So we now know how much time to devote to exercise, but what kind of exercise should we do?  The short answer is any exercise that you enjoy so that you keep doing it.  For the long answer, let’s take a look at this Ultimate Metabolic and Calorie Burning Makeover, adapted from a recent lecture by exercise expert, Len Kravitz, PhD.

Importance of Warming-Up Before Working Out

Warming up for 5-10 minutes before your workout increases blood flow to your muscles for better performance.  It also gets your carbohydrate and fat enzymes going.  Translation: you will burn more calories and fat during your workout if you warm up first!

Cardiovascular Calorie Burn

After your warm-up, increase the intensity by 10-15 percent (this can mean going faster, increasing incline, etc.) and continue for 4 minutes.  Increase your intensity again by 10-15 percent for 4 minutes.  Continue this pattern until you have reached your moderately vigorous intensity level.  Maintain this for as long as you feel comfortable.  Then decrease the intensity by 10-15 percent for 4 minutes, and again another decrease for 4 minutes until you reach your original intensity level.

Weight Training Burns Fat!

It was once thought that weight training was only good for strengthening and building muscle.  Turns out we also burn fat during weight training and up to 2 hours after our workout is finished!  Try this regimen: Do 3 sets of 10 repetitions (lifts) at 85% of the maximum amount of weight you can lift.  Rest for only 90 second between sets.

References:

Donnelly, JE. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain in adults. J Medicine & Science in Sports & Exercise. 2009, vol. 41, 459-469.

Herrera, L and Kravitz, L. Yes! You do burn fat during resistance exercise. IDEA Fitness J. 2009, vol. 6, 17-19.

The authors found that the subjects who watched the most television gained significantly more weight back in the year after joining the Registry than those who watched the least.  In addition, those who increased their television watching during the succeeding year gained more than those who did not, particularly if they also reduced their level of physical activity.  Specifically, subjects who increased television watching while decreasing physical activity averaged gaining back 9.0 pounds during the year, versus an average weight gain of 2.2 pounds for those who increased physical activity and reduced television watching.

These results are not too surprising.  After all, the great increase in the incidence of obesity in the last 20-30 years has been associated in time with a greatly increased role of television, VCRs/DVDs, and computers in the daily lives of most Americans.  We have become a largely sedentary culture, with so many means of entertainment for which we primarily sit and do not move.

This study did not provide a definitive answer for why television watching is associated with weight regain.  Certainly, low physical activity is one factor, but when level of physical activity was held constant, subjects who watched a lot of television or increased their watching still gained more weight over the course of the year than those who did not.  Snacking during watching television may be a culprit; many people who gain weight report a tendency to snack a lot, particularly with high-calorie and high-fat food and at night.  If people get used to eating in front of the television, the mere act of turning it on may become a learned cue for desiring and eating food.

These results challenge all of us to consider how watching television (or, for that matter, engaging in other sedentary entertainment such as using the computer) might affect our own ability to maintain or extend weight loss in the long-term.  Do such activities take us away from the physical exercise needed for success?  Has the television or the computer become a conditioned cue for overeating? If so, how can we combat these effects?

The best ways to prevent weight gain associated with sedentary entertainment vary from person to person, but several ideas may be helpful.  One might be to combine television watching with exercise, perhaps with a treadmill or stationary bicycle.  Another might be to arrange regular exercise on a schedule, or to make sedentary entertainment contingent on completing a certain amount of exercise each day.  You might also consider how to reduce calorie intake in front of the television or computer, perhaps by making a rule to eat only at the table, or to eat only prepared low-calorie snacks.  Using the three behavioral principles of self-monitoring, goal-setting, and support may also be helpful.  You are likely to benefit from keeping track of what you eat in front of the television or computer, setting specific and realistic goals for such eating, and/or enlisting the help of your support system to encourage you while you work on behavioral change.

Related Resources:

• Emory Bariatric Center

Reference:  Raynor, DA, Phelan, S, Hill, JO, & Wing, RR.  Television viewing and long-term weight maintenance results from the National Weight Control Registry.  Obesity, 2006, vol. 14, 1816-1824.

Findings from the two new studies were published this week in The New England Journal of Medicine and have helped shed light on a trend doctors have been noticing for years, that bariatric surgery often rids its patients of Type 2 diabetes as well.

“Type 2 diabetes is one of the fastest growing epidemics in human history,” and in the U.S. alone, the number of diabetes cases has tripled over the last 30 years. There are currently over 20 million Americans living with diabetes.

The first study compared two different types of bariatric surgery with the typical medical treatment regimen for Type 2 diabetes. After two years of following the participants, those in the surgical weight loss group had complete Type 2 diabetes remission rates of 75%-95%, whereas those in the standard medical treatment group saw no remissions from diabetes. The second study compared two surgical procedures with a more intense medical treatment regimen.Findings showed ~40% remission rates in the surgical group, whereas the rates were much lower, 12%, for the medical treatment group.

In addition to the findings from these studies, research at Emory has shown that bariatric surgery can also aid in the improvement of Gastroesophageal reflux disease (GERD), sleep apnea, depression, and joint pain among other conditions. The sleeve gastrectomy and gastric bypass procedures were two of the surgeries evaluated in the studies up above, both of which are offered at the Emory. For more information on the study and these procedures, see the links the below.

Related Resources:

• Emory Bariatric Center
• Atlanta Bariatric Center at Emory Johns Creek
• More on Sleeve Gastrectomy
• More on Gastric Bypass
• NY Times Article – Surgery for Diabetes May be Better Than Standard Treatment

About a quarter of our plates should be filled up with starches, including whole grains. The world provides us with a plethora of great grain options to keep us healthy and provide variety. Travel the globe through eating grains that are native to other countries and banish the boring. Here are two grain options to start your adventure.

Teff – is a grass native to Ethiopia with small seeds which cook quickly. The teff flour is traditionally used to make injera bread and now is used as a grain side dish in cultures in Europe and the US. Teff is an adaptable grain, thriving in both drought and waterlogged soil environments.

Teff is a very nutritious grain being a good source of fiber, niacin, iron, thiamin, copper, magnesium, phosphorus, calcium and protein. Containing all 9 essential amino acids, it is considered a complete protein. It is also a gluten-free product so it can be eaten by people with Celiac disease.

Millet - Millet is the name given to a number of different small seed grains grown widely around the world. There are many varieties of millet with Pearl Millet being the most widely used variety. India is the largest producer of millet, with it often eaten as a popped snack, where as in the US, people often feed millet to birds! Americans are now giving millet a second look and seeing the value in consuming it themselves. Millet is a gluten-free grain and therefore can be consumed by people with Celiac disease. Millet contains high levels of magnesium, niacin, B6, calcium, iron, potassium, and zinc; however, millet needs to be roasted or germinated before boiling to get the most out of these nutrients. The protein in millet is similar to that in wheat. Millet is often cooked as porridge or with a stew and made into bread and crepes.

Meat, poultry, fish, and eggs:   Animal products are excellent sources of complete proteins and essential vitamins and minerals such as iron and B vitamins.  When eating these foods, make sure they are lower in fat because they can be high in bad saturated fat.  Lower-fat sources of meat and poultry include chicken with no skin, ground beef ≥90% lean, and lean cuts of beef (sirloin side, top sirloin, top round, eye of round, and bottom round steaks all have ≤2 g saturated fat per 3.5 oz).  Fish like salmon, tuna, mackerel, herring, trout, and halibut not only have protein but also heart healthy Omega-3 fatty acids.  Try to include these fish on your plate at least 2 times per week.

Beans and peas, nuts and seeds, and grains:  Beans and peas are an excellent substitute for animal products and are a good source of fiber, iron, potassium, magnesium, folate, and zinc.  Aim to buy dry or frozen beans and peas instead of canned to reduce the sodium in your diet.  Nuts and seeds are also good sources of protein and essential vitamins and minerals such as B vitamins, vitamin E, potassium, and phosphorus.  Try to include a variety of unsalted nuts and seeds each day.  With all the research linking the nutrients found in nuts/seeds and good overall health, you could say “a small handful of nuts and seeds a day might keep the doctor away!”  And finally, many grains are an excellent source of protein.  Be adventurous and try a different healthy grain each week to increase your total intake.  Examples of protein packed grains are quinoa, amaranth, barley, buckwheat, oats, millet, rye, durum wheat, teff, and spelt.

• The average overweight person underestimated his or her calorie intake by 30-40% (versus 20% for normal-weight people). The more they ate the greater percentage they were off in their estimates.
• People ate 53% more popcorn if given a large container versus a small one, even though it was stale and they had just eaten.
• Even PhD students in nutritional science ate 31% more ice cream at a party if their bowls were big rather than small.
• When a candy dish at their desk at work was transparent, people ate 71% more candy versus if the dish was opaque, even with the same amount of candy in the dish.
• If Hershey’s kisses were within reach at a secretary’s desk, he/she ate nine per day on the average, versus four if the candy was six feet away.
• The more people are around us, the more we tend to eat; if we have 7 or more friends around us, we eat double the food than when alone.

Living in the United States, which has the highest obesity rate of any large country; it is easy to become overweight just following what others in our culture do. Our biggest weapon in being “counter-culture” is awareness: knowing what is in the food that we eat and how much of it we are eating. Wansink’s findings have some clear implications for people who want to lose weight:

• Think of times when you tend to be least aware. Often these times occur when people are in social situations, when they are served food by another person, and/or when they are tired, bored or stressed. Come up with a plan for controlling eating in these situations.
• Consider filling out a food diary during difficult times to make you aware of your eating habits and the number of calories you consume.
• Think of how you can make a 100-calorie change in your eating or exercise per day. Examples would be: to cut out one can of a sugared beverage per day; skip one dessert per day, walk for 15 minutes daily; regularly take stairs rather than elevators, park further away from stores or other destinations, and/or walk while talking on a cell or portable phone.
• Preplan how much you will eat during parties and social occasions and how you will control your food intake. An example would be to fill up one plate during a buffet, consume a preset number of chips at a Mexican restaurant, or decide to eat half a portion at a restaurant and to ask for a box before you start eating. Consider alternative activities with friends besides those associated with overeating.
• Control your environment so as to make problem foods less available. Shop from a list and when not hungry so that problem foods are not in the house. Put any such foods in the back of the panty or refrigerator and store them in small containers.  (Many people find it helpful to put pre-measured meals or snacks aside.) Resolve never to take a big box or container in front of you and eat from it. Keep seconds away from reach and serving containers off the table.
• Use smaller plates, bowls and glasses. For many people, their use saves many pounds each year.

Reference: Brian Wansink, Ph.D. Mindless Eating. Bantam Dell Publishers, New York, 2006.

1. Don’t be afraid to ask for what you want. Have your server put high-fat condiments like salad dressing and mayonnaise on the side so you can control how much gets put on your meal.  Ask to substitute high-calorie side items like French fries for salad or steamed vegetables.
2. Take half your meal home. Ask for a to-go box as soon as your meal comes to the table.  Put half of it away before you are finished eating.  Now you have two (or three) meals in one!
3. Pass the bread. Save your calories for your main course!  Put the bread/chip basket on the other side of the table to resist temptation.   Better yet, ask your server to not bring it to your table at all.
4. Fill up on low-calorie foods. Order a side salad (with light dressing) or a broth-based soup to help fill up your stomach when you are really hungry.  This will help you eat slower and eat less when your main course arrives.
5. Go for an after dinner stroll. If you feel like you have eaten too much, it’s tempting to lie down.  This may actually make you feel more uncomfortable.  Instead, try going for a light 10-15 minute walk.  This will aid in digestion and help push food out of your stomach.

What else? Any other tips you have to add to this list? If so, please share them with us and our readers using the comments below!

To help you steer your team of party goers in a healthy direction, below you’ll find two fantastic Super Bowl party recipes to incorporate into your festivities this weekend:

Healthier Buffalo Chicken Strips

This recipe packs in all that Buffalo wing flavor without the traditional Buffalo wing fat. Try these spicy chicken tenders marinated in buttermilk and hot sauce for a tasty, low fat crowd pleaser.

Ingredients

• 1/4 cup hot sauce
• 1/2 cup low fat buttermilk
• 1 1/2 lb boneless, skinless chicken breasts, cut into 2 inch strips.
• 2 egg whites
• 1/4 cup whole wheat flour
• 1/2 cup whole wheat bread crumbs
• 1 tsp paprika
• 1/2 tsp cayenne pepper, or to taste
• 1/8 tsp black pepper

Preparation

• Preheat oven to 400°. Place a wire rack on a rimmed baking sheet.
• In a small bowl, whisk together hot sauce and buttermilk until combined. In a large shallow dish, arrange chicken tenders in one layer. Top with hot sauce mixture and toss to coat chicken evenly. Cover and marinate in the refrigerator for 30 minutes.
• In a shallow dish, whisk egg whites until frothy. In another shallow bowl, combine flour, bread crumbs, paprika, cayenne and black pepper.
• Dip chicken tenders in egg whites, then roll in bread crumb mixture to coat evenly, shaking off the excess. Arrange coated chicken tenders on wire rack on baking sheet. Lightly spray with canola oil cooking spray.
• Bake for approximately 15 minutes, turning halfway through cooking, or until juices run clear. Serve immediately.

Nutritional Information

• Calories: 189
• Fat: 2g
• Saturated Fat: 0.5g
• Cholesterol: 66mg
• Sodium: 365mg
• Carbohydrates: 8g
• Fiber: 2g
• Protein: 34g

Healthier Veggie & Fruit Dip

Here’s a healthy dip alternative for your chips or veggies that can be turned into a fruit dip too!

Ingredients

• 2 containers (16 oz. each) low fat cottage cheese
• ¼ cup fresh chopped chives
• ¼ cup fresh chopped basil
• ¼ cup fresh chopped flat-leaf parsley
• 1 clove garlic, minced
• 3 tablespoons fresh lemon juice (about 1 lemon)
• Black pepper, to taste

Preparation
Combine the first six ingredients and mix well. Add black pepper to taste.

Variation: Substitute the herbs and garlic for honey and cinnamon for a tasty fruit dip

Nutritional Information

• Serving Size: ¼ cup
• Calories: 70
• Fat: 1.5 g
• Saturated Fat: 1 g
• Cholesterol: 6 mg
• Sodium: 308 mg
• Carbohydrates: 3 g
• Protein: 10 g

We hope you enjoy your Super Bowl festivities this weekend! And whether or not your team wins, if you try out these recipes and think they’re winners, please let us know using the comments below!

Related Resources:

• Emory Bariatric Center Website
• Comfort Foods: Substitution is the Name of the Game
• Emory Healthcare Healthy Recipes Website

Dr. Edward Lin

Because the demand for information on surgical weight loss options is growing, Dr. Edward Lin of the Emory Bariatric Center has been taking big action to help educate the community. Today, he held an online chat on the topic of surgical weight loss options (check out the transcript) to help answer questions on the pros and cons of weight loss surgery and dig deeper into the differences between each type of weight loss surgery.

Dr. Lin’s efforts were also recognized by Fox5 News of Atlanta recently, in a story documenting Emory patient, Jim Blackburn’s experience in undergoing a gastric bypass with Dr. Lin as his surgeon.

At 47, and 420 pounds, Jim Blackburn was ready to lose weight in a serious way. “I think I added up 24 different diets that I had been on. I had severe sleep apnea. I had a fatty liver condition, and I was on a lot of medications,” Jim told Fox5. He was worried he wouldn’t make it long enough to watch his children grow up. “My knee joints, ankle joints, hips, I hurt. At 47 years old, that was, that was frightening.”

After Jim decided to undergo surgery, he found Dr. Lin, who looked at Jim’s family history of obesity, his failed weight loss attempts, and identified Jim as a good candidate for gastric bypass.

But according to Dr. Lin, gastric bypass, a permanent procedure, is not for everyone. Pros of the gastric bypass procedure include: dramatic, rapid weight loss and reversal of health problems (including 85% reversal of Type 2 Diabetes cases). However, gastric bypass is a major surgery and is only reversible in a medical emergency. It also comes with a few short term risks, including bleeding and infection. But, because gastric bypass is permanent, it forces patients to adopt new lifestyle and eating habits, typically resulting in better long-term weight loss results.

In contrast, a lap band procedure comes with fewer risks and is a less invasive surgery. The band that is placed around the entrance of the stomach during the procedure can also later be loosened, tightened, or removed, making it less permanent than a gastric bypass. Because of its flexibility, patients who undergo this procedure require “a lot more willpower and mind control,” said Dr. Lin.

Two years after his gastric bypass procedure, Jim Blackburn is now 200 pounds lighter and feeling great. And as findings from a recent study support, family members of weight loss surgery patients, such as Jim’s wife who has since his surgery lost 80 pounds, also benefit from being around relatives who have undergone surgery.

For more information on each of the procedures discussed above and others, check out the Emory Bariatric Center website.

Related Resources:

• TRANSCRIPT – Dr. Lin’s Chat on Weight Loss Surgery
• Full Story from Fox5
• Emory Bariatric Center Website
• Families of Weight Loss Surgery Patients Lose Weight Too

At one year after surgery, patients lost an average of 100 pounds and decreased their body mass index (BMI) from 48.7 to 33.3. In addition, their overweight spouses and family members lost an average of 10 pounds and decreased their BMIs from 38 to 36.3.Family members also watched less television, exercised more, and reported fewer instances of uncontrollable eating.

The result of this study reinforces the importance of social support as a motivator to maintain healthy changes. If we mimic the positive lifestyle changes of those around us, we might find ourselves making healthier decisions more often. You may not realize, but people may use you as an inspiration to change their lifestyles! It is important to remember that over time, small steps turn into large strides.

If you’re interested in learning more about weight loss surgery and the options that exist for you or someone you know, now is the perfect time to sign up for a free online chat with Dr. Edward Lin of the Emory Bariatric Center. You don’t be ready for surgery or live in Atlanta to attend, just sign up using this form, and you can ask Dr. Lin all of your questions on weight loss surgery during the chat on January 26th.

Related Resources:

• UPCOMING WEB CHAT – WEIGHT LOSS SURGERY
• Emory Bariatric Center Website
• More on this story from the New York Times