Archive for November, 2007

Pedometer use associated with weight loss

Posted in Cardio exercise on November 27, 2007 by Dr. CJ

A recent JAMA (Journal of the American Medical Association) article demonstrated improvements in physical activity, BMI, and blood pressure in groups of people fitted with pedometers. It was a meta-analysis (summary of multiple similar studies) of results over an average of 18 weeks. I read the actual print article (always better than just the abstract). It seems like an obvious conclusion; really no groundbreaking science here, but there are a few take-home points for me.

It certainly confirms that my 1st “Tenet of Effective Weight Loss” is alive and working in real-life, that being the importance of keeping a record. Human nature is such that if you give someone a pedometer he/she will challenge him/herself to actually use it and to aim for improvement.

Primarily, I like the fact that this study demonstrates that such a simple intervention regarding physical activity can result in measurable changes in one’s health, in a relatively short period of time.

The 10,000 Steps program has evolved recently as a motivator to incorporate more physical activity into our daily routines. It doesn’t take much to make a difference, especially if you are relatively inactive.


10 Tenets of Effective Weight Loss – #2 – Have a fitness goal

Posted in 10 tenets of effective weight loss on November 25, 2007 by Dr. CJ

2) Stay focused on a goal

Of first importance is to have a goal in mind, whether it be fat reduction, muscle gain, or fitting into those old clothes. It may be useful to find a picture of your ideal body appearance as a motivating factor. Your goal may change once you begin, or you may discover a new goal once you reach the first one. Be open to some change, but don’t give up on your goal if it seems unattainable once you begin.

This tenet also implies a long-term commitment. The word “diet” is usually used in the sense of a short-term change, such that after you change your eating habits to get to the point where you’re satisfied with your body, you may return to your original eating habits – the ones that got you to your unsatisfied state. You need to make lifestyle changes that you will sustain long-term in order to maintain the fitness level you desire.

The “diet” mentality is the reason that so many people are able to lose weight for a period of time, but then gain it back (and often more). Failure to maintain the changes that led to the initial success is incompatible with maintaining the improved fitness level.

There will be times when you feel that it would be easier to revert to your old ways, especially after realizing some progress. Sure, you can get back to that point with some renewed discipline, but you must recognize that it would be easier to stick with your plan and further your progress then to recover after a lapse in discipline.

In addition to whatever you visualize as the benefits to this new lifestyle, there will most certainly be other benefits that you had not thought of or imagined. Obviously, you could expect improvements in a number of health-related measures over time. Other benefits may involve social interactions (e.g. ability to participate in activities with others, appearing more attractive, etc.) and even financial situations (e.g. health insurance discounts, fewer healthcare visits, fewer medications).

10 Tenets of Effective Weight Loss – #1 – Keep a record

Posted in 10 tenets of effective weight loss on November 22, 2007 by Dr. CJ

Nearly everyone wants to “lose weight” at some point in their lives. Unfortunately, it’s probably the most common New Year’s Resolution by a long shot, because it seems to be an unreachable ideal for so many. Weight loss is pretty simple, really: calories in vs. calories out. So, why is it not that simple in real life? We’re human. We have created all kinds of fluff in our lives that keeps us from doing the things that our body needs, fluff being things like work, meetings, organizations, hobbies, etc. We are animals (a sophisticated animal, mind you), and animals by their very nature are active, needing to seek out their own food and travel by means of their own bodies (not vehicles). Animals do not produce Kristy Kreme doughnuts, watch TV, or drink beer.

I’d like to outline some lessons I’ve learned regarding effective weight loss. They are my “tenets of effective weight loss” – a series of suggestions to guide your fitness plan, no matter what your goal. Let’s start:

1) Keep a record

As you start to make progress with weight loss, muscle gain, etc., you will no longer have your old self to compare to. It may get frustrating if you cannot detect some meaningful improvements in your body after all that hard work. The last thing you want is to get discouraged from continuing on your fitness plan, so make sure you have some way[s] to document progress. An Excel spreadsheet would be the ideal way to document these data over time, also providing the capability of displaying the data in graph form.

The simplest and most common measurement is weight. Invest in a user-friendly, accurate scale that will allow you to log your weight. Of course it gets more complicated: you may want to be able to measure down to the nearest 1/4 pound vs. accepting only whole numbers. There’s digital vs. analog scales, stand-up scales with rulers for measuring height built into them, scales with body fat calculators, etc. Don’t get hung up on any of these – just figure out what works best for you and be willing to adapt over time to meet your needs.

You may want to do specific body measurements, such as waist size or measuring biceps, thighs, chest, hips, etc. Get a cloth ruler and measure away.

You may want to calculate body fat percentage, with a caliper system. They are fairly accurate and affordable. I have a Slim Guide skin calipers that works well that I bought for $19.95. There are, of course, fancier methods for calculating body fat, but those require special equipment and facilities. Body fat reduction should be the ultimate goal for most people – it’s not just about weight loss, because you may be replacing fat with muscle and that won’t be reflected in your scale measurements.

Photographs are a very useful method for tracking progress. Sure, there are a million health-related reasons why we want to be fit, but we’re also fairly vane creatures who want to look good to others. By all means, do not get hung up on body image in a pathologic sense – despite what the media tells us, not everyone can or should look like celebrities/supermodels. Pictures taken at regular intervals can be a huge motivator, especially when the measurements may not be changing like you expect.

There will also be the real-life measurements, how well your clothes fit or what other people notice. These measures are perhaps the most rewarding when you are struggling to make a change. Keep a journal of these, as well.

What is BMI?

Posted in Monitoring progress on November 21, 2007 by Dr. CJ

There’s a lot of talk about BMI in the news and in fitness magazines, etc. But, what is it and why should we care about it? There are BMI charts posted in my exam rooms (not my doing) that intrigue everyone. I always catch patients plotting their own heights and weights on the chart, which serves as a nice lead-in to discussing the uncomfortable topic of weight.

BMI stands for Body Mass Index. It is meant to be a simple numerical representation of how “fat” your body is, a ratio of your weight to your height. It is calculated as:

BMI = kg / m^2

or = [mass (in kilograms) / height (in meters) squared]

Here’s an easy BMI calculator where you can enter your data in feet/inches and pounds rather than using metric measurements.

What do the numbers mean?
BMI < 25 – Ideal
BMI 25-30 – Overweight
BMI > 30 – Obese

For most body types, this value has moderate usefulness. It’s especially useful to be able to tell someone that their morbidly obese body habitus far exceeds the expected values as above and to give them a goal. However, it is of absolutely no value in individuals with a fair amount of muscle mass. This equation obviously does not differentiate between weight from fat vs. weight from muscle. Therefore, an individual with a large muscle mass could appear obese on this chart despite having a body fat percentage of less than 10%, for example.

I quickly throw this calculation out the window when confronted with a high value in someone who has a fair amount of muscle mass. Unfortunately, I fear that insurance companies will start to track more data like this and will inappropriately punish individuals like this who have abnormal BMI’s due to a large amount of lean body mass.


Posted in Introduction on November 18, 2007 by Dr. CJ

I am a family physician who has a special, renewed interest in physical fitness and, of course, all kinds of health issues. I had always enjoyed fitness, but it was never a priority for me. I suffered the classic laziness when I got my driver’s license and no longer rode my bike all around town; I suffered a smaller version of the “Freshman 15” in college; worst of all, I put on a lot of weight in medical school – a function of stress-eating and a hectic schedule. I went on exercise binges during medical school and would drop several pounds, but then gain it back quite easily when the demands of school overwhelmed me again. I had tinkered with weight training, but like most beginners I feared the free weights and never really understood what I was doing. I certainly never worked on cleaning up my sloppy diet.

At the beginning of this year (NOT a New Year’s Resolution), I committed to shaping up my lifestyle. There were many factors that culminated in this decision, one of which was turning 30. I knew I could make the necessary changes – it was just a matter of sticking with them long enough to get the results I wanted. One small (but HUGE victory): I haven’t drunk a Mountain Dew since 1/17/2007 and haven’t looked back. After researching the fundamentals of all-around fitness, I invested in free weights and an elliptical and began my own transformation.

My goal of this blog is to demystify the world of fitness and weight-loss and to share my experiences, with suggestions on how to implement similar lifestyle changes for other people. As a physician, I hear all kinds of ballyhoo about the latest/ greatest/easiest weight-loss plans, and frankly, I’m quite disturbed at the notions that drive people to follow these marketing schemes. Work with me – I’ll try to sort it out for you.

It goes without saying that you are responsible for your own health. Before starting on any kind of diet or exercise plan, you should have a [face-to-face] discussion with your regular physician about whether it is appropriate for you. This weblog is simply a collection of my experiences and reflections on a very complicated field. I am not responsible for any adverse events attributed to ideas expressed herein. Any discussion regarding diagnosis and/or treatment of any conditions discussed within this forum does not substitute for a face-to-face interaction with a health professional and should not be considered a professional opinion.