Dr. Wolfe’s Diet Revolution

The following is an excerpt from an article written by Health Letter Editor-in-Chief, Dr. Sidney Wolfe. The full article has been published in previous editions of this newsletter. We feel that the article is just as valid today as when it was written over 20 years ago, and just as timely, too. This January, as many of us resolve to make 2007 the year we win the battle of the bulge, keep in mind Dr. Wolfe’s advice on attainable and sustainable weight loss.

Principles of Weight Loss
For most people, losing weight is a problem of how to shed five to 20 pounds. Despite the unhappiness and impatience you may feel with this extra weight, the best approach to losing it safely and permanently is to take it off slowly and with painstaking attention to traditional diet principles. In dieting, as in other activities, there is a balance sheet that says, if more calories are eaten than burned, weight is gained; if more calories are burned than eaten, weight is lost.  It’s as simple as that — and as uncompromising.

Unfortunately, as most would-be dieters can testify, losing poundage is not easy. Dieting is a long-term project involving permanent changes in eating habits and physical activity. In fact, experts agree that the best short-term solutions to moderate weight loss, namely the 1,200-calorie diets that help you shed pounds in a hurry, are the hardest to maintain over the long haul. Why? Possibly because choice is more difficult to handle in long-term dieting than in the strict dietary alternatives that are more life modified fasts. The critical factor in any diet attempt is that concurrent with cutting down calories, you work on permanently changing your eating habits.

Even if you are 20 pounds or so overweight, you may not need to go on an extreme diet. It’s simple arithmetic again: at 3,500 calories per pound of flab, you need to account for 70,000 excess calories, and this can be done in a number of ways. If you cut your energy intake (or raise your energy output) by 250 calories a day, you will lose 20 pounds in about nine months without having to practice a lot of self-denial. Just being careful might be more successful for you than participating in any kind of prescribed diet or system. Once again, we’re talking about choices — and those are strictly yours to make: cutting down on portion sizes, selecting foods carefully, preparing them conscientiously, and eliminating desserts and junk foods — by making these sorts of conscious interventions, it’s possible you will be very successful over the long run. Remember, the name of the game is not just taking weight off, it’s keeping it off. 

Many moderately overweight people won’t find slow reduction as rewarding as the crash diet that supposedly will get you into the size 10 dress within two weeks. The temptation always exists to take shortcuts and try “get-thin-quick” reduction schemes. But slimming is like most other things in life: if a proposition sounds too good to be true, it probably is. Any program that promises short-term weight loss without any dietary or lifestyle changes will typically fail after early success. Most people on so-called low calorie diets regain weight back almost as quickly as they lost it.

A Reasonable Plan: How to Lose a Pound a Week — Safely
Setting a caloric adjustment that will result in permanent weight loss and allow you to integrate these changes into your life is a considerable challenge. The goal is to develop new, healthier diet and exercise habits, not just to lose weight fast (only to gain it back). Minor or gradual alterations in diet are a more realistic approach to long-term weight loss than switching to a radically different diet.

A reasonable, fairly ambitious program is to make an adjustment of 3,500 calories per week, resulting in an average weekly loss of about one pound, assuming that your weight is now fairly constant with your current diet and activity.

In a long-term program like this one, weight loss may be more pronounced early in the program than later on, as in any weight loss regimen. During the initial period significant water loss occurs, along with other bodily adjustments. After this initial drop, your weight may level off (sometimes for a few weeks) before falling again. Don’t be discouraged! This pattern of plateaus followed by resumed weight loss continues throughout a reducing program.

A caloric adjustment of 3,500 calories per week requires a net change of 500 calories each day. We recommend that 80 percent of this (400 calories) be accomplished through a decrease in dietary intake and the other 20 percent (100 calories) through stepped-up physical activity.

Diet: How to Eat 400 Fewer Calories Per Day
Any effective weight control program involves changes in diet. We suggest that you design a reduction in calories that you can live with for good, not just for the short-term.

To cut your daily diet by 400 calories, review what you eat to see what you can eliminate. You may find a “calorie counter” book helpful; they are inexpensive and available in many supermarkets and bookstores. Then:

• Make some sensible substitutions, using more low-calorie foods in your regular daily diet. For example, if you eat a lot of meat, substitute chicken (skin removed), fish, or seafood for beef, lamb, or pork. They have less fat and, generally, fewer calories. Eat more vegetables and less meat. Tofu (bean curd), one of a variety of vegetable protein sources that has become widely available, has even fewer calories than poultry and fish and is a good source of protein. Other simple substitutions can include: low-fat cottage cheese for regular cheese; skim milk for whole milk; raw veggies for sweet, salty or fried snacks; and fresh fruit for higher-calorie desserts.
• Eliminate “invisible calories” (calories that do not add to the taste, quality or appearance of food) by trying new methods of food preparation. Several excellent cookbooks now on the market will help you prepare flavorful meals with far less fat and sugar. Try trimming visible fat from meat, removing skin (a major source of fat) from poultry prior to cooking, preparing foods in bouillon or broth instead of butter or oil, and using lemon juice or bouillon to baste or season fish and vegetables. These culinary tricks will eliminate calories that you will scarcely miss.
• Learn to be calorie-wise when dining out. Ask the server to remove temptation in the form of rolls or bread from the table, and, if possible, substitute fresh celery or carrots. Enjoy a glass of club soda with a wedge of lime instead of a drink before dinner — alcohol is a major source of non-nutritional calories. On salads, substitute a squeeze of lemon for oily, fat-heavy salad dressing. Avoid fried foods.
• Arrange for low-calorie meals. If your meals are prepared in a school dormitory, company cafeteria, or similar mass-feeding center where you do not control food preparation, talk with the director of food services. It may be possible to work out a low-calorie meal plan using available foods, and sometimes, depending on the size and resources of the institution, a dietician can help you get specially prepared meals. Most major airlines serve low-calorie meals if notified a day before the flight.
• Keep a record of what and when you eat; check out portion sizes with a small scale. This will help you to learn what you should avoid in order to acquire and maintain your desirable weight. If you tend to be a fast eater, a constant snacker or someone who pays no attention to what you consume, a big part of your weight reduction program could be managed right here, through making yourself aware of all the little extras that add up in the course of a day.
• Learn to recognize and handle stress without responding by overeating. Frequently people with weight problems use food as a way of coping with stress. Anxiety, anger, sadness, even boredom are feelings attributable at times to stressful situations. People sometimes handle uncomfortable emotions by seeking comfort in food, leading to overeating. This, in turn, leads to guilt feelings, which lead to more stress and so ad infinitum.
• Seek help from others. Losing weight can be a long and frustrating process. Find people in your life who can support your effort. Sometimes talking with a family member, friend, clergy, counselor, or psychotherapist will help. Choose people who understand the importance of what you are doing.

Proper Nutrition and Dieting
During a weight control program, it is especially important to provide the body with proper nutrition. A program involving only minor changes in old habits, as described in this section, should not result in nutritional deficiencies as long as the old habits themselves were nutritionally adequate.

The average American diet provides about 50 percent of its caloric intake from fats, 30 percent from carbohydrates and 20 percent from proteins, which is far from an ideal mix. We ought to be getting 50 percent of our calories from carbohydrates, 15 percent to 20 percent from proteins and 20 to 30 percent from fats, mainly non-animal fats (de-emphasizing butter, cheese, and ice cream). Our nutritional goal of a well-balanced diet calls for an increase in calories obtained from complex carbohydrates and a decrease in fat, sugar, cholesterol and salt. Many high fiber foods, whole grains, vegetables and beans are also higher in complex carbohydrates and better sources of energy than simple sugars (such as cane sugar, honey, or molasses).

If you plan to diet on less than 1,200-1,500 calories a day, it’s advisable to take a multivitamin/mineral capsule daily.

Exercise: 100 Calories More Per Day
As anyone who has tried it knows, losing weight and keeping it off by dieting alone is very difficult. As an example, a woman of 120 lbs. in a sedentary job (burning about 1,800 calories per day) would have to cut caloric intake by 28 percent (500 calories per day) to lose one pound per week through dieting alone. She would have to cut her meals back to Spartan portions (maintaining only minimally adequate nutrition), with little or no leeway for fattening “treats”. By contrast, if she walked briskly for 20 minutes (such as to and from her job) each morning and evening, she would only have to cut back calories by 17 percent (300 calories per day) to lose the same amount.

Starting a serious exercise program after years of relative inactivity can be a strain on your body, especially your heart. If rigorous exercise has not been a part of your life for some time, we recommend starting with brisk walking rather than more strenuous exercise.

As noted earlier, you should seek medical advice before starting an exercise program if any of the following are true:

1. You are over 45 and have not had a check-up by a physician in the last two years, especially if you have been fairly inactive.
2. You have heart disease, high blood pressure, diabetes, or kidney disease or are under the care of a physician for any other chronic disease.
3. You have a family history of heart attacks.
4. You experience any chest pain, dizziness, or shortness of breath with or without physical exertion.

We recommend that you burn at least 100 additional calories every day. One hundred calories is roughly equivalent to one of the following: 20 minutes of brisk walking (about one mile); 12 minutes of bicycle riding; nine minutes of swimming; or five minutes of fast running. Exercise hard enough to make yourself breathe faster, but precede and follow any new kind of exertion by several minutes of stretching exercises, especially at the ankles and hips.

Depending on your physical condition, you may find that you are able to increase this amount of exercise, and hence burn more calories, thus helping move your weight control program along. But don’t do this just off-and-on; any increased exercise should become a permanent daily activity.

Keep a log of your exercise. This can serve not only to keep you faithful to your program, but also to encourage progress. Perhaps surprisingly, exercise won’t necessarily make you ravenous. It gives many people an increased sense of energy and a decreased desire for food.