<p>I always eat my biggest meal at breakfast.
I still struggle to get my 7 servings of fruit & veggies on.
Got to get my garden going.</p>
<p>As a 5’10", 150 lb male, I have nothing to add personally but would like to pass along a story from one of my wife’s patients. </p>
<p>A woman brought her 12 year-old daughter in for an appointment, worried about thyroid because her daughter was pushing 200 lbs. even though she “hardly ate anything at all.” They ran the standard blood tests, found nothing, so she was referred to a pediatric nutritionist. The nutritionist had her (and mom) weigh and measure everything she ate and drank for a week and keep notes. They were not to do any analysis on their own, just record the inputs.</p>
<p>It turns out that “hardly anything” was actually 5500 calories per day, concentrated heavily in drinks and snacks. The disconnect between the mom’s qualitative analysis and the quantitative data was astounding, even to my wife. So, my advice as a technical guy, would be to keep a scale and measuring cups handy until gaining a better sense of guesstimating calories.</p>
<p>People have no idea how many calories they consume with beverages. It adds up. They tend not to count them.</p>
<p>It definitely does help to have a digital scale and measuring cups handy. We got a $20 digital scale from amazon that we love and that has worked for us.</p>
<p>One thing I realized was that I failed at weight loss for two years because I assumed I was eating too much and focused all my energy on exercising more and eating less, and when I actually started calorie tracking I realized my calorie range was already right where it was supposed to be. I was just eating the “wrong” foods and not exercising as much as my body requires to maintain a healthy metabolism. It is important to track and experiment and collect that data on your own body so you can make decisions that will work for you. My mom has been overweight for the last 20 years and every few years tries really hard to diet and exercise, this last year is the first time it’s worked-- why, you ask? Every time she tried to diet before she was only letting herself eat 800 calories a day and she was doing 3 miles on the treadmill daily. My advice is don’t ASSUME anything-- don’t assume because you are hungry means you are not over-eating, and don’t assume because you are overweight means you are over-eating. Weight loss is more complicated than just calories-in/calories out sometimes. That’s why some people can’t help getting technical, for some of us that’s what we’ve had to do to get to our own weight loss-- but nobody starts out that complicated and you don’t have to. Just track yourself and take notes and see what is working and what isn’t. And if something doesn’t work don’t get discouraged, there are always more things to try.</p>
<p>Weight Watchers has actually been amazing to help my mom realize not just how much is too much, but how much is not enough, too. It took me a while to convince her the target point value is a MINIMUM, and that consistently falling below that number is NOT good-- less is NOT necessarily more. I have to remind her, “if your body thinks you are trying to kill it, it will fight back!” What’s nice about the program is that it helps you set minimums AND maximums and gives you the flex points to use, or not, when you need them. It’s not for everybody but we really like it.</p>
<p>Breakfast: Coffee with a splash of half and half, one banana, two slices of toasted whole grain bread with a small amount peanut butter (have been buying Vermont Yoga bread - small slices, full of seeds).</p>
<p>Midmorning snack: cup of nonfat cottage cheese or yogurt</p>
<p>Lunch: As much as I want of the leftover veggies from the night before - zucchini, broccoli, sweet potatoes, sautéed spinach are typical. I usually grill or roast vegetables and drizzle a small amount of olive oil on the top. Small grilled chicken breast, or turkey in a wrap. If I’m going out to lunch, I usually order salad with grilled salmon on top.</p>
<p>Midafternoon snack: almonds or cashews and an apple or a Fiber One bar</p>
<p>While making dinner: glass of white wine and a 100 calorie bag of pretzel sticks (very satisfying)</p>
<p>Dinner: mixed salad, 8 oz piece of chicken or fish, or occasionally a tenderloin steak, two or three cooked vegetables - as much as I want (see lunch), occasionally a few pieces of chocolate or a small amount of ice cream for dessert, or strawberries or melon.</p>
<p>I always eat if I’m hungry, but stick to healthy foods. I never limit the quantity of vegetables and I only eat whole grains…almost never eat pasta. I work out with a trainer three times a week - strength, weights, pilates, then I walk on nice days and use my Water Rower during bad weather. More muscle = a more efficient metabolism = means you can eat more calories without gaining weight. Muscle also gives us older folks a more attractive shape - muscle supports the skin and adds definition.</p>
<p>I use smaller size plates and find that is quite helpful. Also got a scale, though I am not fanatical about using it. My main meal is lunch. I have also found that keeping a food journal was great in holding myself accountable, and I continue to use it whenever I start tipping the scales again. Putting food on a plate vs. eating out of a container (even with healthy foods) is helpful. Otherwise, I lapse into mindless eating. Protein keeps me feeling full. I eat very little red meat these days. Most of the time I have only fruit or veggies for dinner.</p>
<p>I did Atkins in college and while I lost weight, I could not stay away from carbs for the long term. When I started this journey, my goal was to get healthier and reduce my glucose levels, which had gotten to pre-diabetic levels. My mom had multiple major health issues associated with extreme weight, and those are part of what ultimately killed her. I wanted to avoid winding up in the same boat – totally bedridden at age 64. (Not that I can say this to my family, but there it is.)</p>
<p>Had no idea I would lose this much weight, but also had no idea I’d die on my kitchen floor a year into this, either – so it’s a good thing I had lost 45 lbs. already when that happened. I wanted to figure out a way I could eat without feeling constantly deprived and in a way that I could maintain and still be able to enjoy special occasions.</p>
<p>There are some foods that are my triggers for bad eating, so I steer clear altogether. </p>
<p>A couple folks asked me what I eat, so I’ll quote from my journal:</p>
<p>Water, tea or coffee – nonfat creamer, sweetener, very limited amounts of caffeine
No fruit juice or sugared sodas</p>
<p>Breakfast –
1 container nonfat Greek yogurt
1/3 c. Kirkland Ancient Grains or Pumpkin Flax cereal
banana
or
egg beaters with low fat cheese, onions, mushrooms, tomatoes
turkey/chicken sausage
or
oatmeal w/dried fruit</p>
<p>Lunch –
2 slices whole wheat bread or whole wheat pita (tortillas tend to be high sodium)
1 T hummus instead of mayo
store brand fresh mild salsa – tomatoes, peppers, onions, corn, cilantro (my grocery store has it in very, very low sodium)
2-3 oz. Kirkland honey roasted turkey breast (160 mg sodium/oz)
or
Chipotle salad – brown rice, black beans, pico de gallo, corn (no guac, sour cream, cheese) – 570 cal, 1400 mg sodium
or my fake version of the same made at home, where the pico and corn total 10 mg sodium instead of 900
or
chicken salad w/ chicken breast, grapes, celery, light poppyseed dressing, nuts</p>
<p>Snack Options –
2 servings fruit
pita with hummus
small bowl of marinated eggplant (get it at Costco – yummy and low sodium)
1 oz package of unsalted nuts (TJ’s carries these – otherwise I’d eat a whole can of nuts)
gluten free crackers
Hearty cinnamon graham crackers (TJ’s)</p>
<p>Dinner –
4-6 oz salmon, other fish/seafood or chicken breast
and/or
salad with lots of veggies
1 teaspoon light dressing or Vidalia tomato dressing (almost no sodium, tastes great, also makes for good topping on fish)
and/or
asparagus, cauliflower, butternut squash, sweet potato, brussel sprouts, baked potato</p>
<p>Occasionally: Barilla whole grain or veggie pasta, cheese, Chinese (I get steamed chicken/shrimp/veggies w/sauce on the side and use a little bit)</p>
<p>Notice how many of the snacks being listed are fruit/veggie/protein rich. Satisfying and keeps you “full” longer. </p>
<p>Counting Down’s menu is a good example of eating well but not like a bird!!! Variety, yummy stuff and more than one food item at a meal. “Healthy”, not “DIEt”!!! </p>
<p>If I ate all that food in one day, though, I’d gain in no time flat. I gained 6 lbs during Passover and wasn’t even that bad. Ate brisket, matzah ball soup, veggies and a slice of chocolate cake at the seder. (Picked cake > latkes.) Ate lots of matzah products that week, though, which was probably my undoing. Went to Ireland and gained 10 in 14 days, despite walking a lot and eating (fairly) healthfully.</p>
<p>Realistically, I eat one full meal (lunch), two small ones and two snacks. Will also admit I constantly think about food.</p>
<p>musicprnt, I appreciate that you are not saying ALL doctors are idiots, but I remain curious about your frame of reference. I am sure “many” are locked into outdated modes of thought, but I would say that number is a much lower percentage than is true of the general population. I would even go so far as to say what you describe sounds pretty unusual. When I am not on CC I am on medscape ( or Gardenweb!), and folks who bring up outdated stuff are not suffered liightly! (is that how that saying goes? I’ve been trying to work it into a conversation lately.). My husband (FP), just spent several months preparing for recertification, which he “only” has to do every 7 or so years, provided he does some modules regularly. It is my experience that most doctors try hard stay on top of things, especially things that they see regulalry, and obseity or weigh concerns are right up there. Still, I think a nutritionist is better, and generally has more time. </p>
<p>I also disagree with the implication that we prefer to learn about new drug protocols. While it makes sense to be ready for th latest “ask your doctor” commercial, given enough time, my impression is that we would much prefer to convince our patients to accept a referral to the nutritionist. But often that is not what people want. They have seen some commerical, or been on some forum, where they have been told they have so and so, and to get so and so, and don’t back down. </p>
<p>If the patient trusts the doctor, or has a relationship with her, a discussion can be productive, but sometimes folks start out convinced that the doctor is an idiot, and you have to pick your battles. There is a current controversy regarding coding being overweight being an “illness”. Some think it is just another excuse to prescribe pills, but from where I sit, if you don’t have a billable code, there is no way to be reimbursed for the time it takes to talk about these things. This seems especially true in mental health. </p>
<p>With regard to “feeling full”, I hate to feel full. I get full very quickly, and don’t often get hungry. I might get a headache, or get irritable. I am not as concnered about my weight as i am my alertness and concentration. I find simple carbs during the day make me very sleepy. On my longest days, I usually eat the filling from a few carnitas tacos. </p>
<p>Well said @Shrinkrap. If I even mention a nutritionist to a patient, not only will they get offended, but they will probably have their complaint letter written to the hospital’s CEO before they wake up from anesthesia.</p>
<p>Last week, my 490 pound patient was angry that he was partially awake for his surgery because of the idiot anesthesiologist. I knew exactly that the “idiot” anesthesiologist did what it took to keep him alive. Did I recommend a nutritionist? “Oh #ELL NO!” Not stepping on that landmine. But told him due to his obesitt he could easily die from surgery.</p>
<p>The whole goal of a low fat diet is the fact that fat is energy rich. Gram for gram, you will have to eat half as much fat as carbohydrates. Furthermore, if you eat your carbohydrates as leafy vegetables, you can easily be full with much fewer calories. By the way, for the obese or diabetic with high cholesterol, reducing fat intake and calories will lower the overall serum cholesterol.</p>
<p>I don’t consider foods as cures. But when eaten in excess quantities are toxic.</p>
<p>I know a wonderful primary care physician who is a former pro bodybuilder. She counsels her new patients on nutrition and puts them on a plan. If the obese ones refuse to lose weight, she fires them!!! Her policy is that she won’t chase diabetes, HTN, and cholesterol issues if the patient is not willing to modify the most common risk factor. </p>
<p>Frugaldoctor: you said something up thread about being able to climb 3 flights in a certain amount of time. I googled this and couldn’t find anything. How much time? </p>
<p>Re chasing diabetes: Reading the advice on the medical school threads regarding specialties, this is the sort of thing that frustrates doctors and keeps them from wanting to go into primary care. </p>
<p>@TatinG, there isn’t a time frame that has been studied. I was suggesting that there should be. We ask how many stairs a patient can climb prior to anesthesia to assess a patient’s Metabolic Equivalents (exercise capacity) in lieu of a stress testing. But to me, it doesn’t make sense if one patient takes an hour to climb 3 flights vs. 1 minute.</p>
<p>If you want to eat as much natural* food as you want…well, within moderation and certainly enough not to go hungry, build muscle! Walking or the treadmill won’t make a difference…you should do it because it’s good for you, but it’s not going to make you look any different or boost your metabolism. I do Pilates at a nearby gym and there is a woman who has my same time slot…for years. She’s always on the stairclimber…constantly, and really working hard and sweating. She’s still about 50 pounds overweight…looks the same as she did when I first met her. I’m sure the increased activity has increased her appetite, so she’s not losing weight no matter how hard she works. Eat lean, clean, and build muscle…and don’t go to bed hungry.</p>
<p>Natural means that it’s recognizable or you know where it came from; so, it’s an apple or you cooked it yourself and everything you put into it was recognizable, or if you didn’t make it yourself, the ingredient list is short and recognizable.</p>
<p>Well, frugaldoctor, when I told my doctor I wanted to lose weight and she offered a referral to a nutritionist (“do you think it would help to consult with a nutritionist?”, I jumped on it. It turned out that I was right, I did eat in a very healthy way–but my portions were a bit too large. Don’t make assumptions. </p>
<p>I have 2 registered dietitians I refer to frequently. One works in an endocrinologists’ office and the other in local hospital. Not everyone follows through, especially if not covered by insurance, but these RDs are good & realistic.</p>
<p>I just wanted to mention my #1 food for help in controlling weight–soup. I make vegetable soup, cabbage soup, others. I rarely add salt (sour salt to cabbage soup). </p>
<p>A friend wanted to lose a little weight, so he cut out the one 11.5 ounce of iced tea he drank every day (drank water with his lunch instead) – no other changes. He lost about 15 pounds in 6 months or something similar. He was astounded and started sharing his remarkable weight loss secret with others. </p>
<p>Many sweetened beverages contain the equivalent of 1 teaspoon of sugar per fluid ounce, with all the same calories!</p>
<p>Salad dressings are a sneaky additional calorie count and can really add to the total intake. </p>
<p>It amazes me how much sweetened beverages people consume! I prefer to spend my calories on food over beverages nearly always!</p>
<p>Funny thing is once you get away from sweetened beverages, you can rarely go back. Soda and juice taste like cough syrup to me. Sickening sweet. </p>
<p>When I read a doctor saying what they think patients expect or do not want-- for example, when frugaldoctor says that patients don’t want to hear about nutritionists-- I’m reminded of this small study about doctors’ beliefs about what patients wanted, compared to what patients actually wanted: <a href=“The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior - PubMed”>The relationship between perceived parental expectations and pediatrician antimicrobial prescribing behavior - PubMed;
<p>This study measured whether doctors prescribed antibiotics to children with mild illness as a function of whether the doctors thought the parents wanted antibiotics. This is of course relevant, because antibiotics are wildly overprescribed for conditions for which they are not warranted.</p>
<p>If the doctor thought the parent expected antibiotics, the doctor was more likely to prescribe them by a huge margin. But it turned out that the doctors beliefs about parental expectations were unrelated to the actual expectations-- the doctors were just random. Moreover, if a parent expected a prescription but didn’t get one, that did not affect their satisfaction with the interaction. </p>
<p>In this particular study, the doctors thought they knew what their patients wanted. But they were completely wrong, and they made bad decisions on the basis of their wrong beliefs.</p>
<p>So, maybe some obese patients fly into a rage when a nutritionist is mentioned. But what about the ones that don’t fly into a rage? Are they glad that they got the nutritionist referral, but they don’t say anything? Did they never think they should see a nutritionist, but now that it is brought to their attention they do it? Sometimes the squeaky wheel is not representative of all the wheels.</p>
<p>@TatinG I have to pick my battles. When a patient starts the conversation with an attack on their previous doctor, the last thing I want to do is suggest that they had a hand in their complication by recommending a nutritionist. I’ve been there with the complaints for suggesting this in the past. So, I have to pick my battles rarely and carefully. Every overweight patient with high body fat should be referred to a nutritionist as part of their care. But the reality is that we have to be very cautious when it comes to addressing weight when a patient presents for something else.</p>
<p>I appreciate what Frugaldoctor is saying. Many overweight patients complain that they go to their internist for a cold or flu, and he/she brings up weight. When the patient trusts the doctor, it is easier to bring up a referral to mental health or R.D. Best when the patient initiates the topic.</p>