Remember the fable about the hare and the tortoise? The hare, alternating between showy spurts and long lapses, was no match for the slow but steady tortoise, who plodded step by step to victory. That story's moral applies to managing your weight, says Christopher Still, DO, director of the Center for Nutrition and Weight Management at the Geisinger Medical Center, Danville.
Why, Dr. Still asks, would anyone set themselves up for failure by adopting an overly ambitious set of diet and exercise goals when there's ample evidence that changing habits little by little works better? Losing even a few pounds (with enough daily exercise to keep them off) often yields major health benefits.
"Just a modest weight loss of 5-10 percent," Dr. Still says, "can have significant impact on all the medical problems associated with obesity, which include high blood pressure, Type 2 diabetes and cardiovascular disease. Take someone who is 300 pounds. They don't have to get down to their ideal body weight to get real health benefits."
Pennsylvanians are at risk
There's no question that excess weight and obesity pose major health risks, including disability resulting from heart problems or diabetes, and even premature death. Some medical authorities suggest that in the United States obesity has become as much of a public health hazard as smoking.
Pennsylvanians, especially older Pennsylvanians, are often at serious risk from weight problems. Dr. Still was the principal researcher on the Geisinger Rural Aging Study, which focused on elderly patients in rural areas. Forget the stereotype of the elderly as frail and thin; fewer than 3 percent of those studied fit that description. By contrast, about seven out of ten were overweight and one in three obese.
Moreover, many of the elderly people in the Geisinger study were consuming more calories than their bodies needed and were still undernourished. That is, where food was concerned, they were choosing quantity over quality. Their diets tended to be especially deficient in the nutrients found in leafy vegetables and dairy products.
About 70 percent of the people in the study took vitamins, proof that popping a vitamin pill can't make up for nutritional deficiencies in the diet. However, Dr. Still says that a multivitamin with recommended amounts of folic acid and minerals like magnesium and zinc isn't a bad idea, as long as you don't try mega doses. He also often urges patients to take 400 I.U. of vitamin E, plus vitamin D and calcium.
But the real payoff comes from eating a few extra servings of:
all of which contain micronutrients and fiber. If you eat enough of those kinds of foods, you'll feel less need for high-fat, high-calorie junk food.
Baby steps toward health and fitness
In fact, with overweight patients who are also elderly, Dr. Still doesn't even emphasize weight loss as a goal. Instead he urges attention to good nutrition and a series of "baby steps" toward health and fitness.
As a rough rule of thumb:
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You'll maintain your body weight if you consume 8 to 10 calories per day for every pound that you weigh.
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That is, someone who weighs 240 pounds will begin to lose weight at any caloric intake under about 2,400 calories.
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On average, a decrease in just 500 calories per day will promote the loss of about a pound a week, or 4 pounds a month.
Your doctor can help you understand whether your metabolism—the rate at which your body burns food for energy—is above or below average. Whatever your metabolism, everyone has a point at which eating the equivalent of just one fewer cookie triggers weight loss. Reaching that point is likely to require less sacrifice than you might expect.
Give your metabolism a boost
As you begin to lose, your body needs less energy, so your metabolism in effect resets itself at a lower level. The key to keeping weight off is exercise. Even a modest gain in muscle tissue resets your metabolism higher because muscle must burn calories to maintain itself. On exercise, too, Dr. Still is a fan of the tortoise. You're not really in a race; you're changing habits.
"I usually have people start walking for three minutes, three times a day—and each week add a minute to that," he says. "The goal is a total of 30 minutes a day. But try that all at once and you may tire or collapse after 10 minutes and never get back to it. Over time we increase our exercise tolerance, so we can work up to that 30 minutes."
You can also use a pedometer, which measures your steps. Dr. Still starts patients at as few as 500 extra steps per day. Anything that gets your pulse up, makes you breathe hard, or raises a light sweat on your brow counts as exercise-as long as it's over and above your normal routine.
"A lot of my patients can't walk because of degenerative arthritis," Dr. Still adds. "But they can sit in a chair in front of the TV and take two cans of soup and raise them over their heads every time a commercial comes on. You'd be surprised how much that increases their range of motion and ability to do the activities of daily living."
For both diet and exercise, Dr. Still urges that you maintain a written record of what you actually do. Jot down every one of those three-minute walks in a notebook, so that you'll know when you moved up to four minutes. You don't have to show these notes to anyone else. They're to keep you accountable—to yourself.
Copyright 2002, Fred D. Baldwin, PhD, used by permission.
Baldwin is a freelance writer who lives in Carlisle, PA. He's a member of the Author's Guild, National Writers Union, and National Association of Science Writers and is the co-author of Infomedicine, A Consumer's Guide to the Latest Medical Research.
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