize it.

Where does the Menopot come from? As a woman enters her perimenopause, she is slowly withdrawing from powerful sex hormones. Pre-40's, estrogen usually directed any fat storage to the hip, thigh and buttocks. Post-40, estrogen begins to wax and wane, and any extra fat heads for the abdomen, resulting in the mission impossible of zipping up those jeans. In Body for Life for Women, I wrote that what's important during this critical time in a woman's life is that she pay attention to her body composition, not just her weight – the amount of muscle, fat and bone. Every woman should march into her gym or buy a body fat scale and know what her numbers are. Body fat should be in the 20's, preferably around 25%. Fewer fat cells mean a reduced risk of breast cancer. Her girth should measure less than 35" to decrease her risk for diabetes and heart disease.

I would advise women who want to drop their over 40 weight to:

Get your body composition and waist measurement done.

Know your thyroid and cholesterol profiles, as well as your fasting blood sugar and blood pressure.

Keep a journal of your eating for one week to observe your patterns--- it may be quite an eye opener.

Never eat less than 1200 cals per day or you'll effectively shut down your metabolic drive, and thus your calorie burning potential. Aim for 1400-1600 calories per day based on activity level.

Eat smaller, balanced feedings every 3-4 hours starting with breakfast and ending with dinner.

Eat lean protein at every meal and the mid afternoon snack. Protein is your appetite, carb crave killing friend.

Avoid alcohol except once or twice on weekends. Too much packs on the belly weight.

Cross train your cardio (don't do the same thing all of the time--- mix it up). Burn 400 calories of cardio 5 days per week. Increase your activities of daily living. Get up and move more.

Add intensity intervals. Too many women look like night of the living dead on their treadmill or elliptical. Ramp it up and shake up those post-40 fat cells. Sweat!

Lift weights 2 x week, paying attention to your upper body especially, since your legs are getting their cardio workout. Don't forget your core and stretches at the end of each session.

Please take a patience pill. For crying out loud, you're over 40 and you need to give your body a chance to adapt and adjust as you shed excess weight. Practice a little self love and don't starve yourself or live in a physical boot camp for weeks on end. Gradually and patiently, you can minimize your Menopot.

Lifestyle Approach or Gastric Surgery

noreply@blogger.com (Dr. Pam Peeke) — Mon, 10 Aug 2009 13:32:00 +0000

Which Way to Go for Weight Loss
If you’re over 100 pounds above the recommended range for healthy weight for your age and gender, you may have found yourself wondering which way to go to drop the weight. Recently, I’ve been messaging with Therese, a young woman on my weight management board. Here’s an excerpt from her email:

"Hi everybody, this is kind of an update from my first post on this board. For a recap I am a 22yr old female, with diabetes and neuropathy. I recently began seeing a new internist, he highly recommends that I have weight loss surgery, my BMI is 36.2, which my doctor tells me is not typically big enough for surgery but he said because of my health problems I qualify. The hospital I am planning on having the surgery at has a wonderful bariatric program and is supposed to be one of the best in the USA. But even knowing that I am very nervous, I know this is something I have to do though, in my case it could really prolong my life. My doctor said it could possibly make the diabetes either go away completely or make so I wouldn't have to take medication for it. … I am leaning towards the gastric bypass surgery, I like the fact that it would help me drop the weight faster and help me keep it off. Either way failure is not an option for me. …Thank you All Very, Very Much, Therese"

I’ve been dealing with gastric surgery patients for many years. Here’s a valuable lesson I learned through one particular woman who did not opt for the surgery, but slugged it out to remove 150 pounds by taking on her own addictive demons, getting buddy support, and becoming more physically active. This was no easy feat but she pulled it off and has maintained for 10 years and counting. I once asked her why she didn’t choose surgery. She smiled and said these words, "Dr. Peeke, gastric surgery is GI surgery, not brain surgery. I would have gone into surgery with the same bad mental habits as I came out of surgery with. Once the weight came off, I’d still have to deal with my own mental demons, just waiting to sabotage me." I never forgot those words. And, she’s right. What I am making certain is that Therese and other folks considering surgery make sure to realize that unless their surgical program is affiliated with a strong support team of nutritional, fitness and mental health experts, success in the long run is unlikely. You don’t just undergo the surgery and call it a day. You need strong ongoing support to help you as you adapt and adjust to significant weight loss. When I wrote "lifestyle or surgery" as the title of this blog, the true truth is that either option has to involve a major lifestyle change. You have to become more physically active, vigilant about the quality and quantity of calories, and you must learn how to rein in self destructive habits leading to weight gain.

I have observed that people do indeed drop weight, but by about the 12-16th month post op, weight begins to creep back on for those people who did not take the time to do the mental homework involving tackling the tough work of learning new, healthier habits. That’s the tragedy you don’t want to happen – to undergo surgery and regain it all back. It’s mental and physical work that is needed for success. Surgery does not eliminate that work. It is not an easy way out. Gastric surgery is only life saving if it’s done with the right team and the individual is ready and willing to do the work for a lifetime. Those are the words of wisdom I’ll be sharing with Therese as she contemplates her choices.