Q: I’ve been following a Weight Watchers type diet for 2 1/2 months now. I’m 44 yrs old, 5′4″ and weigh just over 150 lbs. In the past, as recently as last year, I have been able to go a month or two with a WW type diet and lose 5 lbs minimum. This time I have not been able to lose even 1/2 lb.

I have really been careful about sticking to eating well, but I feel at a real loss right now and don’t know what to do next. Any advice you can offer to help me lose weight would be appreciated. What would you advise as the next steps?

A: This is a great question. There’s some evidence that as we get older – into our 40s and 50s – that it can be more difficult to lose weight. Everyone is different, of course, and there’s been some research focusing on this but nothing conclusive as to the actual cause.

What we do know is that this requires more attention to calorie balance. The first thing to look at is your amount of exercise. Folks tend to be less and less active as they move toward their 50s. A lot of factors contribute to this – job, home, stress – quite simply, the time constraints of modern life. In a woman your height, burning an extra 200 calories per day is the difference between weight loss and maintaining stable weight. Losing Weight After 40

Q: I am a 46 year old woman and was diagnosed with DCIS breast cancer in Dec. of 2007. I had a lumpectomy and a sentinal lymphectomy followed by 30 treatments of radiation. In May of 2008 I had an oovarectomy because of many complicated cysts on both ovaries. I had started taking Tamoxifen in March 2008 and was taken off of it by my oncologist in June 2008. She thought it wasn’t necessary because I am without estrogen producing ovaries now.

I have recently discovered edamame and love it! It has helped immensely with the hot flashes and night sweats I’ve been dealing with.

I was hoping you could elaborate on the effects of edamame on women in my situation. I understand it is good for young girls but what about a woman of 46 who was suddenly thrown into menopause?

A: What we know about soy and breast cancer has been a little difficult to interpret because most of the research offers us only indirect evidence. Ideally, research would be performed that would have women eat more soy products after being diagnosed with breast cancer and compare them with those without disease to see if there are higher or lower rates of recurrence. It’s unlikely that we’ll have that sort of information anytime soon.

It is the phytoestrogens in soy that appear to have anti-estrogenic properties. As such the belief that a diet high in soy might prevent breast cancer has some merit. It is those properties that appear to help some women with menopausal symptoms. Edamame and Menopause

Q: Do you recommend against adding table salt while cooking and before eating?

Can we get all the required sodium from the vegetables that we eat? I have heard that the amount of sodium the body needs/uses is around 300mg per day. Is that correct?

A: I don’t recommend using added salt at the table. I am a big fan of measuring salt carefully when cooking recipes.

Here’s the minimum Recommended Daily Allowance of sodium for different age groups. Daily Sodium Requirements

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

They’re always surprised when I say, “Nuts.”

“But what kind of nuts,” they ask.

“Nuts,” I say again.

And I go on to explain that it really doesn’t matter what kind of nuts they eat. Certainly, I would agree that you should avoid nuts that are honey roasted or have other varieties of sugary coatings, and that unsalted is better than salted and that plain is better than roasted (even dry roasted). But if you’re going to have a snack, a small handful of nuts, with their crunchy texture and higher levels of fiber, are going to be far more satisfying than other salty/savory snacks. Nuts Still the Best Snack

Sounds like a real conundrum, but researchers at Pennsylvania State University thought of a sneaky way for kids to get more vegetables and reduce the calorie density of the foods they eat: hide vegetables in them! How to Get Kids to Eat More Vegetables

In the past thirty years or so we’ve seen fewer families eating dinner together regularly, and this has coincided with the increase in individual’s waistlines. Plenty of studies have looked at the relationship between family meals and weight in children, but few have looked at the family unit as a whole or at the weight of the various family members – not just children.

A recent study in the journal Appetite takes an initial look at family meals and family weight (2011;57:517-524). The researchers recruited 103 families who were visiting Cornell University in Ithaca, New York, in order to attend campus tours. (This meant that at least one person in the family unit was a young adult.) The family groups averaged just three people, so 327 persons participated in the study.Do family meals affect family weight?

This is why Waist to Hip Ratio is becoming the more favored method of estimating body fat, better than Body Mass Index. Body Mass Index only looks at weight in relation to height, which is a good indicator of overweight and obesity for most people, but it is limited by being unreliable for children, the elderly, people under 5 feet tall, and those who are very muscular. Waist to Hip Ratio, on the other hand, tells us physicians far more about where your body fat is deposited, which we are finding is far more of an indicator of increased health risks and is relevant for everyone. Whole Grains and Belly Fat

We know that those people following a Mediterranean-style diet are less likely to be overweight or obese, and that a Mediterranean-style diet can help reduce blood pressure and improve cholesterol scores and insulin levels. But for those who are already overweight, are there advantages to a Mediterranean diet? Researchers in Greece used information from an ongoing health and nutrition survey to find out. Mediterranean Diet Advantages Not Limited to Normal Weight

Dr. Tim Says….

I suppose that I can’t put this off any longer. The discussion about high fructose corn syrup (HFCS) can really get people riled up. At virtually every single talk that I give, someone in the audience asks about it. Something seemingly simple like, “What about high fructose corn syrup?”

Should you care?

I think you should, but not for the reasons put forth on myriad blogs that demonize this sweetener as being responsible for the obesity epidemic, diabetes, hyperactivity and numerous other maladies. While there is some evidence that the higher levels of fructose may be of concern, I don’t see that research as being conclusive. My reading of the literature at this time does point to some very worrisome issues that implicate all added sweeteners as being a major contributor to obesity. What Not To Eat: High Fructose Corn Syrup Edition

Featured Recipe

Fish Tacos with Asparagus Salsa

I love tacos and there are endless variations. After creating the Asparagus Salsa recipe I decided that it would be fantastic on fish tacos and I was not disappointed. The salsa is better the second day, so if you can make it in advance (you can do the fish in advance too), you won’t be disappointed.

This week’s death of Blair River, the 575 pound spokesperson for the Heart Attack Grill is disturbing to be sure. First and foremost because this young man was only 29 years old. This means that he lived a scant 11 years as an adult and this kind of story always makes my heart ache.

There was a tremendous amount of press surrounding Mr. River’s death because of his role as a morbidly obese man pitching a restaurant that profiteers from today’s tremendous problem with weight gain in America. Founded by Jon Basso, who uses the moniker “Dr. Jon,” the restaurant serves burgers and fries with no limit on the calories, fat or salt. In Memoriam

Featured Recipe

Creamy Crab and Asparagus Fettuccine

This is a light pasta dish with the flavor of the crab enhanced by both the slight creaminess and the flavors of the lemon and oregano.

I am fortunate enough to live on the Gulf Coast and there’s great quality crab here. I purchase mine at the farmer’s market here in New Orleans. You can find great quality crabmeat even if you don’t live on the coast – ask at the fish counter of your local store.

In devising a research strategy, they also noted that other research suggests that people believe that participating in positive (healthy) behaviors can serve to offset the effects of negative (unhealthy) behaviors later. (Makes sense: how often have you thought something to the effect of, “I’ll take this long walk so I can have ice cream later.”)

Even further, Wansink and his colleagues theorized that just thinking about exercise – not actually doing any – could affect how much food a person served themselves afterwards. Just Thinking About Exercise

But would eating more whole grains and legumes actually help you lose weight? A group of researchers in the United Kingdom and New Zealand designed a study to shed some light on the subject. Slim Your Waist with Whole Grains and Legumes

Unlike an overview, which details the results of many studies on an individual, study-by-study basis, a meta-analysis combines the results and data of several studies to yield results as if they were all one study. (Those of you with a science background will recognize that this explanation is rather simplified.) The strength of a meta-analysis lies in the fact of its aggregate size: the larger and longer a study is, the more reliable are its results. The drawback, of course, is that this is a grouping of studies, all performed by different people with different standards and methods. More on Sugary Beverages and Your Health

Recently a team of researchers at Harvard published an overview of current research on sugar-sweetened beverages and obesity, type 2 diabetes and other metabolic disorders in the journal Physiology & Behavior.

Here are just a few highlights of the articles they mention which cite large-scale studies: Sugary Beverages and Your Health

The physicians contacted to respond to the survey were affiliated with the University of Michigan and were those who could be (broadly) considered “primary care” physicians: internists, family practitioners, endocrinologists and cardiologists. Between March and April of 2009, nearly 200 of these physicians responded to an emailed survey. Doctors, Exercise and Nutrition

A group of researchers in Scotland recently published a study focused on the effect of higher whole-grain food intake on fairly healthy individuals. Whole Grains and Heart Disease Risk

Of course we know what the outcome is of such overeating: holiday weight gain followed by a New Year’s resolution to diet and exercise.

A group of Swedish researchers looked at the long term effects of such overeating in a small study that was just released by the journal Nutrition & Metabolism. Short Term Splurge – Long Term Fat

Every now and then I’ll hear someone who is overweight say, “I can’t lose weight. My whole family is overweight. It’s genetic.” An interesting article in the International Journal of Obesity says that while that may be true for some people, it doesn’t appear to be an unavoidable fate. Exercise Trumps Heredity

It is estimated that nearly 7% of daily caloric consumption in the United States is from high fructose corn syrup. This estimate has been labeled as conservative, with other studies indicating that over 10% of daily calories come from fructose in the U.S. today. That’s a whole lot of calories! The research over the last five years has been mixed on whether HFCS has contributed to folks being overweight or obese. I don’t find any definitive studies that prove that it does, but there’s enough evidence to be concerning.

Most of the research that “proves” that high fructose corn syrup is not an issue has been funded by the manufacturers. There’s no doubt in my mind that funding can lead to bias, and any study not funded by a neutral party should be suspect. More on High Fructose Corn Syrup (HFCS)

Featured Recipe

Cowboy Steak with Cowboy Pinto Beans

This Cowboy Steak recipe is about as quick and easy as it gets. It is the perfect cookout recipe for the grill, but it’s best to marinate the beef in the sauce for at least a few hours first.

The key to the Cowboy Pinto Beans is to cook the beans fast for about ten minutes on medium-high heat. Stir them often in that first ten minutes and then reduce the heat to very low and simmer, covered. Stir them only occasionally. The stirring will break up a few beans and help thicken the sauce.

Weight, Lean Body Mass and Exercise
Exercise with Jacques Courseault

You have finally made a commitment to regularly exercise, build up strength and tone your muscles. You step on the scale a few weeks later to find that you have not lost or maybe even gained weight! You figure that something is wrong with the scale, because your pants are too big and you look and feel thinner. Chances are that your scale works just fine. The truth is that combining healthy nutrition with proper exercises has caused you to gain weight in the form of lean body mass (LBM), or fat free mass. Weight, Lean Body Mass and Exercise

Eating higher amounts of added sugars has been associated with overweight and obesity, along with tooth decay, diabetes, and an overall poor diet. Researchers at Emory University in Atlanta noted this and wondered if poor cholesterol scores might also be associated with eating more added sugar. No Added Sugar

At one point, you flashed a general guideline that stated something along the lines of; a 5-foot woman should weigh 105lbs; then add 5-lbs for each inch. I’m 5′6″ and the possibility of Christ coming out of heaven and asking my hand in marriage seems more likely than achieving 135lbs! I run 3 hours a week (15 miles) and do Pilates 2 hours a week (I weigh 160) and I have for YEARS! I just can’t believe that I don’t have enough muscle mass to count for something.

A: It’s a challenge to pack a lot of information into an hour lunch time lecture and have folks understand fully what should really take about 3 hours to talk about. That said, the formulas I gave you are meant as a guide and during the discussion I mentioned two other important measures. We talked about how they are at least as important as your ideal body weight (and maybe more so). One is Body Mass Index (BMI) and the other Waist to Hip Ratio (WHR). Both of these are equally important and help folks to do exactly what you are discussing – put your height and weight information in context.

It seems to me it would be a great program for elementary schools. The sooner the better. Is anyone doing this now?

A: I love your question, and while it is not the sort of question I usually answer for the Ask Dr. Gourmet column, I certainly want to address it.

My belief is that it is never too early or too late to start. We have great research that shows even making lifestyle changes into your 70s can make a huge difference. So can making changes in young adulthood. My opinion is that we have a challenge to create the curriculum for our students at every level – elementary school, high school, college or graduate school. It used to be that this sort of teaching would be done in home economics, Girl Scouts and even Boy Scouts, now that those programs are largely gone we have many young adults that simply don’t know how to cook.Teaching Cooking to Students

There’s been a lot of controversy about whether calorie counts should be a part of restaurant menus or not. Laws have been enacted around the country, with the most notable being in New York City. The legislation has been vigorously fought by the restaurant industry, with them actually suing to block these requirements. I have been saying for years that information matters and that knowing what is in the meal you eat makes all the difference. The real question is, does this work and can it work for you?Information Matters

Featured Recipe

Mexican Style Risotto with Whitefish

I had set out to do this recipe using salmon, but when I went to the market the drum was so much better looking. Take this approach when you are looking at recipes – you don’t usually have to stick to a particular fish. Generally speaking you can substitute another whitefish for recipes where the fish is lighter and another dark fish with dark fish recipes.

This recipe has a lot of ingredients, but don’t let that intimidate you. About half of them are spices. For some folks this may be a bit too spicy and you can leave the cayenne pepper out if you like.

This recipe is safe for Coumadin users, is low in sodium (salt) and is gluten-free. Those who are lactose intolerant but can tolerate cheese may be able to enjoy it. Those with GERD / Acid Reflux should avoid it.

How to Begin an Exercise Regimen
Exercise with Jacques Courseault

Exercising is an important lifestyle change that you should begin making if you haven’t already. The purpose of this article is to get you from sitting in your computer chair, to the point where you are seconds away from sweating, burning calories and improving your overall health. How to Begin an Exercise Regimen

But what about the reverse? If you don’t smoke, get enough exercise, and maintain a healthy weight are you actually less likely to get sick or die? The Effects of Being Healthy

Why am I not always more direct in helping them set goals? Because folks can often be pretty unrealistic about their health and their weight. Usually people are shocked when I tell them what an ideal weight would be for them.

There are a few ways to look at what your best weight should be, but Body Mass Index (BMI) is one of the most reliable to help you know what a healthy weight is for you.

BMI is based on a calculation that estimates weight in relation to height. There are more precise measures of weight, but BMI allows researchers a quick and inexpensive way to compare the weight of different populations. Because this has been the research standard you can easily compare yourself to the findings of researchers on what is considered a healthy weight.

It’s pretty clear that being overweight can have serious effects on your health. There are well established connections between obesity and many illnesses, with heart disease, diabetes, high blood pressure, breast cancer, colon cancer, arthritis and stroke being the most common problems.

While you have probably heard all of this before, I like to talk with my patients about the real consequences for them of these conditions. If your weight leads to having diabetes or a heart attack will you be able to dance at your son’s wedding? Will you live to see your daughter’s first child graduate from high school? There’s real pain in carrying around too much weight – arthritis of the knees, difficulty breathing, swelling of the ankles, diabetic foot problems – these are the facts of life for most with a BMI in the obese range.

BMI is a rough estimate of body fat. When I say “rough estimate” I mean both – an estimate and a rough one at best. The limitation is that it doesn’t measure body fat directly, so BMI can be misleading for those who have an especially high ratio of lean muscle mass to their overall weight. For the vast majority of us, however, Body Mass Index is a good indication of whether your weight is in a normal range for your height.

This table shows the range of weights for a normal Body Mass Index. Your Ideal Body Weight should fall between the weights for a BMI of 19 to 25.

For instance, if you are 63 inches tall (5 foot 3 inches) a good range for a healthy weight is between 107 lbs. and 141 lbs.

If your BMI is not in the normal range you can use the BMI table below along with the BMI calculator on this site to see if you fall in the Overweight, Obese or Severely Obese ranges.

Now, for some of you this is going to be shocking information. It is amazing to me how disconnected people are today from what a healthy weight should be. While BMI information is not perfect, it is a pretty good guide, especially for the majority of the population.

Don’t worry, you can get to a healthy weight if you are overweight or obese. It does take some planning and work at taking action, but as you read through these articles, each day you’ll learn a little more about how to make that happen.

Lunchtime is one of the places where people get way too many calories. It amazes me how many people don’t make their lunch to take to work with them, since it is so expensive to eat out these days.

Being very conservative, if you eat lunch out every day and it costs $5.00, that’s $25.00 per week or about $100.00 each month. $1,200.00 per year. (That’s a trip to Cancun!)

Save your money and save your life! Start making your lunch each day and taking it with you. It takes all of 10 minutes to make a sandwich and put it in a bag with a piece of fruit. This is a critical part of this program. By making your lunch, you not only save money but you are in complete control of the amount of calories you’ll have each day at lunch.

Researchers from the Centers for Disease Control worked with scientists at the German Institute of Human Nutrition on a study that included over 23,000 men and women between the ages of 35 and 65. At the start of the study, each person received a score of 1 or 0 (yes or no) on four positive health factors. Sometimes It’s Just That Simple

One major sedentary behavior is television watching. In fact, according to Neilsen Inc. the average American adult watches television for almost 5 hours per day. Not only is it sedentary, but we also know that distractions while you are eating, such as television, lead to eating more and weighing more (News Bite 11/07/06). Researchers at the University of Vermont devised a study to find out if reducing the amount of television a person watched would actually reduce their caloric intake or their weight. Try Turning Off the Television

I just don’t understand why there’s no real effort at making this better.  I ask repeatedly but get a shrug.  There is one meeting that I have some influence with and this month it’s going to be different.  Stay tuned…

Dear Dr. Gourmet,

Q: I am a 30-year veteran of the Army and in pretty good condition. I am active, no weight problems and (other than fried chicken) eat pretty reasonable meals. My big drawback is cholesterol. Mine has been as high as 285. My family has a history of high cholesterol.

I have tried every statin on the planet and have terrible reactions to them all. I have unbelievable muscle pains and had to be hospitalized after taking Pravachol. The doctors say this is rare. Right now I am not on any meds for the cholesterol. I am taking a few natural herbs like fish oil. What can I do that will help?

A: The most important consideration is your cholesterol profile. Occasionally I will have a patient who has been put on medication for a high cholesterol score, but their low density lipoprotein (LDL) cholesterol isn’t putting them at high risk when other risk factors are taken into consideration. Family history, smoking, diabetes and hypertension play a role in evaluating such risk. We also consider weight (Body Mass Index), waist circumference, race, activity level as well as stress. When you can’t take cholesterol-lowering medications….

Q: Could you please tell me how I can calculate the Body Mass Index of my husband? He is an athletic person with a muscular body and you have said that the regular Body Mass Index would not apply to people like him.

A: We know that obesity is a major problem and one way that we track this is the Body Mass Index (BMI). It is not a perfect measure, however. It’s used because of how simple and inexpensive it is to collect the data for research purposes. We use it as an indirect measure of body fat.

What we most care about is central adiposity (belly fat to most of us). There is now tons of research to show that obesity with a large waist circumference is as important (or maybe more important) than BMI. Assessing BMI for Athletes

Q: I purchase large jars of pickled onions imported from Italy and they are the best I have ever tasted. On the main (front) label it states “in balsamic vinegar” but on the ingredients list it states “wine vinegar”.

When finished with the onions there is, of course, lots of vinegar left. Can I safely reuse this vinegar to pickle beets? Other ingredients listed are water, sugar, salt, citric acid and trace of sulphuric anhydride, whatever that is. These sometimes come in cans and then olive oil is also listed.

A: The onions you purchase sound delicious. You could use the leftover liquid, but it likely is not your best choice, because pickled foods such as onions, peppers and artichokes are packed in vinegar as well as all of those other ingredients you listed. The issue that would most likely have an effect on your recipes would be the added salt. Reusing Pickling Vinegar

Q: I have been using your web site information since going on Coumadin (warfarin) about a year ago. It’s been very helpful to me and my wife for adjusting my diet to this medication that I will be on for the rest of my life (artificial heart valve).

I read on one of your replies about parsley being in certain dishes and not combining too many in one day. That made me wonder: how much parsley is in pizza sauce? Is it bad to have 3 slices of pizza for dinner? Should I be more wary about my weekend treat of pizza?

A: This is a really tough question. If there’s parsley listed in the ingredients in your tomato or pizza sauce, it could contain a fair amount of Vitamin K.

Your best choice is to make your own tomato sauce and not use any parsley. For convenience you can look for a tomato sauce that doesn’t have herbs in the ingredient list.

Have a question? Send it to askdrgourmet@drgourmet.com and your question may be answered in this column. Read more Ask Dr. Gourmet questions.

http://www.executivehm.com/news/cost-of-obesity-in-the-united-states/

So what? Of course your food comes from what you have at home. Researchers at Rutgers University wondered if there was a difference in what foods were actually in the home between those families with overweight members and those families who were all of normal weight. If It’s In the House….

Every now and then I’ll hear someone who is overweight say, “I can’t lose weight. My whole family is overweight. It’s genetic.” An interesting article in the International Journal of Obesity (2009;33:29-36) says that while that may be true for some people, it doesn’t appear to be an unavoidable fate. Exercise Trumps Heredity

Of course, another strong indicator of bone mineral density in women after menopause is… wait for it… their bone density before menopause. Some studies have indicated that the amount of fatty acids in a woman’s diet can have negative effects on her bone density. What about other variables, such as Body Mass Index, hormone levels or even ethnicity? Researchers at the University of Texas Medical Branch designed a study to assess womens’ bone density in relation to these and other factors. Leaner Body, Stronger Bones

A recent study known as the ARIC study included over 14,000 African-American and white men and women between the ages of 45 and 64 (J Am Diet Assoc 2008;108:1881-1887). At the beginning of the study, in 1987, the participants completed a food questionnaire that asked how often they ate specific foods or beverages. Less of This, More of That

Obesity and Subclinical Heart Disease

When a patient meets certain set criteria for a disease or condition, we doctors say that they have clinical [disease or condition]. For example, the World Health Organization and the National Institute of Health have designated a Body Mass Index of 30 or more as clinically obese. On the other hand, with some conditions a patient might have the condition, yet not show symptoms, and that is called subclinical [condition]. I have heard, for example, of marathon runners and dedicated bicyclists who dropped dead of heart attacks because they had subclinical heart disease.

But runners and bicyclists who still have heart disease despite their healthy lifestyle are the exception rather than the rule. A study published in the Archives of Internal Medicine (2008;168(9):928-935) looked at the relationship between subclinical heart disease and Body Mass Index across several ethnic groups. Obesity and Subclinical Heart Disease

Researchers at the University of Minnesota and the Minneapolis Heart Institute Foundation rounded up the results of 12 studies that incorporated weigh-ins into the studied weight loss or weight maintenance strategies. Weigh More… Weigh Less

The researchers at the UCLA Center for Health Policy Research have taken this type of study a step further. They correlated income and census data for the state of California with the results of a large-scale telephone survey which asked about weight status and specific health issues. This information was further correlated with a geographic survey of California….