Eat, Drink, and Be Healthy

by Walter Willett

  One likely reason the Mediterranean eating plan led to successful and long-term weight loss is that the participants reported being highly satisfied with the variety and flavors of their new way of eating and didn’t feel deprived.

  THREE STEPS TO WEIGHT CONTROL

  Given how easy it is to add a few pounds here and there, and the food temptations that bombard us, how can you avoid gaining weight or lose weight if you need to? I recommend this three-pronged strategy:

  1. If you aren’t physically active, get moving. If you are, try to be even more active.

  2. Find an eating strategy that works for you. Those offered in this book are a great place to start.

  3. Become a mindful and defensive eater.

  I wish I could give you a more precise set of instructions guaranteed to control weight. But I can’t—and I don’t think anyone else can, either. Chalk that up to the wonderful diversity of the human race. People are as unique as snowflakes. They come in different sizes and shapes, have different metabolisms, and like and dislike different tastes and textures. So no single weight-loss strategy can work for everyone. You need to find what works for you and stick with it using a scale and your waist size as guides.

  What I can do is suggest different strategies that have worked for others and that may work for you.

  1. Get Moving

  Although I have focused on the intake side of the energy balance equation so far, the expenditure side is critically important.

  Exercise counts most toward good health. Exercise is essential to getting healthy or staying healthy and keeping chronic diseases at bay. Exercise is far more than merely a way to lose or control weight. Regular physical activity:21

  • improves your odds of living longer and living healthier

  • helps protect you from developing heart disease or its handmaidens, high blood pressure and high cholesterol

  • helps protect you from developing certain cancers, including colon and breast cancer

  • helps prevent type 2 diabetes

  • helps prevent arthritis and may help relieve pain and stiffness in people with it

  • helps prevent the insidious bone loss known as osteoporosis

  • reduces the risk of falling among older adults

  • eases symptoms of depression and anxiety and improves mood

  • helps prevent erectile dysfunction

  • controls weight.

  Build muscle, burn fat. Physical activity burns calories that would otherwise end up stored in fat. It also builds muscle or at least maintains it, an often ignored but absolutely essential ingredient in weight control.

  Even when you are sleeping, your muscles are constantly using energy. When you walk, run, swim, lift weights, dance, play tennis, clean the house, or do anything active, your muscles burn even more calories. Physical activity stimulates muscle cells to grow and divide, prompting them to grow in strength and size. The more muscle you have, the more calories you burn, even at rest.

  Without exercise, fat replaces muscle. If you don’t exercise, your muscles gradually waste away. It’s the same kind of atrophy that occurs when you wear a cast on an arm or leg only stretched out over years rather than weeks, so it’s impossible to feel or see. The less muscle you have, the less energy your body uses at rest and the easier it is to gain weight. To make matters worse, lost muscle is usually replaced by fat (see Figure 11). This starts a vicious and tough-to-break cycle. For a fifty-year-old person who isn’t physically active, a 10-pound weight gain over the years may really mean a loss of 5 pounds of muscle and gain of 15 pounds of fat.

  Unlike muscle, fat uses little glucose and burns few calories. As the balance between muscle and fat shifts further and further in favor of fat, resting metabolism slows even more. And as the body needs less and less energy to take care of its basic needs, more and more food goes into fat stores. The extra weight can also act as a physical or mental barrier to activity, which further reduces resting metabolism. In other words, the shift from muscle to fat makes it easier to gain weight, makes it harder to maintain your weight, and increases your risk of heart disease and diabetes.

  A colleague of mine once saw her physician for one of those “big birthday” physical exams. Everything was fine, with one exception: her blood pressure was too high. When her doctor told her she needed to lose 30 pounds or so to get her pressure under control, she shot back, “Where were you when I was putting on those pounds?” It’s a great question. The physical and physiological changes wrought by decreased muscle mass and increased weight are tough to reverse and in some cases may be irreversible.

  Ounces of prevention are better than pounds of cure. It is easier to prevent weight gain than it is to lose weight. In fact, gaining weight makes your body more receptive to future weight gain and makes getting rid of extra pounds doubly difficult. To make matters worse, some of the effects of excess weight, such as diabetes, heart disease, or stroke, may not fully disappear even with successful weight loss.

  Figure 11. Age-Related Changes in the Absence of Physical Activity. Total weight, the amount of muscle and fat, and the number of calories the body burns at rest tend to change with age (assuming no increase in physical activity). Muscle mass declines, owing to decreased production of sex and growth hormones. Less muscle mass means the body uses less energy at rest and accumulates more fat. An increase in physical activity can break this vicious cycle.

  The two big questions about exercise are these: How much exercise do we need each day? And what is the best kind of exercise?

  Walk for health. Experts once thought that we needed vigorous exercise to keep the heart and circulatory system in shape. Not so. Brisk walking offers many of the same benefits as sweating it out in a noisy gym or jogging through your neighborhood.

  For many people, walking is an excellent type of physical activity because it doesn’t require any special equipment, can be done anytime and anyplace, and is generally quite safe. More vigorous exercise, such as running or bicycling, lets you pack the same cardiovascular workout into a shorter period and also gives you a higher level of physical fitness. Although activities more vigorous than brisk walking may provide some added benefits, you can achieve much in the way of chronic disease prevention with a good daily walk.

  Among women participating in the Nurses’ Health Study, there is a very strong link between walking and protection against heart disease: women who walked an average of three hours a week at a brisk pace were 35 percent less likely to have had a heart attack over an eight-year period than women who walked infrequently.22 Vigorous exercise offered similar protection. Brisk walking also substantially cut the risk of diabetes; more vigorous exercise was associated with an even lower risk.

  Exercise at least thirty minutes a day. You need to intentionally burn at least 2,000 calories a week to truly reap the benefits of physical activity. That’s a difficult number to calculate. Most recommendations translate this into time: thirty minutes of physical activity on most, if not all, days of the week. There is no question that this much activity is far better than inactivity.

  Fast Fact: What, Exactly, Is “Brisk?”

  * * *

  The pace described as “brisk” means walking quickly enough so your heartbeat and breathing speed up, but not so fast that you can’t carry on a normal conversation. It’s moving as if you were late for an important meeting. If you are a counter or measurer, brisk walking is taking around one hundred steps a minute or walking at a clip of three to four miles per hour.

  But thirty minutes of activity a day isn’t much when you think about how active our farmer or laborer forefathers and foremothers were. Even someone who runs five miles a day usually sits for most of his or her other waking hours. So consider thirty minutes of physical activity as a daily minimum for maintaining your health and weight. And keep in mind that most people will benefit from more.

  A word of caution here: The intensity of your activity also matters. Sauntering through the mall for f
ifteen minutes beats sitting—and it may help your bones and mood—but it won’t do much for your heart, lungs, and blood vessels. For an activity to help your cardiovascular system, it must speed up your heartbeat and your breathing. Think brisk.

  Quit sitting around. The average American spends more than half of his or her day sitting: working at a computer, commuting, watching television, or doing other in-activities. All that sitting isn’t good for the body. A 2015 meta-analysis of forty-seven studies that included more than 800,000 participants showed that the longer people sat, the greater their risk for dying during the study period or developing cardiovascular disease, cancer, and type 2 diabetes.23 That was true even for people who exercised regularly. If you sit much of the day, find ways to get up and move about. Pace while you are talking on the phone or when commercials are playing on television. Make a point of standing and walking around every hour you spend sitting. Or try working at a standing desk.

  Make your day more active. There are many ways to inject more activity into your day. Some people choose to live close enough to their jobs so they can walk, run, or ride a bike to work. Not only does self-propelled commuting improve your health, it makes a small contribution to others’ health by cutting down on traffic congestion and air pollution. Restructuring your day can add small “activity bits” that add up. Possibilities include walking up the stairs at work instead of taking the elevator; parking in a far corner of the lot and walking to your building; getting off your train or bus a stop or two early and walking the rest of the way; using a rake for leaves or a shovel for snow rather than a leaf or snow blower.

  Have fun. Many people turn walking into a social activity, a chance to touch base with a partner or friends several times a week. Others enjoy the challenge of learning new skills, like rowing or tennis, and pushing themselves to improve. If you make exercise a fun priority, you’ll find a way to fit in thirty minutes of activity a day, either in one long stretch or in several small bursts. It might help to consider this outlay of time as a solid investment that will offer an excellent return for your long-term health and the well-being of those who depend on you.

  2. Find a Diet that Works for You

  If your weight has been holding steady in the healthy range, you are clearly doing many of the right things as far as the amount of food you are eating. Even so, you can probably fine-tune your diet so it’s even healthier. The Healthy Eating Pyramid and Healthy Eating Plate, and information in the following chapters, can help you choose the right foods to further improve your health.

  Figure 12. A Big Spread. Individual responses to a year of dieting vary widely. In one controlled trial, people lost—and gained—weight on both low-carb and low-fat diets.

  But if your weight has been creeping upward or if you are already overweight, a new direction is in order. Its compass points are eating fewer calories and burning more of them. Many people get lost. Some ignore exercise, a crucial part of losing weight and keeping it off. Others are overwhelmed by the legions of diets and diet books, have trouble following a particular diet, or try one and it doesn’t work. That’s too bad, because there’s a way for almost everyone to lose weight or at least stop gaining weight.

  A diet must work for you. One finding buried in the data from diet trials is that individuals respond differently to weight-loss strategies. Take low-carb diets as an example. Overall, low-carb dieters lose an average of 10 to 15 pounds over the first year of dieting. That average hides what really happens to each individual. Some lose more than 25 pounds, some see smaller changes in weight, others don’t lose any weight at all, and a few gain weight. These differences, which are probably due to a combination of genetic, environmental, and psychological or social factors, are actually good news. It shows that there is a route for just about everyone who wants to lose weight. Individual differences are one reason why this book doesn’t define healthy eating by a rigid breakdown of calories into percentages from protein, carbohydrate, and fat. Instead, we provide a variety of information to help you find the best program for you.

  If you are one of the lucky folks who have successfully controlled weight with the first diet you tried, thank your genes, your psyche, and your family. But if you try a diet and it doesn’t work, don’t give up! It may not have been right for your metabolism, eating habits, or social situation. Experiment with other weight control strategies as long as they emphasize healthy sources of fat, carbohydrate, and protein and include regular physical activity. You should be able to find the one that’s right for you.

  Diets low in refined carbohydrates often work best. For years we’ve been hearing that low-fat diets rich in carbohydrates are the best route to weight loss and improved cardiovascular fitness. For many people, probably most people, just the opposite is true. As I describe in chapter six, only people who are lean and active can tolerate a lot of carbohydrates. For others, too many carbohydrates promote weight gain.

  The Atkins, South Beach, Dukan, and other low-carb diets ask you to take drastic measures, at least at first, and stop eating virtually all carbohydrates. As long as you aren’t gobbling no- or low-carb foods packed with saturated and trans fats, limiting or eliminating refined carbohydrates is a good step to take. Keep in mind, though, that “crash” diets overemphasize short-term weight loss when the real goal should be finding a healthy eating pattern that can help you control your weight for years. The strategies described in this book are aimed at exactly that.

  Giving up refined carbohydrates in favor of whole grains, vegetables, fruits, and healthy sources of protein and fat will reduce the spikes of glucose and insulin that provoke hunger while also supplying important vitamins, minerals, fiber, and other phytonutrients. Making that switch can also reduce your chances of developing high blood pressure, type 2 diabetes, or heart disease. Cutting out trans fats, cutting back on saturated fats, and getting more monounsaturated and polyunsaturated fats can improve your cholesterol levels, prevent blood clots, allow your arteries to work more effectively, and boost your muscles’ response to insulin. Not eating red and processed meats and eating in their place fish, nuts, beans, and poultry will reduce the risks for colon cancer, prostate cancer, premenopausal breast cancer, diabetes, and heart disease, even if the total amount of fat you are eating remains high.

  Choose a healthy global diet. An eating plan that borrows heavily from the Mediterranean and other traditional diets offers a healthy nutritional foundation. Plenty of vegetables, moderate amounts of intact and whole grains, and relatively little red meat can help you feel satisfied on fewer calories. The abundance of vegetables and whole grains, as well as the relatively high percentage of fat (30 percent or more of calories, mainly from olive and other vegetable oils), make for mild effects on blood sugar. Just as important, these kinds of diets are open to creative interpretation. You can incorporate cuisines from around the world, as well as your own creations, into an eating pattern with enough variety and pleasure to last a lifetime.

  3. Practice Defensive Eating

  Most people in our relatively sedentary society need to watch their calories as they age to avoid gaining weight. This involves more than just selecting certain types of foods or a particular kind of diet. It also means learning how to avoid overeating, which I call defensive eating. Here are some suggestions that can help you be a defensive eater:

  Practice stopping before you are stuffed. Recognize that we are victims of our culture, one that glorifies excess.

  Be selective. Don’t eat just because food is put in front of you.

  Choose small portions when eating out. Restaurant portions are often oversized and a single meal can deliver a whole day’s worth of calories. Think about sharing entrées, or order two appetizers instead of an entrée.

  Slow down and pay attention to your food when you eat. When you wolf down food, you effectively bypass the intricate set of I’m full signals that your digestive system is designed to generate. Eating at a moderate pace gives your stomach and intestines time t
o send these messages to your brain and for your brain to respond to them.

  Beware of desserts. A single slice of the Cheesecake Factory’s Original cheesecake packs more than 700 calories and an incredible 29 grams of saturated fat, or nearly 50 percent more than the average person should take in each day. And that’s one of the better choices: a serving of the carrot cake has twice as many calories (1,550) and just as much saturated fat. Many people consume calorie-laden desserts after eating an entire meal. If you want to order a rich dessert, share it with your dining companions. Better yet, have a healthy meal and finish it off with a piece of fruit or what I call the three pleasures: a few nuts, some fruit, and a bit of dark chocolate (see page 374).

  Be creative with lower-calorie options to show you really care. Don’t love your family and friends to death with calories they don’t need.

  Spoil your appetite. Have a snack, appetizer, or nibble of dark chocolate before eating a meal. Remember the dreaded line “It will spoil your dinner!” that your mother used to utter when you asked for a cookie or some popcorn late in the afternoon? She was right (of course). Use this principle to your advantage.

  Minimize temptation. Many of us find it hard to ignore sweet chocolates, cookies, chips, ice cream, or other goodies when they are sitting on a shelf or in the refrigerator. Out of sight doesn’t necessarily mean out of mind. Keeping calorie-laden snacks out of your home offers a much better deterrent. In their place, keep on hand a supply of low-calorie snacks such as apples, carrots, or whole-grain crackers for when you really want to munch on something.