In a first-of-its-kind study with nuts, randomized controlled-feeding research conducted by the Agricultural Research Service (ARS) of the U.S. Dept. of Agriculture (USDA) found that fat in pistachios may not be completely absorbed by the body. The findings indicate that pistachios may actually contain fewer calories per serving than originally thought, reinforcing that pistachios are one of the lowest calorie nuts with 160 calories per 30 g serving (approximately 1 oz). The study was presented on April 11 at the Experimental Biology conference in Washington, D.C. (Source IFT. June 2011)

Yi is proving to be a formidable tool for non-invasive risk profiling of employees and for providing scientific bench-marks for weight loss.

Interested companies can either contact Beyond Care directly or check www.beyondweight.com, the company’s worksite division.

Intensive lifestyle intervention,  did an even better job at improving health and quality of life, and at a favorable cost when compared with some common medical interventions for other diagnoses, Dr. William H. Herman and his associates reported at the annual scientific sessions of the American Diabetes Association.

In this study, the cost per quality-adjusted life-year gained with the intensive lifestyle intervention compared with the placebo group was $12,000. That $12,000 is on the low end of a $10,000-$50,000 range that’s widely accepted for medical interventions, including the use of beta-blockers after MI, the use of antihypertensive therapy for patients with very high diastolic blood pressure (greater than 105 mm Hg), or the use of statins for secondary prevention of cardiovascular disease in patients who’ve had an MI. Dialysis for end-stage renal disease costs $50,000-$100,000 per quality-adjusted life-year gained.

Five Tips To Lose Weight ……That Are Not True!Myth #1: A Calorie is a Calorie is a Calorie….Is it true?

It is not unusual for people battling weight gain to hear from a dietitian or a physician “a calorie is a calorie is calorie.” This old saying implies that to lose weight it doesn’t matter what we eat as long as we cut back on the total calories consumed. The less the total calories taken in, the more the weight loss…. But is it true?

Indeed, outside of our bodies a calorie from orange juice is the same as a calorie from chicken or chocolate. But inside our bodies that old dogma doesn’t hold up because foods are not just consumed, they have to be digested as well. The process of digestion or integration of nutrients into the body is not equally efficient for different food types. For example, fat is 95% efficient. Meaning of 100 calories of fat consumed, 95 calories are stored in the body (mostly in fat cells.)

Carbohydrates are about 85% efficient meaning 15% of calories are lost during digestion. Finally, protein is only 70% efficient. Our body cannot store fish, beef or chicken protein. It has to break down all amino acids (the building blocks of proteins) and re-assemble them into human proteins. This process wastes about 30% of the calories consumed from protein. That is one reason that all calories are not the same.

Another reason all calories are not the same has to do with our metabolism – how our bodies decide to process food at any given time. For example, studies have showed that eating the same amount of calories (in a study of college students it was 2000 calories) in one meal in the morning versus in the evening have different effects on body weight. Eating more at night causes more weight gain.

Myth # 2: Shut your mouth and you will lose weight!

How many times have you heard overweight people say but “I do not eat much at all?” How many times have you noticed that your overweight friends or relatives eat very little at the dinner table? People who skip meals or even starve themselves are under the impression that the only way they will lose weight is to drastically cut their caloric intake. Indeed, even doctors tell their patients “shut your mouth and you will lose weight…” We now know that this “myth” is not true.

The discovery of a gut-brain axis regulating appetite and satiety has shed a new and fascinating light on the physiology of cravings, feeding, as well as energy storage. Signals released from our stomach such as the hormone ghrelin, or leptin which is released from fat cells, among others, all “talk” to neurons in our brain.

Ghrelin levels rise when we fast, peak immediately before meals, and are typically higher during weight loss and in anorexia – as if the stomach is telling the brain to eat more. Before a meal, blood ghrelin levels can double depending on the timing and amount of calories eaten at the previous meal. Skipping lunch would therefore trigger more appetite for a bigger dinner. In addition to controlling appetite, ghrelin also shifts the body’s metabolism to an energy-sparing mode by slowing fat breakdown and by lowering body temperature.

So, people who starve themselves should know that by doing that, they are shutting down their metabolism and increasing their appetite. When they finally eat, whatever the portion size, the food “sticks to them” that is it goes directly to fat cells for storage.  By eating the right food choices, it is possible to lose weight while eating more. Raising your metabolism is similar to feeding a furnace high-octane logs around the clock. It burns faster and hotter!

Myth # 3: Tell me your secret.

There is a diet out there called the “Da Vinci Code diet.” When people ask me what it is, I tell them I do not know because it is a secret! At any given time, roughly half of all American women are dieting – often in secrecy. None of us like to admit that we are unhappy with our weight and are trying to lose weight with the latest diet. The latest diet because the previous ones are no longer trendy or failed to work. Even when people succeed, they do not want to tell friends, family members and co-workers that they had to diet to lose weight.

The truth is that there is no secret diet or weight loss solution out there. Even if there were secret solutions, they would not apply to everyone. Your secret diet, supplement, surgery, medication, or exercise routine may not work for your friends even if you divulge it to them. It is not about a secret formula or a secret diet. When people ask “oh, what is your secret” they are really saying “ congratulations!”

Here is how I see it: As you lose weight the healthy way, people acknowledge your success and are appreciative of your newly regained sense of control. There is indeed a lot of pleasure in weight loss. The waistline is shrinking, the cheekbones are once again prominent, and energy and libido are back up to where they were decades ago. People are noticing, sometimes they even try to ask you out. Others come to you and quietly ask you how you did it, where did you go, what are your secrets, etc. You are glowing in success. You have truly achieved something that millions of people want but are unable to get. You have lost fat, gained strength in body and in your spirit and look fantastic. If your life and body transformation do not bring you the sweetest pleasures there is something wrong! You are delighted that your efforts have paid off. You are body proud and you know it: that is your secret!

Myth # 4: Doc just tell me what me what to do.

Unfortunately, I hear this from my patients more often than I would like to. “Doc jest tell me what to do” translates as “Doc spare me the details of the process just give me a diet…” The problem is without grasping the knots and bolts of the process of change, all diets (or any lifestyle change) are bound to fail. Dietary and exercise guidelines are important. But cognitive skills such as time management, setting priorities and boundaries, organizational and stress reduction techniques are more important. Further, these skills have to be customized and personalized. For example, for people who travel a lot, lifestyle change tools have to take into account and adjust to time spent in airports, meals at restaurants or the road, nights spent in hotels and sometimes lack of access to healthy food choices or exercise equipment.

The flip side of this myth is in the fact that doctors cannot tell people what to do when it comes to lifestyle change. Docs do not learn much nutrition, even less about exercise in their medical training and have even less understanding of weight gain or loss! Finally, they do not have time to interview their patient in debt to give them personalized and relevant lifestyle change advice.

So what are you supposed to do? First, understand that there is no quick fix even it is recommended by your doctor. Second, understand that the “money” so to speak is in the coaching process. Third, understand that there are many ways to lose weight – some are more successful or easier than other – and that there is one approach out there that will work for you. Finally, understand that for lifestyle change to take roots, it has to be constantly re-evaluated and changed. The exercise you begin with will have to be modified for you to reach your goals. The food choices and the portion sizes have to be re-examined as well. So, “doc just tell me what to do” should be replaced “doc I need a health coach, can you help me?”

Myth #5: No Pain No Gain. Exercise to get bigger?

I often hear: “Doc I exercise everyday and I am getting bigger.” Or, “I had to fire my trainer because he would kill me but I was getting bigger and bigger.” Is it possible that exercise would cause more weight gain? Absolutely, most exercise regimens are anabolic meaning they help you get bigger and stronger. Sometimes, it is important to gain muscle to lose fat. But usually, people who are overweight or obese have plenty of muscle. Therefore, they just have to use them to burn calories. Sub-maximal and frequent fat-burning exercise such as a brisk walk or low-impact aerobics, and whole body callisthenic workouts is the way to go. Here are other reasons why some people don’t lose weight with just exercise:

Exercising, dieting and still gaining weight?

Which group do you belong to?

-Hefty Athletes (crew, football and hockey players in particular) who eat everything in site after a long aerobic training session.

-College Partiers who exercise hard for three straight days but party and hang out starting Thursday nights till Sunday (pizza, pasta, beer, cake…)

-Good Wives who watch what they eat all day and even exercise an hour a day but overeat to keep company of their husbands at nights or weekends – husbands usually choosing the menu!

-Weekend Bingers. They work hard all week, exercise regularly and then drop the ball completely on the weekends. A weekend getaway: extra bonus!

-Socialites. Try to be committed to weight loss, fundraisers and board meetings all at once! The “society calories” win over the private sweat and chagrin.

-Boat People. Once off shore, the rules of thermodynamics no longer apply. Calories do not count when consumed on the boat!

-Serious Bingers, Night Eaters and Closet Eaters: Calories do not lie no matter how much you exercise.

Why am I writing a blog?

Have you ever felt like sharing personal experiences with others because those experiences are so unique? Not sharing special moments means they fail to be captured and they’ll just fade away in time — so, the purpose of my blog is to share my experiences.

As a physician, I am privileged to learn from my patients (who will be referred to as “members” since they are not always sick.) Like traditional family recipes that you want to remember forever, I feel like the lessons I learn from members of my practice are so rich that they should be saved and shared with others.

An important note: in all my blogs, the identity and confidentiality of all members will be respected as an absolute rule. I will change the context, the nature and details of my exchanges so no one feels that their private relationship with me or my practice are compromised.

And second, a disclaimer: my blogs and all the exchanges I’ll be sharing are for educational purposes and because they’re interesting. Do not expect medical advice or even health coaching here – that’s not what I am doing, nor is it possible. So please think of my blog and any exchanges we have as writings that will enrich our lives and enjoy them as trusting and supportive material limited to the following topics (click on categories on the right to see each blog thread):

Stress and Stressors:

Learn how people feel stress, identify stressors and handle them.

Lifestyle Management:

The process of change for a healthy and enhanced lifestyle.

Meditation Moments:

Simple observations, thoughts, reflections and random accidents that make us pause for a moment and then move on enriched by the experience.

Goal Setting:

We live in a world defined by goals. Well okay, some do not set goals – it is a turn-off for them. But those people end up as drifters, they go with the flow and often that leads to the dead waters. In this track, I will write about goals … setting targets and committing to the process … reaching them … and then setting new ones. As part of this track, I will share with my teachings about various subjects such as reward systems, organizational skills and time management among others.

Exercise:

Always a big topic. I will write and share personal, member experiences and their results; latest trends and other matters related to and aimed at designing an exercise regimen.
Nutrition: Another big topic. There is so much mis-information out there about diets, foods, cooking, supplements, etc., that I believe this track will be a big player on this blog. Every now and then I will include a recipe…

Life Cards:

This is one of my favorites …often, life hands us cards, good or bad that we have to know how to play. However, one lifetime is not enough to experience and learn from all the possible twists and turns of our lives. My goal here is to share these experiences and their results with fellow readers so that we are all well-equipped to deal with the next life-changing event. Learn to make “lemonade out of lemons.”

Healthy Fun and Play:

There is no point in setting goals and reaching them, only to be disappointed that in other layers of life, we are miserable and unhappy. Being mindful of the need for fun and play in life is critical to achieving long-lasting happiness. Topics like parties, games, pet stories, surprising stories fit here.

News:

I feel like I cannot keep up with health-related, medical and scientific news that I am interested in. One day a medication or a supplement is a “must,” then another day it is harmful to your health. One day, a medical breakthrough is celebrated, another day it is refuted. We need someone to navigate us thru all this enormous amount of information. I hope my blog can help separate noise from news.

…That Are Not True!

Myth #1: A Calorie is a Calorie is a Calorie….Is it true?

It is not unusual for people battling weight gain to hear from a dietitian or a physician “a calorie is a calorie is calorie.” This old saying implies that to lose weight it doesn’t matter what we eat as long as we cut back on the total calories consumed. The less the total calories taken in, the more the weight loss…. But is it true?

Indeed, outside of our bodies a calorie from orange juice is the same as a calorie from chicken or chocolate. But inside our bodies that old dogma doesn’t hold up because foods are not just consumed, they have to be digested as well. The process of digestion or integration of nutrients into the body is not equally efficient for different food types. For example, fat is 95% efficient. Meaning of 100 calories of fat consumed, 95 calories are stored in the body (mostly in fat cells.)

Carbohydrates are about 85% efficient meaning 15% of calories are lost during digestion. Finally, protein is only 70% efficient. Our body cannot store fish, beef or chicken protein. It has to break down all amino acids (the building blocks of proteins) and re-assemble them into human proteins. This process wastes about 30% of the calories consumed from protein. That is one reason that all calories are not the same.

Another reason all calories are not the same has to do with our metabolism – how our bodies decide to process food at any given time. For example, studies have showed that eating the same amount of calories (in a study of college students it was 2000 calories) in one meal in the morning versus in the evening have different effects on body weight. Eating more at night causes more weight gain.

Myth # 2: Shut your mouth and you will lose weight!

How many times have you heard overweight people say but “I do not eat much at all?” How many times have you noticed that your overweight friends or relatives eat very little at the dinner table? People who skip meals or even starve themselves are under the impression that the only way they will lose weight is to drastically cut their caloric intake. Indeed, even doctors tell their patients “shut your mouth and you will lose weight…” We now know that this “myth” is not true.

The discovery of a gut-brain axis regulating appetite and satiety has shed a new and fascinating light on the physiology of cravings, feeding, as well as energy storage. Signals released from our stomach such as the hormone ghrelin, or leptin which is released from fat cells, among others, all “talk” to neurons in our brain.

Ghrelin levels rise when we fast, peak immediately before meals, and are typically higher during weight loss and in anorexia – as if the stomach is telling the brain to eat more. Before a meal, blood ghrelin levels can double depending on the timing and amount of calories eaten at the previous meal. Skipping lunch would therefore trigger more appetite for a bigger dinner. In addition to controlling appetite, ghrelin also shifts the body’s metabolism to an energy-sparing mode by slowing fat breakdown and by lowering body temperature.

So, people who starve themselves should know that by doing that, they are shutting down their metabolism and increasing their appetite. When they finally eat, whatever the portion size, the food “sticks to them” that is it goes directly to fat cells for storage.  By eating the right food choices, it is possible to lose weight while eating more. Raising your metabolism is similar to feeding a furnace high-octane logs around the clock. It burns faster and hotter!

Myth # 3: Tell me your secret..

There is a diet out there called the “Da Vinci Code diet.” When people ask me what it is, I tell them I do not know because it is a secret! At any given time, roughly half of all American women are dieting – often in secrecy. None of us like to admit that we are unhappy with our weight and are trying to lose weight with the latest diet. The latest diet because the previous ones are no longer trendy or failed to work. Even when people succeed, they do not want to tell friends, family members and co-workers that they had to diet to lose weight.

The truth is that there is no secret diet or weight loss solution out there. Even if there were secret solutions, they would not apply to everyone. Your secret diet, supplement, surgery, medication, or exercise routine may not work for your friends even if you divulge it to them. It is not about a secret formula or a secret diet. When people ask “oh, what is your secret” they are really saying “ congratulations!”

Here is how I see it: As you lose weight the healthy way, people acknowledge your success and are appreciative of your newly regained sense of control. There is indeed a lot of pleasure in weight loss. The waistline is shrinking, the cheekbones are once again prominent, and energy and libido are back up to where they were decades ago. People are noticing, sometimes they even try to ask you out. Others come to you and quietly ask you how you did it, where did you go, what are your secrets, etc. You are glowing in success. You have truly achieved something that millions of people want but are unable to get. You have lost fat, gained strength in body and in your spirit and look fantastic. If your life and body transformation do not bring you the sweetest pleasures there is something wrong! You are delighted that your efforts have paid off. You are body proud and you know it: that is your secret!

Myth # 4: Doc just tell me what me what to do.

Unfortunately, I hear this from my patients more often than I would like to. “Doc jest tell me what to do” translates as “Doc spare me the details of the process just give me a diet…” The problem is without grasping the knots and bolts of the process of change, all diets (or any lifestyle change) are bound to fail. Dietary and exercise guidelines are important. But cognitive skills such as time management, setting priorities and boundaries, organizational and stress reduction techniques are more important. Further, these skills have to be customized and personalized. For example, for people who travel a lot, lifestyle change tools have to take into account and adjust to time spent in airports, meals at restaurants or the road, nights spent in hotels and sometimes lack of access to healthy food choices or exercise equipment.

The flip side of this myth is in the fact that doctors cannot tell people what to do when it comes to lifestyle change. Docs do not learn much nutrition, even less about exercise in their medical training and have even less understanding of weight gain or loss! Finally, they do not have time to interview their patient in debt to give them personalized and relevant lifestyle change advice.

So what are you supposed to do? First, understand that there is no quick fix even it is recommended by your doctor. Second, understand that the “money” so to speak is in the coaching process. Third, understand that there are many ways to lose weight – some are more successful or easier than other – and that there is one approach out there that will work for you. Finally, understand that for lifestyle change to take roots, it has to be constantly re-evaluated and changed. The exercise you begin with will have to be modified for you to reach your goals. The food choices and the portion sizes have to be re-examined as well. So, “doc just tell me what to do” should be replaced “doc I need a health coach, can you help me?”

Myth #5: No Pain No Gain. Exercise to get bigger?

I often hear: “Doc I exercise everyday and I am getting bigger.” Or, “I had to fire my trainer because he would kill me but I was getting bigger and bigger.” Is it possible that exercise would cause more weight gain? Absolutely, most exercise regimens are anabolic meaning they help you get bigger and stronger. Sometimes, it is important to gain muscle to lose fat. But usually, people who are overweight or obese have plenty of muscle. Therefore, they just have to use them to burn calories. Sub-maximal and frequent fat-burning exercise such as a brisk walk or low-impact aerobics, and whole body callisthenic workouts is the way to go. Here are other reasons why some people don’t lose weight with just exercise:

Exercising, dieting and still gaining weight?

Which group do you belong to?

-Hefty Athletes (crew, football and hockey players in particular) who eat everything in site after a long aerobic training session.

-College Partiers who exercise hard for three straight days but party and hang out starting Thursday nights till Sunday (pizza, pasta, beer, cake…)

-Good Wives who watch what they eat all day and even exercise an hour a day but overeat to keep company of their husbands at nights or weekends – husbands usually choosing the menu!

-Weekend Bingers. They work hard all week, exercise regularly and then drop the ball completely on the weekends. A weekend getaway: extra bonus!

-Socialites. Try to be committed to weight loss, fundraisers and board meetings all at once! The “society calories” win over the private sweat and chagrin.

-Boat People. Once off shore, the rules of thermodynamics no longer apply. Calories do not count when consumed on the boat!

-Serious Bingers, Night Eaters and Closet Eaters: Calories do not lie no matter how much you exercise.

Weekly rewards are a bit more significant. Here the strength is not in numbers. These rewards have to be delicious and joyful enough to attract you like a night lamp attracts moths. A session of physical pleasure and/or relaxation is a good choice: massage, pedicure or manicure, a nice long bath, yoga or a dance class would qualify. Spending time with children, with your partner or going out with a friend may be fun. But keep in mind that rewards have to be about you, reminding you that you are on a mission entirely about You – not your children or your family. During my interviews, I ask every one of my patients to name a few of their most favorite activities. By simply asking that question I remind them that they have not been putting themselves “first” and that now it is time to reset priorities.

Monthly rewards have one common characteristic: they are permanent. Daily rewards get their strength in numbers, weekly rewards are about pampering, and monthly rewards are here to stay. Effective monthly rewards include inspirational pictures, objects or projects. Framing that picture of you when you were fit and placing it somewhere special; buying a special decorative object such as a lamp for your bedroom; a pottery piece for your office; or painting a room a nice color or working on a piece of antique furniture are examples. Of course, clothes (if your closet is not full of clothes that you are dying to be able to wear again) are big monthly rewards. After a few months, these monthly rewards may become more ambitious, such as a trip for two to a favorite getaway destination. (Trips are not permanently displayed so do not forget to take lots of pictures or bring back souvenirs.) Finally, even bigger rewards are reserved for the time when you reach your goals. These may include buying a new car, remodeling your house or landscaping your garden, etc.

In a recent large European study (published in N Engl J Med 2010; 363:2102-2113 on November 25, 2010 ) by Larsen and colleagues, 1209 adults who had lost at least 8% of their initial weight using a low-calories diet were randomly assigned to various “maintenance” diets. These diets included a low-protein and low-glycemic-index diet, a low-protein and high-glycemic-index diet, a high-protein and low-glycemic-index diet, a high-protein and high-glycemic-index diet, or a control diet. In the analysis of participants who completed the study, only the low-protein–high-glycemic-index diet was associated with subsequent significant weight REGAIN. The authors concluded that even a modest increase in protein content and a modest reduction in the glycemic index led to an improvement in study completion and maintenance of weight loss.

This study is further validation of our approach to weight loss: the kind of foods we consume has more impact on our metabolism and thus our weight than calories. Of course, consuming too many calories leads to relapse and weight regain. However, within a caloric target, cutting back on carbohydrates (starches and sugar) and increasing lean protein yield better results both for weight loss and maintenance.

I was driving in today’s blizzard and decided to listen to AM radio for local road and weather conditions. I was surprised by how many ads – back to back – were about quick-fix supplements and diets to lose weight. Not a single ad was about exercise. I know gyms pick up traffic this time of the year. But a lot of gym goers don’t know what to do, get injured or don’t get results. Here are some tips for beginners:

Today's Blizzard From My Window

Think of your exercise regimen as a process with phases. Each phases targets one aspect of your fitness.

Phase I. Preparation. Get Ready in 4 to 8 Weekly or Bi-weekly 30-minute Sessions.

These sessions focus on the basics of body awareness, breathing exercises and fitness education. Warm up, movement, balance, breathing, awareness of fatigue, soreness, physical limitations and handicaps are key parts of these sessions. In addition, learn to use simple tools such as free weights, machines, and physioballs among others. Finally, general safety measures, proper rehydration, appropriate clothing and shoes, stretching, relaxation techniques and use of rest periods are very important in these sessions. This phase may seem elementary and insignificant. But just as the early years of schooling are both important and delicate, there is more to the beginning sessions of a long-term program than meets the eyes. The worst outcome is to get injured or frustrated in these early stages. The best situation is to build confidence and prepare the body in a gentle and natural way. Your body is not going to go through a dramatic transformation immediately. Appreciate the slow pace of change.

Phase II: Cardio Respiratory Fitness: Build Stamina in 10 Weekly or Bi-weekly Sessions.

Most people who suffer from metabolic syndrome and obesity get winded quickly in spite of strong muscles (especially in the legs.) De-conditioned individuals are often unable to engage in a long exercise session without excessive fatigue and shortness of breath. This phase  - which is different from “cardio” routines – improves lung capacity, cardiovascular tone and the neuromuscular response to exercise. Gentle aerobic exercises using the treadmill or stationary bike are preferred in the beginning. Use of free weights and resistance training should be limited to isotonic repetitions – that is high reps and low weights. Whole body exercises such as calisthenics, yoga and pilates are also very effective to build heart and lung capacity for beginners.

The goal here is not to get stronger (that will come later), but to increase the cardio respiratory capacity. So whatever combination you choose, your heart rate and breath frequency should remain moderately high for the entire duration of exercise – even if the session is only 15 minutes. As a rule, for most midlife people this corresponds to a heart rate of 100 to 120 beats per minute. The breath work should be such that you are slightly aware of breathing when you talk and exercise. If you are able to engage in a conversation without any difficulty you are not working hard enough. But if you cannot catch your breath, slow down. As always, discuss your concerns and medical risks with your trainer and if necessary with your doctor since your case may be different.

Phase III: Full Exercise Program. 12 -16 Weeks of Full Workouts 3 Times Per Week

The key difference between this phase and the previous preparatory phases is in the variety of choices, the order of exercises and most importantly a transition from gentle aerobics to resistance training. By this time, you should be able to engage in aerobic exercise routines comfortably and safely. Several options are possible and for most people we recommend only one of them. The first option is to increase the intensity of the session. If the cardio session included walking 30 minutes on the treadmill, we will replace it with 30 minutes of jogging. Although this is a viable option, it is not always possible for big people and may not be safe. The second option is to increase the duration of the session to 45 or 60 minutes. This newly prolonged session could also be split into two sessions: 30 minutes in the morning, 30 minutes in the afternoon but this may not be practical for everyone. The third option, which I prefer, is to add a variety of other routines, which complement each other. These complementary routines mix up resistance training with machines or free weights, use of the physioballs, calisthenics, core strength training and balance exercises with aerobic work-outs.  Since you are now exercising more often, adding variety will keep you engaged and committed to long-term exercise regimens.

Phase IV: “The Sky is the Limit” Program. 6 Months to Forever!

This phase of the program is designed for the rest of your life! For that reason it is flexible and somewhat complex. By this time, most overweight individuals have reached their fat loss goal. This phase corresponds therefore to the maintenance phase of a dietary program. But it differs from a maintenance program per se because it still contains goals, which go beyond fat loss. For example, a goal may to reshape or sculpt your body to gain more definition. The fat in the belly is gone but there is still subcutaneous fat to get rid of in the arms or the buttocks. Or in other cases, fat loss or even the toning may not be the goal anymore. It may be power, endurance or external goals like being able to kayak or mountain climb. If you are at this stage of change, you should be truly body proud and feel euphoric. You deserve it. It is time to take a deep breath. Reassess your achievements and your bodily assets. Go back to your trainer and ask for refresher sessions. You will have to know how to rotate your regimen, how to change your rest intervals according to your day-to-day schedule. You have to learn to modulate your program according to seasonal changes and according to events in your life: vacation, work travel, moving to a new town, pregnancy, a divorce or losing a job, having family members visit, etc. The key is to be mindful of your life situation and adjust your exercise routine accordingly. You are in charge, you have all the skills you need to readjust, fine-tune and if necessary redesign your program entirely.

Some additional tips:

Exercising, dieting and still gaining weight? Which group do you belong to?

-Hefty Athletes (crew, football and hockey players in particular) who eat everything in site after a long aerobic training session.

-College Partiers (usually young women) who starve for three days but party and hang out starting Thursday nights till Sunday (pizza, pasta, beer, cake.)

-Good Partners who watch what they eat all day and even exercise an hour a day but overeat to keep company of their spouses at nights or weekends.

-Weekend Bingers. They work hard all week, exercise regularly and then drop the ball completely on the weekends. A weekend getaway: extra bonus!

-Socialites. Try to be committed to weight loss, fund-raisers and board meetings all at once! The “society calories” win over the private sweat and chagrin.

-Boat People. Once off shore, the rules of thermodynamics no longer apply. Calories do not count when consumed on the boat!

-Serious Bingers, Night Eaters and Closet Eaters: Calories do not lie no matter how much you exercise.

I saw her a few days ago. I was surprised to see her look so good! She has lost weight, exercises regularly and has even started dating! The kids are doing much better too. So, I asked her how she did it.

Her answer reminded me of an old saying in medieval psychology: “treat Saturn with Jupiter.” Medieval psychology used the astrological profile of planets as metaphors to describe people and their emotions. Saturn was thought to represent depression and darkness (as well as power and money…) and Jupiter was the planet of exuberance, joy and genius (like Mozart’s music…)  So, “treating Saturn with Jupiter” means that if you are depressed and have dark emotions, do not go see a sad movie, or spend time commiserating with other depressed people, instead hang out with fun people. Do not isolate yourself. Call jovial friends and family members and tell them that you have the “blues” and you need their company. Do not watch the news channels all day instead watch comedies. Sign up for group activities, so at night, you can go out to an arts and crafts, yoga, signing or other classes, and so on.  Do not listen to sad music and when possible take the scenic roads while driving. You get the picture…

A Moment of Pause and Reflection

In his erudite book, Ancient Medicine, Edelstein summarizes a typical exercise regimen as recommended by ancient Greek physicians:

…youths and men go to the gymnasium for training; older men go to the bathhouse, or likewise go to the gymnasium, to anoint themselves. When this is done, a carefully selected meal is eaten at home, toward noon, after which a nap in cool shade is beneficial…Next a walk is taken, then a rest, and one returns to the gymnasium. Immediately after the exercises, which take the entire afternoon, one takes a bath or anoints the body, and goes home to an evening meal shortly before sunset. At this meal, too, only dishes selected in accordance with definite rules are served. Following the evening meal, one either goes to bed immediately or takes another walk…

(Ancient Medicine, Ludwig Edelstein, The Johns Hopkins University Press, 1987, p307.)

One wonders if Greek men who followed this kind of regimen ever worked! Nonetheless, the exercise regimen described here (which would be varied from day to day) was meant to be an integral part of a lifestyle. It was incorporated in a program that also included diet, and rest as well as self-care. For an exercise regimen to be sustainable and successful, it has to be safe, carefully planned, and gently paced. Wellbeing was the main goal of the Greek’s ancient exercise training and should remain our goal in the 21^st Century.

East River Sunny Side

Some Tips For a Personal Exercise Program:

- Understand that a program that worked for you when you were in your twenties may not be advisable for you in midlife. Also, a regimen, which worked for a friend of yours or even a family member may not give the same results for you.

- Do not lose focus of your goals. You may have long-term goals such as fat loss or a certain dress size. You may also have short-term goals such as increasing your cardio respiratory capacity. And you may even have weekly and daily goals. Do not lose sight of your goals and if you get discouraged or lose motivation, remind yourself of your goals. An individual without a fitness goal becomes a “gym rat,” that is a person who just hangs out at the gym wasting time!

- Be kind to your body. Do not use exercise as a means to stress your body or to “punish” yourself for acts or feelings that frustrate you, such as overeating. Use exercise as a positive tool to de-stress and to feel good about yourself. Do not push yourself beyond reason and do not get into a competition with yourself.

- If you have medical conditions, talk to your doctor about exercise. Your doctor may not be an expert in exercise physiology, but he or she may alert you to certain risks and conditions, which you may have so you can discuss them with your trainer. For example you may have forgotten that you have suffered from abdominal hernias in the past or you may overlook nerve damage in your feet.

- Finally, our bodies change and so do our goals. It is important to reassess your program periodically. If fat loss is your primary goal, you need to reconsider the frequency and intensity of your routines, rest intervals, the specifics of your regimen, every few months. Once you have reached your weight loss goals, you have to reassess your regimen for maintenance or toning purposes.