A Big Problem

The message is straightforward — excess weight can be deadly. It is a major risk factor for heart disease, diabetes, vascular disease and sleep apnea, even in the absence of family history and other risk factors. It adds pain and pressure on arthritic joints. A recent seven-year study of 20,000 women by the World Cancer Research Fund and the American Initiative for Cancer Research documented a connection between excess weight and endemetrial, esophageal, kidney, postmenopausal breast cancers and leukemia.

“Yet the problem of excess weight is escalating,” says Lannette Madden, RN and clinical exercise specialist at Littleton Regional Hospital. Littleton Regional Hospital was recently designated by the American Heart Association as one of four “Fit and Friendly” companies in the state. Madden works with the cardiac rehabilitation team.
“Our national habits get us in trouble,” she continues. We’re rushed, so we opt for fast food or a heat-and-serve package at home. We consume ever-larger portions.

Twenty years ago a standard serving of pasta was one cup. Today it is two cups and often more. A bagel was three inches in diameter. Today it’s six inches. That’s a difference of 210 extra calories. “You would have to rake leaves for an hour,” she says, “just to work off the difference.”

In addition to “portion distortion,” much of what we eat is highly processed. Madden says that “enriched” on a food label usually means that a natural substance has been removed and a substitute added. But there are no adequate substitutes for whole grains, fruits and vegetables and lean protein. It isn’t necessary to adopt one of the popular diets, she advises, or to keep charts and measure calories in categories.

Make changes gradually — from sweetened cereals to whole grain, non-sweetened, for example. Have an apple or carrot sticks with your sandwich instead of chips. Bring a piece of fruit to work instead of buying a pastry for a mid-morning snack. Make your favorite double cheeseburger or steak an occasional treat, not a regular item.

Most people have no idea of how much sugar is consumed in snacks and drinks. A small fruit and yogurt cup? Six teaspoons of sugar. A can of soda? Twelve teaspoons of sugar. Madden suggests that increased sugar consumption plus the sweetness of diet soda has changed our concept of a sweet treat. What once would satisfy no longer seems sweet enough. She sees the results affecting children. “As recently as 25 years ago,” she says, “type 2 diabetes did not exist among children. Now thousands of children are diagnosed with this disease that was seen primarily in older adults.”

How much weight is “too much,” many people ask. What defines “excess”? A recent study published in the “Journal of the American Medical Association” states that being overweight is not a risk factor for heart disease and cancer, but does boost the risk of dying from diabetes and kidney disease. Obesity is seen as a significant risk for cancer and heart disease, as well as the aforementioned problems. This report was greeted with considerable skepticism.

“We use the American Heart Association guidelines for body mass index,” Madden explains, “to define weight categories. A BMI from 18.5 to 24.9 is usually regarded as the desired range. Being fashion-model-thin is not healthy, either.” BMI is computed by a formula based on your weight and height. (You can google BMI index to get tables.) Excess weight around the waist is often of greater concern than excess weight evenly distributed. Consult your primary care physician to assess individual risk and weight concerns.

Madden suggests setting a modest goal for weight loss, whatever your final goal might be. A goal of 50 pounds is overwhelming, but losing 10 pounds seems manageable. Congratulate yourself, then reset your goal. As you progress, you will also be changing your eating habits.

The other half of a weight loss program is … exercise! Much has been written about our sedentary way of life. More office work, longer commutes, more machines to do household tasks; we spend much of the day sitting. Even the parents of young children, racing from one event to the next, spend much of that rushed time sitting, driving and watching soccer practice.

“It’s easy to be intimidated by the demands of a rigorous exercise program,” Madden says. “Even heart patients, highly motivated to exercise, may slacken their efforts as time goes by. But it isn’t necessary to become a ‘jock’ or hire a personal trainer.” The American Heart Association recommends a minimum of 30 to 60 minutes a day of exercise, which can be done in increments.

Start with a modest goal, says Madden. Assess your schedule. A 15-minute walk at noon might work well. Add another 15 minutes, perhaps five minutes of stretching and 10 minutes of strength building exercises and you have an adequate beginning exercise program. When that routine is comfortable, expand it a little, perhaps with a longer walk or a more structured strength-building program.

There are many good exercise videos for home use. For a parent at home with small children or an older person who doesn’t get out on a regular basis, an at-home program is often a good solution, especially in winter. Most hospitals provide no or low-cost exercise classes open to the community. Elliott Hospital’s Senior Health Center (Manchester), for example, offers ongoing groups in strength training, gentle aerobics, relaxation techniques and more, in its fitness center. Cheshire Medical Center/Dartmouth Hitchcock-Keene provides a senior hiking group (weekly, open to all ages) and a variety of eight-week classes throughout the year. NH

Eating out is dangerous for dieters — all that good bread and butter, yummy salad dressings and, oh, you have to have dessert. Here’s the danger, according to the American Heart Association: Many types of “away from home” meals, including prepared meals you buy at the grocery store, are high in saturated fat, trans fat, cholesterol, added sugars and sodium. And portion sizes have increased dramatically over the last several years, which means more calories to eat. Here are some tips to avoid temptation.

• To keep portions smaller, split an entrée with your dining partner or take half home when dining alone.
• Ask for sauces and dressing on the side to control the fats, sodium and calories you eat.
• When ordering, choose foods that have been grilled, baked, steamed or poached instead of fried, sautéed, smothered or au gratin.
• Try ordering two or three appetizers instead of a full meal and add a salad (watch the dressing) or soup.
• If you choose a dessert, split it with your dining partners or ask for fresh fruit. Another alternative is a fat-free cappuccino or espresso beverage instead.
For more information on diet and lifestyle,
visit www.americanheart.org.