By Dr Louise M Vanslager
As an endocrinologist, I see many obese patients in my practice of medicine. This is because so many people come to me convinced that their obesity is “glandular.” Also because I treat many diabetics who should be lean if their disease is to be kept under control.
In their initial visit (usually after a complete physical examination with the necessary laboratory tests), I spend about an hour and a half educating my patients in the dietary facts.
I try to teach them what to eat, how to eat, and when to eat. I never use either “reducing” injections or pills. Eventually, the patients are able to control their weight at will.
This pattern consists of common-sense rules that add up to easier dieting. Here are the 9 rules which make up my diet plan:
1. Relax – lose weight slowly
I set my patients a realistic goal of losing around two pounds a month. This means that each must do without 7200 calories (about four days’ normal eating). Spread over a month, the pounds are lost with little effort and stay off.
Most people lose weight quite rapidly during the first few months, usually much more than two pounds a month. The more overweight you are, the greater the amount of water in the fat cells.
The outer fat cells are the first to be emptied, being made up of much more water than the inner fat cells, and making for an initial weight loss that is quite dramatic. Thus, the weight loss over an entire year for a moderately overweight person will be considerably more than 24 pounds.
An important added bonus of losing weight slowly is that you end up looking younger and firmer. If weight is lost slowly, the skin and its underlying tissues gradually reconstitute themselves, so that no unsightly folds are left.
2. Don’t weigh yourself daily
Weight varies appreciably from day to day; people who weigh daily tend to get bogged down in this variable pattern, becoming confused and discouraged. Long ago, I found that whatever the scale shows on a daily basis encourages weight gain.
If the scale shows a decrease one day, the patient is easily tempted to splurge a little with desserts. If the scale shows an increase, the patient feels depressed and upset – again causing the patient to eat.
At my office I weigh patients monthly, on accurate, balance-type scales, which prevents their seeing the daily up-and-down cycle. They only see the general downward trend, which most patients find very encouraging and reassuring.
3. Try to make dinner the lightest meal of the day
I like my patients to try to remove some of the calories from their last meal of the day. People who eat a larger breakfast or lunch and a smaller dinner do much better with respect to their weight.
This is because the calories you take in earlier in the day spark a lot of energy, the added energy causing you to use up more of the calories. Even taking only 50 to 100 calories from the evening meal and transferring them into lunch or breakfast can give a dramatic result over a given length of time.
4. Do not eat during the last four hours before bedtime
One of the main problems with people who are slightly overweight is that they eat late at night before going to bed. People are all generally active during the day, but after the evening meal, few are active. While an intern, I lost 25 pounds in one year simply by giving up the glass of milk I used to drink immediately before bedtime.
5. Shun fatty food
On a diet one should never eat anything fried. Well, almost never. I tell my patients that if they are invited out to dinner and their hostess serves them fried shrimp they certainly should go right ahead and enjoy it. The relatively infrequent eating of fried foods is not what makes one gain weight. It is the almost daily fried food eating that causes weight gain.
Meats should be grilled, boiled, stewed, or otherwise cooked – but never fried. Eggs can be boiled or poached but “fried” only in a non-stick pan with water, never with fat or butter. And meats should always be as lean as possible, with all fat cut off before cooking.
Potato chips, as well as most of the other tasty snacks that people eat while watching TV, are fried and extremely high in calories.
6. Use lower-fat milk and low-calorie salad dressings
I also suggest that my patients change from a regular milk to a lower-fat or even non-fat milk. I also urge them to change from a regular salad dressing to a dietetic dressing (usually only 2-3 calories per serving).
An unvarying principle of mine is this: I want my patients to enjoy whatever it is they eat. I ask them to try all the low calorie and low-fat foods I have suggested, but if they do not find things they like I tell them to forget it. If they keep on with something they can’t stand, the entire diet will become intolerable to them.
7. Eat a moderate amount of starchy foods
I ask patients to consume no more than two slices of bread a day. I don’t care what kind of bread is chosen. If the patient really likes a particular kind of bread he will appreciate those two slices all the more.
If he eats rice or noodles with any meal, one serving is roughly equivalent to one of the slices of bread; so, for that day, only one slice of bread is allowed.
Potatoes are moderately high in calories, but almost everyone feels that they have to be fried, mashed with butter or cream, or, if baked, served with sour cream and chives. It is easy to see that the caloric value of potatoes can rise to prodigious levels. I feel that potatoes should be eaten only rarely.
Pastries are quite high in calories, but if my patients are used to eating a lot of pastries I just have them switch to those that are lower in fat and sugars and urge them to stay away from those that are made with lots of shortening.
It is remarkable what a difference switching a few things like that can make in the long run.
8. What to do about fruits, alcohol, desserts, and soft drinks
Quite a few people feel that fruit has no calories or very few. This is not true. Of course, it’s healthful to have some fruit every day. This serving can be had as dessert.
For other “sweets” I suggest switching from regular gelatin dessert to dietetic gelatin and from ice-cream to ice milk cubes.
I always mention to my patients that alcohol is high in calories, and if they are regular drinkers, I urge them to shift from mixed drinks to dry wines. Anyone wanting to lose weight will have to limit his drinking, for every cocktail adds about 125-300 calories.
Dietetic soft drinks do come fairly close to being non-caloric. However, many contain caffeine for its stimulant effect. This is all right during the day, but if caffeine in coffee keeps you awake at night, so will a stimulant diet drink.
9. Have plenty of fresh and cooked green, yellow, and red vegetables daily
Most vegetables are relatively low in calories and high in vitamins; thus they are calorically the very best food bargain available. I urge my patients to have as many vegetables as they like – especially the yellow, green, and red vegetables. The only ones I ask them to limit are dried lima and navy beans, dried peas, and so forth.
There you have the diet plan I give my patients. It seems to work for most people.
I know that if a patient follows but a few of my suggestions, he will lose weight. And if part of the diet should prove disagreeable, he can discard that part and not the whole diet.
The main secret, I would say, is to make sure my patients relax, take it easy, and lose weight slowly.