We just left Orlando, Florida, where the Annual Scientific Meetings of the American Diabetes Association (ADA) were held. I’ve been a member of the ADA since the 1970’s and I have been active especially in our local area ADA (the Northern Illinois Southern Indiana Area). As usual, the ADA national meeting was excellent with attendees and faculty from all over the world sharing in the latest advances and knowledge in Diabetes understanding and treatment. Although our knowledge about Diabetes and our ability to treat it is constantly expanding, it dawned on me that new knowledge and education is not the problem – it is our inability as patients and health care providers to use the tools and apply the knowledge we already have. Of course, research should and must continue for the future, but, what about the millions of individuals who have Diabetes now? In future posts I will continue to attempt to get individuals to use the tools we already have, especially lifestyle, to be healthier and I will talk much on my feelings that “Health Insurance” as we think of it today is really “Illness Insurance.” The only person that can really insure our health is our self. In future posts I will comment on not only my mantra “Your Weight Management = Your Lifestyle Management = Your Health Management” but also topics such as the health care debate, quality of life, and other issues.
After Attending the Recent American Diabetes Association Scientific Meetings, I’ve Changed My Idea of What My Blog Should Be
July 1st, 2010
My Patients Ask – “How Many Calories Per Day Can I Eat and Still Maintain My Weight?”
February 9th, 2010I’m always thrilled when a patient asks me this question, because, I believe, an individual’s understanding of how many calories he/she needs to maintain current weight is the first, and most important, of the three “anchor points” that we must embrace if we are to be successful maintaining weight, losing weight or maintaining weight loss. The second “anchor point” is using the scale regularly (weekly is best) to monitor how we’re doing weight wise and the third “anchor point” is the performance, on a daily basis, of as much physical activity as we can do – preferably a cumulative hour plus per day.
Estimating (its not an exact science) the daily calories needed to maintain our weight is easy – for women, multiply your weight by 10 - 11 calories per pound and for men by 12 – 13 calories per pound.
A woman who weighs 150 lbs can eat only 150 x 10 – 11 = 1500 – 1650 calories per day.
A man who weighs 180 lbs can eat only 180 x 12 -13 = 2160 – 2340 calories per day.
Surprised? When one understands that a meal of a burger, fries, and a soft drink averages 1000 + calories and that this equals 2/3 of the daily calories a 150 lb woman can eat to maintain her weight (leaving only 500 or so calories for the rest of the day) its no wonder women, especially as they get older, and especially if they áre physically inactive, have trouble not only losing but maintaining their weight. That same 1000+ calorie meal represents around 1/2 of a 180 lb man’s maintenance calories per day leaving 1000 to 1300 calories for the rest of the day.
Getting the picture? One has to deficit (not eat or consume) 500 calories per day or 3500 calories per week to decrease one’s weight by one pound. This means that a 150 lb woman would have to decrease to 1000 -1200 calories per day and the 180 lb man to 1600 -1800 calories per day to lose 1 lb per week!
I want you to think about all of this. I’ll discuss calories further as well as the other two anchor points in upcoming posts.
As usual, I’d appreciate your comments.
For My Weight Loss – Why “Eating Healthy” Was Not the Total Answer – “Good” vs. “Bad” Foods
January 27th, 2010First, an update on my own weight loss efforts – two pounds this past week by a combination of daily physical activity and less calories while going out to restaurants to eat three times, eating most of a triple fruit pie (a regular recipe without low calorie ingredients) that I personally baked, and having a daily cocktail. Am I eating healthy? What does this mean? Why did I lose weight?
I guess what most people mean by “Eating Healthy” is avoiding “junk” food (my pie and alcohol?) with its refined contents, sugars, chemicals, pesticides, and preservatives, and other “empty” calories plus avoiding trans fats, saturated fats, and cholesterol and replacing these with non processed (non refined) and ”organically” produced foods such as fruits and vegetables, whole grain cereals, monounsaturated and polyunsaturated fats, seafoods as opposed to meats, less caffein, and perhaps taking vitamins and other “health improving” additives or supplements. It’s the same old refrain replace ”bad” foods with “good” foods – “bad” calories with “good ” calories. A lot of individuals are doing this to a more or less degree. Are they “healthier” because of this? Most definitely. Are they losing weight? Most are definitely not. Why? Because a calorie is a calorie is a calorie, “bad” or “good.” An ounce of high fructose corn syrup’s ”bad” carbohydrate has the same number of calories as an ounce of the “good” carbohydrate in whole grain cereal – an ounce of saturated or trans “bad” fat has the same number of calories as an ounce of the “good” monounsaturated fat in olive or peanut oil. An eight ounce glass of regular soda pop has the same number of calories as a glass of orange juice. Is the orange juice healthier? Of course it is! Will substituting a glass of orange juice for a glass of pop help you lose weight? Of course not because they’re calorically equal! Getting the picture?
Now, back to me. I lost weight while eating out a lot, eating home made pie, drinking alcohol - eating in a way most would consider “unhealthy” – because I consumed less calories than I needed to maintain my weight. Therefore, for me it was the quantity (total number) of calories not the type (good vs. bad) of calories which made the difference. Yes, I also performed daily physical activity but really no more than I had done before I decided to lose those pounds.
Remember, your “eating healthy” will result in weight loss only if, by “eating healthy” you are actually eating less calories than you need to maintain your weight!
I’ll discuss how we can easily calculate our daily calorie needs in my next post.
“Weighing In” the New Year Continued – Why So Difficult?
January 20th, 2010The sheer number of new articles, books, advertisements, diet programs, and other hoopla, blitzing us in the new year attest to the problem of overweight and its consequences being literally and figuratively a huge problem. As I mentioned previously, after gaining 5 pounds in the past 8 weeks or so I weigh more now than I have in awhile. Although gaining 5 pounds sounds like I really overate, in truth, my total daily average excess calorie imbalance (a combination of more food and less physical activity since Thanksgiving) was only around 300 calories a day! Doesn’t sound like a lot does it? It isn’t. An extra drink here, a snack there, a little less walking easily accounts for the 300 calories. That’s why its so easy to gain and so hard to lose those pounds. So, now, I’ve ramped up my daily physical activity and I’ve decreased my calorie intake by around 500 calories a day and I’m losing about a pound a week. Why does it work for me and why do others have such a problem? It has to do with understanding how many calories one needs to maintain weight and the sum total of all the calories one eats daily plus physical activity calorie expenditure. I’ll discuss how to calculate these parameters in my next post. I’ll give you a hint its not simply “eating healthy” – whatever that means.
A New Year and Time to “Weigh In” Again!
January 13th, 2010Happy New Year and Happy New Decade to all.
Here it is only 13 days into 2010 and I, like I suspect everyone else, seem to be experienceing the same old things. I’m trying to lose weight and I’ve developed writer’s block – I’ve actually been trying to write my first blog post of the new year ever since we returned from Florida January 3! It’s so frustrating! For me, losing weight is a chore and I’m the “expert.” I have to develop a plan just like I adv ise that my patients do. This I’ll discuss tomorrow (ah, that procrastination thing again!). Of course, I feel I have a very good reason to put off my weight loss plan discussion because my writer’s block is a more pressing issue and I need a plan for this. Plans, plans, and another plan – I’m going in circles. “Just do it” “Priortize!, ” I keep telling myself. “Post that post!” OK, I will now! “Weighing In” is certainly difficult.
Good Times to All No Matter Your Beliefs!
December 19th, 2009Before I take some end of the year time off, I thought it best to do one last post for 2009. I’ve reread my previous postings and, for the most part, I’m satisfied with them. However, I realize that I’ve not discussed many (if any) really controversial issues. By this I mean the nitty gritty of lifestyle management – “good foods vs. bad foods;” “emotional (psychological) eating;” genetics and overweight; “plateauing” while dieting; “All calories are the same (I believe they are);” “I can’t lose weight!”; “bad” carbs and “good” carbs (I dare to say here they’re all the same); “I can’t exercise!” – to mention only a few.
Meanwhile, like almost everyone else I’ve recently gained some weight and I’m struggling a bit in this regard. This is disconcerting, but, I’ll discuss how I’ll manage this.
I hope in 2010 to stir up some conversation concerning “Your Weight Management = Your Health Management. ” Meanwhile keep on moving that body and, remember, every calorie counts!
My Reflections on “Health” and “Health Care” as I Visit the Mayo Clinic
December 9th, 2009As I sit in my hotel room across the street from the Mayo Clinic unable to drive home because of a raging blizzard, I’m grateful that my wife and I both got passing reports on our examinations performed at Mayo this week. We’re “healthy” with decent weight, blood pressure, cholesterol, x-rays, etc., and we were advised as to how often and when we should be vaccinated, and screened with procedures such as colonoscopy. What a relief! My hope is that the movement for health care reform that our country is now in the middle of will provide everyone with an opportunity to experience such medical care. Admittedly, the Mayo Clinic is special. But, as special and friendly and medically expert and up to date and efficient and famous as the Mayo Clinic is – what did it do to make me “healthy,” and, by extension, what did my “health insurance” that’ll help pay for my Mayo Clinic visit do to make me “healthy?” The answer, is, truthfully, not as much as one would think. Medical care, even the “best” medical care, doesn’t make us healthier. What it does is provide treatments for things we have no control over such as the need for surgery, treatment for diseases such as cancer, treatment after accidents, cataracts, Diabetes, heart attacks, strokes, to name only a few. Don’t get me wrong such treatments are very, very, important and everyone of us deserve to have access to them. However, health insurance (really “illness insurance”) even when it helps pay for a terrific organization like the Mayo Clinic cannot get us to do daily physical activity and eat less calories to keep our weight down which would truly make us “healthier” and prevent or delay those heart attacks, strokes, cancer, Diabetes, arthritis, sleep apnea, and the myriad of other lifestyle diseases. If we all took better care of ourselves, we wouldn’t need as much “illness insurance” and that insurance would then provide medical and surgical treatments for problems we cannot prevent or treat ourselves. Again, “Your Weight Management = Your Health Management.” I’ll sign off now, it’s stopped snowing. We have to leave Rochester early tomorrow morning so we can be back in the office tomorrow afternoon. As always, I look forward to your comments. Also, what do you think of my recent post on “Diabetes?”
Our Epidemic of Unhealthy Lifestyle = Our Epidemic of Overweight/Obesity = Our Epidemic of Type 2 Diabetes
December 8th, 2009It’s time I utilize Type 2 Diabetes (previously called Adult Onset or Old Age Diabetes and the prototypical lifestyle disease) to explain and illustrate - “Your Weight Management = Your Health Management.”
Over the last 25 years or so there has been an increase in the number of people of all age groups including young people and children with Type 2 Diabetes (not Type 1 Diabetes which is a different disease). This Type 2 Diabetes epidemic is worldwide - almost everyone either has or knows someone who has Type 2 Diabetes. Why the epidemic? To answer this question we must first understand what Type 2 Diabetes is.
Type 2 Diabetes is always a genetic (inherited from parents) disease and the genetics haven’t changed in centuries. A Type 2 Diabetes individual inherits two things: first, an inabilty (from birth) for that individual’s insulin to work properly to lower blood sugar – this is called insulin resistance – the need for more insulin to lower blood sugar compared to someone without Diabetes; and, second, a planned or programmed gradual failure from an early age of that individual’s insulin producing cells (Beta cells). Eventually, the Type 2 Diabetes individual’s Beta cells simply fail to the point that they can no longer produce enough insulin to overcome the insulin resistance and the Type 2 Diabetic’s blood sugar (glucose) starts going up. This used to happen (prior to the Type 2 Diabetes epidemic) in an individual’s late 50’s, 60’s, or 70’s – hence the term “Old Age Diabetes.”
If the genetics haven’t changed, why are more and more people, including youg people, being diagnosed with Type 2 Diabetes? Why this epidemic? The answer is that as an individual with genetic Type 2 Diabetes weight increases, his/her problems with blood sugar elevation increase. This happens because as the individual with genetic Type 2 Diabetes gains weight (eats too much and with less physical activity becomes less fit) doing this causes its own insulin resistance which is superimposed on (added to) that individual’s genetic insulin resistance and this stresses the Beta insulin producing cells even more and they fail earlier and earlier. The majority of young people (children and teens ) who are diagnosed with Type 2 Diabetes are morbidly obese. The average individual with Type 2 Diabetes in the USA is obese with a BMI of 33.
The Type 2 Diabetes epidemic is not simply associated with overweight/obesity – it is caused by overweight/obesity and the unhealthy lifestyle that causes the overweight/obesity.
Therefore, “Your Weight Management = Your Health (Diabetes) Management.”
As usual, I would appreciate your comments, discussion or questions.
Why are a lot of us overweight – does dieting work?
December 1st, 2009Wow, I’ve been derelict in posting! It’s been days! Sorry.
Lately, I’ve been impressed by the message of many articles, comments, and TV programs addressing the issue of overweight and its causes. What we’re witnessing is the development of a consensus that not only is the overweight and obesity epidemic our major public health concern (and not a “benign” happening) but also that its cause or causes are more related to our individual and collective lifestyles and not some unexplainable phenomenon that we, as individuals and as a nation (and world for that matter), can do nothing about. We eat too much and we don’t get enough physical activity. This consensus that “calories in must equal calories out” is of the greatest importance because without it we can not begin to attempt implementing solutions. Simply stated, “Dieting does always work” if one defines “diet” as the appropriate amount of calories and physical activity an individual needs daily to either maintain weight (if maintenance is the goal) or lose weight (if weight loss is the goal). Whether or not an individual can “diet” successfully is an entirely different issue. I’ll address why successful “dieting” is so difficult in future posts. As usual, I look forward to your comments.
Dr. Motto, Why Another Medical – Lifestyle Blog?
November 16th, 2009“Why another medical – lifestyle blog?” An excellent question and one that I’ve been asking myself daily. The answer is that as an experienced physician, a specialist in Endocrinology & Metabolism, I believe I have an obligation to attempt to change the way the medical establishment and patients view disease. In the many years since I graduated from medical school, innumerable advances in medical knowledge and treatment has meant that I’ve had more and more tools to diagnose and help my patients. Despite all these advances more and more of my patients are relying on medications, surgery, all kinds of over the counter supplements and other treatments and fads to achieve control of their medical and emotional conditions. Meanwhile, diabetes, sleep apnea, high cholesterol, high triglycerides, hypertension, heart disease, metabolic syndrome, degenerative arthritis, overweight, obesity, diminished quality of life and mental disorders such as depression are actually increasing, often in epidemic proportions, in my patients and my community. Something is obviously very wrong. What? I believe it’s that most of us either don’t understand or don’t believe that the results of our unhealthy lifestyle – overweight, obesity, and/or physical unfitness – are what’s doing us in. The answer is all of us embracing “Your Weight Management = Your Health Management” (see my previous blog posts which explain this). I do believe that as individuals and communities we can change and I hope through my blog I will help convince you that this is not only necessary but possible. In my next post I will discuss Type 2 Diabetes, the prototypical genetic and lifestyle disease, the progression and outcome of which is profoundly affected by lifestyle habits and behaviors. As always, I look forward to your comments – simply click on “No Comments” below.
