Losing Weight: A Simple Guide to Tackling Weight Issues as a Family
By Anatoly Belilovsky, M.D.
Weight control fits very poorly into the pattern of health care. Part of the problem is in the effort America has put in to making medicine accessible, affordable, and painless. “Improving the delivery of health care” is a catchphrase I have been hearing for a quarter of a century.
When it comes to explaining excess weight, it is commonly said that obesity and other weight issues run in families. What is a problem for the parent is frequently a problem for the child. This is true, but simply referring to “genetics” is not an accurate explanation. Getting to the bottom of familial weight problems requires the expertise of someone who is able to provide adequate counsel to both children and adults. And the most effective expert is your family pediatrician.
When it comes to tackling family obesity, the first question most people have for their family pediatrician is, “does my family have a physical disease that is making us fat?” The answer is, yes and no. “Real” diseases that produce obesity do exist: hypothyroidism and Prader-Willi syndromes are two examples. In pediatrics, however, all these “real” diseases combined account for fewer than 5% of children suffering from obesity. The rest have exogenous obesity – simply eating too much.
What happens to a person who overeats – in very simple terms:
As the food is digested, carbohydrates are converted into glucose. Glucose enters the bloodstream, and the pancreas makes insulin, which signals cells to take in the glucose and use or store it. Most cells have only a limited capacity; the exception is fat cells which can put away a virtually unlimited amount of glucose after converting it to fat. The greater the carbohydrate load, the more insulin is produced to make this happen. And when all the glucose is put away and insulin is still there, the blood glucose drops. You get hungry again. Very hungry.
Two things will produce and contribute to this cycle: overeating and starvation. Low blood sugar will induce severe hunger; severe hunger will lead to overeating; overeating will lead to high insulin secretion; which will lead to low blood sugar. Fat, for all practical purposes, simply goes to fat cells and, mostly, stays there.
Here, therefore, are the key principles of manageable weight loss that both parents and children can abide by:
1. Do not starve.
a. Do not skip breakfast. A small carbohydrate snack such as a fruit or a sandwich is perfect.
2. Do not drink your calories. The only acceptable drinks are:
a. water
b. skim milk (NOT lowfat, that still has plenty of fat in it)
c. IF YOU MUST, diet drinks are acceptable (though not recommended).
d. NOT juice. Juice is a fruit from which everything good has been removed. If you made the juice yourself, then you yourself threw out the good stuff. It’s the fruit that you want, so save yourself calories by eating fruit as opposed to consuming juice.
3. DO NOT eat while doing something else: reading, watching TV, playing games. Parents should make a conscious effort to serve meals at a table with little distractions. Ultimately, eating should be boring enough that you’d be happy to be done with it.
4. As much as possible, eat with family or friends. Their own intake will guide you subconsciously.
5. Know your foods!
a. The simplest factor to control is fat intake. Parents should know the fat content of every food that they and their children eat.
b. Write down everything you eat. Really. That will immediately destroy any illusion you might have that you are eating “not that much” but gaining weight anyway. For the first few days, add up your calories. When you realize how far over 2000 a day you are actually going, you will see room for improvement. After that, just count (and limit) fat. Try to stay under 20 grams a day of fat. In every meal, “simple” sugars and “complex” carbohydrates will be present. More complex carbs are released into the bloodstream slowly, and produce a smaller insulin spike. In any given meal, complex carbs should exceed sugars by at least five times, 10 times would be better.
6. a. For the purposes of weight control, there is very little difference between “good” and “bad” fat – but “good” fat is better for other health aspects such as cardiovascular health. Mammal fats (milk, cheese, butter, cream, bacon, beef) are the worst; fish (not seafood) fats are best; and plant fats vary (olive and canola are probably best). Try to make as much of your fat allowance as possible from the good fats – but sticking to good fats is no reason to go over that allowance.
b. Good (lowfat) meats are bison, ostrich, skinless turkey, skinless chicken breast.
c. Nuts and seeds tend to be high in fat, as are of course olives; avocado is the only “soft” vegetable that is high-fat. All other fruits and vegetables are acceptable.
d. Breads vary: some have more added fat than others; also, the higher the fiber content, the better. Fiber supports digestive health; it also produces the “filled” sensation that fights hunger longer.
These weight loss guidelines might be simple, but many efforts are often wasted when parents fail to consistently monitor progress over the long term. Visit your family pediatrician frequently, so that progress can be accurately measured. Your pediatrician can prescribe the best plan for you and your children, and put your family on the right track to healthy eating habits and successful weight control.
Dr. Anatoly Belilovsky is a leading New York pediatrician and director of the 365-day-a-year Belilovsky Pediatrics (www.belilovskypediatrics.com). Board-certified in pediatric medicine, the Princeton graduate is listed as one of America’s Top Pediatricians and is a recipient of the Americhoice Quality of Care Award for his groundbreaking work with pediatric asthma patients. Dr. Belilovsky received a B.A. in chemistry from Princeton University and his M.D. from the University of Connecticut. Before directing his own clinic, Dr. Belilovsky was Chief Pediatric Resident at Nassau University Medical Center and a Clinical Instructor of Pediatrics at Cornell University.