12 Tips for Healthy Weight Loss… with Benefits Beyond the Scale

By Michelle McMacken, M.D.  

(In case you missed it, here is Michelle on the recent RRP)

As an internal medicine physician and director of an obesity program, I am all too familiar with the struggle that many people face when it comes to weight loss. The statistics in my primary care practice mirror the U.S. national numbers: more than 70% of us are overweight or obese.[i] I’ve seen many people attempt to lose weight, become frustrated and disheartened, and turn to supplements, pills, meal replacements, unhealthy fad diets, and surgery. Unfortunately, most of these are short-term solutions without long-term weight-loss benefits (often accompanied by troubling health consequences).

The mechanisms that regulate our body weight are highly complex – neurologic, genetic, hormonal, environmental, social, and even microbiologic factors are at play. But these factors do not necessarily determine our destiny! We have the power to override them with the food and lifestyle choices we make every day.

Here are twelve of my favorite weight-loss tips:

1.   Start “crowding out” animal products, high-fat foods, and processed foods.

Gradually add more whole plant foods to your diet. You can begin with plant foods you already like and build from there. Eat a whole plant food (such as a piece of fruit) or a dish made from whole plants (such as a vegetable or bean soup or a salad) before one of your usual meals, so that you won’t have as much room for the less-healthful foods.

If you are ready to make the full leap to a whole-food, plant-based diet, you will likely see benefits even faster. Consider trying one of the many plant-based/vegan “kickstart” programs available online or in print.

2.   Focus on the positive—the nutrient-dense, high-fiber foods you are adding to your diet—instead of what you are taking away.

Enjoy experiencing new flavors (this is what I call “taste-bud rehab”), rather than focusing your mental energy on the unhealthy foods you are trying to remove from your diet.

3.   Choose the right kind of carbs!

Avoid processed carbs, such as white bread, white rice, and white pastas, even if they are vegan/plant-based. Stick to whole plant foods in their most natural form—brown or wild rice, quinoa, barley, oats, sweet potatoes, beans, lentils, and of course, an abundance of colorful vegetables and fruits.

4.   Remember that oil is a processed food.

Oil is very dense in calories, so it can easily sabotage your weight-loss efforts. Oil-based salad dressings, for example, dramatically increase the calories in a salad.

5.   Avoid liquid calories.

Don’t drink your calories, especially in the form of sports drinks, sodas, other sweetened beverages, and alcohol. The calories in these drinks add up fast and don’t fill you up. And for weight loss, in my experience, eating whole fruit trumps drinking fruit juice. Water is the only beverage we actually need.

6.   Have conversations with your family and/or close friends.

Talk to the people you live with about how they can best support your weight-loss efforts. Many of us have cravings for certain junk foods and/or sugary desserts, and when these items are readily available in the kitchen, it’s pretty challenging to resist them. Ideally, family members should be on board with not bringing these foods into your house. In my practice, I encourage my patients to bring their partners and other family members to their appointments with them, so we can talk about behavior changes together.

7.   Track positive behaviors (such as taking a walk at lunch, trying a new vegetable, or avoiding a sugary coffee beverage).

Keep track of the positives, so that you can look back and see the progress you are making. Many of these changes have important health benefits, independent of weight loss. Also, keep in mind that losing just 5% of your body weight can have significant health benefits if you are overweight or obese.

8.   Aim for at least 30 minutes of physical activity most days of the week.

Your daily activity can be as simple as walking. Although dietary changes tend to be more effective than exercise for weight loss, exercise is key to preventing weight regain and has numerous other health benefits.

9.   Eat as mindfully as you can.

Whenever possible, avoid reading or using technology (television, computer, phone, gaming, etc.) while eating. Savor each bite and focus on the experience of tasting your food.

10.  Be aware of your hunger cues.

Rate your hunger on a scale of 1 to 10, where 1 is very full and 10 is extremely hungry. Don’t let yourself get to a 9 or 10. This requires some planning. Eat something when your hunger level reaches 7 or 8, so that you won’t become ravenous later and make a desperate, unhealthy food decision.

11.  Don’t worry if you don’t lose weight right away.

The rate at which people lose weight depends on many factors, including activity level, age, muscle mass, health conditions and medications, and of course caloric intake. I don’t encourage setting goals around the rate of weight loss. Rather, focus on behavior and health goals, such as cooking at home more often, eating more servings of whole plant foods, and increasing physical activity. For most people, this approach will result in safe and sustainable weight loss. I’m not a fan of fasting for weight loss, meal replacement programs, weight-loss pills/supplements, or other practices that are not durable and do not promote long-term health.

12.   What if you are already eating plant-based but not losing weight?

Examine whether you are eating refined carbohydrates and other processed foods on a regular basis. Look out for added oils and sugars in your food. Are you eating out at restaurants and/or getting take-out regularly? These meals tend to be much higher in calories than similar meals prepared at home. Finally, consider reducing portions of calorie-dense foods such as dried fruits, nuts, olives, seeds, and avocados.

So what is the best way to eat for weight loss and overall health?

We’ve known for a long time, from large-scale observational studies, that vegetarians and vegans consistently have lower body mass indexes and significantly lower rates of obesity compared with omnivores.[ii],[iii],[iv],[v],[vi] Research also shows that animal products are linked to weight gain[vii],[viii],[ix],[x],[xi],[xii] and that plant-based diets are effective for weight loss, [xiii],[xiv],[xv],[xvi] without calorie counting or measuring portions. [v],[xv],[xvi] This is likely due in part to the high fiber content, which promotes satiety without excess calories.

Research aside, thousands of personal anecdotal reports and years of clinical experience attest to the fact that people who begin following a whole-food, plant-based diet almost always lose weight, and sometimes dramatically!

Probably the most important benefit of following a plant-based diet for weight loss is that it also decreases the risk of heart disease, high blood pressure, high cholesterol, diabetes, dementia, certain cancers, and even death.[xvii],[xviii] I know of no other “weight-loss diet” that can make such a claim. As a physician, I don’t think we should be separating weight issues from other health risks. I question the wisdom of following a diet (high-protein, low-carb, for example) that might help you lose weight in the short term but increases your chance of having significant health problems later on.

Michelle McMacken, M.D., is a board-certified internal medicine physician and an assistant professor of medicine at NYU School of Medicine.  She practices primary care at Bellevue Hospital Center in New York City, where she also directs a medical weight-loss program.  An enthusiastic supporter of plant-based nutrition, she is committed to educating patients, medical students, and doctors about the power of healthy eating and lifestyle modification. Be sure to connect and follow Dr. McMacken on Twitter.

This article was previously published on Forks Over Knives.

  

Sources:

[i]Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, 1960–1962 Through 2011–2012. 

[ii] Rizzo NS et al. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet 2013 Dec;113(12):1610–9.


[iii] Spencer EA et al. Diet and body mass index in 38 000 EPIC-Oxford meat-eaters, fish-eaters, vegetarians and vegans. Int J Obesity 2003;27:728–734.


[iv] Tonstad S et al. Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes Care 2009 May; 32(5): 791–796.


[v] Berkow SE et al. Vegetarian diets and weight status. Nutr Rev 2006 Apr;64(4):175–88.


[vi] Wang Y et al. Meat consumption is associated with obesity and central obesity among US adults. Int J Obes 2009 Jun;33(6):621–8.


[vii] Vergnaud AC et al. Meat consumption and prospective weight change in participants of the EPIC-PANACEA study. Am J Clin Nutr 2010;92:398–407.


[viii] Rosell M et al. Weight gain over 5 years in 21,966 meat-eating, fish-eating, vegetarian, and vegan men and women in EPIC-Oxford. Int J Obes 2006 Sep;30(9):1389–96.


[ix] Halkjær J et al. Intake of total, animal and plant protein and subsequent changes in weight or waist circumference in European men and women: the Diogenes project. Int J Obes 2011 Aug;35(8):1104–13.


[x] Hernández-Alonso P et al. High dietary protein intake is associated with an increased body weight and total death risk. Clin Nutr 2015 Apr 7. pii: S0261-5614(15)00091–6.


[xi] Vergnaud AC et al. Macronutrient composition of the diet and prospective weight change in participants of the EPIC-PANACEA study. PLoS ONE 2013;8:e57300


[xii] Vang A et al. Meats, processed meats, obesity, weight gain and occurrence of diabetes among adults: findings from Adventist Health Studies. Ann Nutr Metab 2008;52(2):96–104.


[xiii] Turner-McGrievy G et al. A two-year randomized weight loss trial comparing a vegan diet to a more moderate low-fat diet. Obesity 2007 Sep;15(9):2276–81.


[xiv] Turner-McGrievy GM et al. Comparative effectiveness of plant-based diets for weight loss: a randomized controlled trial of five different diets. Nutrition 2015 Feb;31(2):350–8.


[xv] Barnard ND. The effects of a low-fat, plant-based dietary intervention on body weight, metabolism, and insulin sensitivity. Am J Med 2005 Sep;118(9):991–7.


[xvi] Barnard ND et al. A systematic review and meta-analysis of changes in body weight in clinical trials of vegetarian diets. J Acad Nutr Diet 2015 Jun;115(6):954–69.


[xvii] Fraser GE. Vegetarian diets: what do we know of their effects on common chronic diseases? Am J Clin Nutr2009;89(suppl):1607S–12S.


[xviii] Tuso et al. Nutritional update for physicians: plant-based diets. Permanente Journal 2013;17(2):61–5.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

Patient Googles His Way Out of Bypass Surgery*

By Robert Ostfeld, MD, MSc

One of the most common operations performed in the world today is coronary artery bypass graft surgery (CABG). I would like to share with you the remarkable story of a recent Cardiac Wellness Program patient here at Montefiore Medical Center (I’ll call him Mr. J), who changed his diet and averted the CABG knife.

Mr. J is a middle-aged man with high cholesterol and a family history of heart disease. Understandably, he desperately wanted to avoid the problems that many in his family had faced, so he ate a “healthy” diet of chicken, fish, and low-fat dairy, with a few fruits and vegetables mixed in. And he exercised. A lot. In fact, he loved exercising so much that he would do it for two to three hours a day — brisk walking, playing sports, etc.

Mr. J. first visited a cardiologist at age 55, after having experienced several weeks of tightness in his neck during physical activity. The condition had worsened to the point that only 30 to 45 seconds of exercise brought on significant discomfort. The doctor ordered a stress test, to see if heart disease could be contributing to this symptom. The test results were so wildly abnormal that he was sent immediately to the hospital for a cardiac catheterization, to look for cholesterol blockages in the vessels that supply his heart with blood. Such severe blockages were found that he was admitted directly to the hospital for coronary artery bypass graft surgery. In less than one day, his life had changed dramatically.

While lying nervously in his hospital bed, he began to think that maybe there was another way to approach this disease, so he went online. There, he read about the impact of a whole-food, plant-based diet on heart disease, and he decided that was the path for him. He called the nurse, gave back his hospital gown, and despite the pleas of his medical team, signed himself out of the hospital against medical advice. Mr. J’s nurse was so concerned that before he was able to leave, she called his wife to have her convince him to stay. He did not. Later, the nurse even called Mr. J at home to plead for his return. He politely declined.

Soon thereafter he found our Cardiac Wellness Program at Montefiore. He was already taking all the appropriate medications, and he chose to completely change his lifestyle as well. He fully embraced a whole-food, plant-based diet without oil and had perhaps the most remarkable turnaround I have ever seen. Within one week, he went from being able to walk only a block before feeling tightness in his neck to walking 25 blocks without incident! Fast-forward three months and he was back to exercising two to three hours each day without symptoms. That is what I call remarkable!

A few weeks later, Mr. J got another call from his nurse. She had just been diagnosed with cholesterol blockages in her heart, and her doctors were recommending cardiac procedures. With Mr. J in mind, she told her doctors no way and called him to learn how to do exactly what he did: embrace a whole-food, plant-based diet!

Mr. J never did get that bypass surgery, nor did he get a coronary stent. In fact, he did not need to have any procedures at all. He got healthier with appropriate medications and by wholeheartedly embracing a whole-food, plant-based diet.

The key to health, it seems, lies at the end of your fork.

* * *

*Postscript: While many heart patients may reverse their disease with lifestyle change alone, Mr. J also continued his prescribed medications, given the severity of his condition, and their doses were lowered as his health improved. Please note that I am not recommending lifestyle change over medical intervention for any particular person, as every case is of course different. Some cases are fraught with more risk than others, so please consult with both your physician and a physician trained in lifestyle medicine before making significant lifestyle changes.

This post was originally published on the Forks Over Knives blog, here.

* * *

Cardiologist Robert Ostfeld, MD, MSc is the founder and director of the Cardiac Wellness Program at Montefiore Medical Center in New York City, where he encourages patients to embrace a whole-foods, plant-based diet. He earned his MD at Yale and his MSc in epidemiology at Harvard, and he is an associate professor of clinical medicine at the Albert Einstein College of Medicine.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.

African Sweet Potato Stew

Even though it is 80 degrees in New York, it’s officially fall. While I’m in no rush for the winter weather to arrive, I am excited that root veggies are officially back on the menu! This dish has it all: nutrient dense, easy to make (one pan only), a great taste, and it’s incredibly filling. Making it perfect for any fall evening -even warm ones!

Between the brown rice, the beans, and the sweet potato this dish is heavily starched-based. But don’t worry, contrary to what the Aitken’s type diets claim, neither starches nor carbohydrates make you fat. This is due to the way our bodies process carbohydrates. While many argue that starches are converted into simple sugars and then stored as fat by the body; that is not how it actually works.

First it is important to note, that unlike fats which has 9 calories per gram, carbohydrates contain only 4 calories per gram. This means you will feel physically full with less calories. Basically this means starches have a low calorie density but a high satiety value per calorie.

After eating complex carbohydrates like potatoes or beans, our bodies break these carbs down into simple sugars. These sugars are absorbed into the blood stream, where they are transported to our cells and used for energy. When you consume more carbohydrate than your body needs to furnish it with energy, the body stores around 2 lbs of it, in the form of glycogen, invisibly in the muscles and liver as a reserve.  Any remaining carbohydrates are typically burned off as body heat rather than stored as fat. This is because humans are very inefficient at turning sugars into fat, a process known as de novo lipogenesis. Even simple sugars are rarely turned into fat. For example, a study found that both trim and obese women fed 50 percent more calories than they usually ate in a day, along with an extra 3 ½ ounces of refined sugar, produced  less than 4 grams of fat daily. That means it would take nearly 4 months of this overeating for a person to gain 1 pound of fat. In comparison, the average passenger on a cruise ship, dinning on high fat and protein animal foods, gain an average of 8 lbs on a 7-day trip.

Fun facts about Sweet Potatoes:

•  Sweet potato and potatoes are two of the only foods that can fulfill all of our nutrient needs meaning they have all the protein, fats, and carbohydrates our bodies need to thrive (with the exception of some micronutrients).
• George Washington grew sweet potatoes on his farm at Mount Vernon.
•  George Washington Carver developed over 118 products from sweet potatoes including a glue and starch for laundry.
• They are loaded with vitamins A, C and E as well as other antioxidants that can help prevent heart disease and cancer, bolster the immune system, and even slow aging by promoting good vision and healthy skin.  They have been recently reclassified as an "antidiabetic" food and they are anti-inflammatory.

African Sweet Potato Stew:

Serves 3-4

4-5 medium sized sweet potatoes

2 carrots diced

1½  cups brown rice

1½  cups of corn

1 red onion-chopped

1 can garbanzo beans

1 can pinto beans

1 large can chopped tomatoes

½ cup almond, peanut, or sunflower butter (I used almond)

¾ bunch of collard greens, de-stemmed and chopped

4 cups veggie broth

1 tablespoon ground ginger

1 tablespoon ground garlic

1 teaspoon ground cumin

1 teaspoon ground coriander

In a large pot, sauté the chopped red onion in 2 tablespoons of water until the onions are translucent.

Add the sweet potatoes, veggie broth and spices and cover for 10 minutes to get the veggie broth hot. As the broth begins to boil, add the remaining ingredients with the exception of the almond/peanut/sunflower butter, the corn, and the collard greens.

Cook for 15 minutes at a simmer. As the sweet potatoes start to soften, add the remaining ingredients and cook for an additional 10 minutes until the greens are soft.

Further reading:

McDevitt, R.M. et all., “De novo lipogenesis during controlled over-feeding with sucrose or glucose in lean and obese women.” American Journal of Clinical Nutrition. 2001.

McDougall, John A. and Mary McDougall, The Starch Solution: Eat the Foods You Loce, Regain Your Health, and Lose the Weight for Good. New York: Rodal, 2012.

As always the information presented in this blog is for educational purposes only. It should not be considered as specific medical, nutritional, lifestyle, or other health-related advice.