I am an expert fat person. I was a needle until age four. My mother blamed my burgeoning fatness on having had my tonsils removed-- which was what they did to most of us kids back then. They also gave a fair number of people thyroid cancer by radiating thymus glands. In hindsight, I tend to blame my burgeoning fatness on being old enough to get into the “refridgidair” (my Russian grandmother’s term) by myself. By early high school I was up to 230 pounds, not bad for someone only 5 feet 7 inches tall. Fortunately, my father didn’t believe in young people having cars so my only mode of transportation was my bicycle. The summer of my junior year in high school, I was all over metro Boston on that bike. I began the next school year at a svelte 170 pounds. Then appendicitis took me down to 150 pounds. (Too bad we only have one appendix.) Since then, with the trials and tribulations of life, I have been up and down in weight several times and it remains an ongoing battle. Weight control is an ongoing battle for all of us obesity-prone folks.

We fat folks are actually superior specimens of the species. Five thousand years ago, we would have been out tearing around catching dinner and dodging scary critters and other (perhaps scarier) humans. Our efficient metabolisms and drive to eat would keep us going for weeks without a big meal while our skinny friends were starving to death. This business with sedentary life styles and readily available food represents only the most recent, miniscule fraction of our existence on this planet. We were not designed for this. Take a wild chimpanzee and stick it in a zoo with unlimited food (and limited exercise) available and you will get a fat chimpanzee every time. We are- and will always be- products of nature. Unfortunately, since the decline of smoking and the increase in our girths, obesity has now become the number one preventable cause of premature morbidity and death in Americans.

The term “dieting” is a misnomer. Our diet is whatever we happen to be eating at the moment. Dieting is a synonym for eating. Controlling your weight requires more than just changing your food regimen; it requires a permanent change in lifestyle. Dieting and diets, in and of themselves, don’t work. “But I lost 50 pounds on that diet.” How much do you weigh now?-I might be inclined to reply. I will say this now and get it out of the way: All those diets out there, every last one of them, are all a load of crap. Yes, you can lose weight on any of them but weight loss is not the problem… weight control is. We fat people need to learn not how to diet but rather how to control our weight.

What we weigh is the sum of how much we eat and how much we burn. Burn more and/or eat less and your weight goes down. Burn less and/or eat more and your weight goes up. The numbers tell the entire story. First off, let’s get rid of this fear of the calorie.
“Calorie” in Latin means heat. A calorie is the amount of energy required to raise the temperature on one gram of water one degree Celsius. Your furnace is rated in BTUs (British thermal units). One BTU equals 251.996 calories. The calories we talk about in dieting are really kilocalories or the energy required to raise 1000 grams (1 liter) of water one degree Celsius. There are 3500 calories in one pound of fat. That is enough energy to raise the temperature of one liter of water 3500 degrees! Don’t forget that black stuff the Saudis are selling you is just aged animal fat. In order to lose one pound of fat you have to burn 3500 calories more then you eat. Your average sedentary male burns 2000 calories per day, female about 1600 calories per day. So, if we ate absolutely nothing we could not lose a pound of fat per day unless we did something to burn more energy. So much for all those diets promising a pound per day.
The dollar is the American unit of financial control. The calorie is the unit of weight control. The math is exactly the same for both topics.

In order to control your weight you have to know what your caloric balance is, how much you are eating and how much you are burning. First, let’s talk about eating. I don’t put people on diets. I get people to understand their own “diets”. The only requirement is to know how many calories you are eating. If the food isn’t labeled with calories per serving, the value can be obtained online or from a calorie counting book. Go to http://www.caloriecountercharts.com . After a short time your favorite foods will be committed to memory and you can just add things up as the day proceeds. For example, this morning I had my usual cup of coffee with Equal-- no calories there. For lunch I had a 350 calorie bowl of soup and a 100 calorie apple. For dinner I enjoyed two 400 calorie chicken legs, a 100 calorie baked potato with 120 calories of butter, broccoli for 25 calories and pineapple for another 100 calories. The total is 1595 calories. I never write anything down, although you can; I just keep a running tally in my head. Without exercise, I burn 2000 calories per day so I would have had a 405 calorie deficit today resulting in the loss of 1/8th of a pound of fat. But today I cycled 30 miles in just under two hours for an additional burn of 1800 calories for a total daily burn of 3800 calories, a deficit of 2205 calories, losing just over ½ pound.

Once you know the caloric value of food you begin to look at food differently. Spaghetti is ok but for 1000 calories per plate I would rather have a lamb rack. I don’t avoid spaghetti because I dislike it but because -for my taste- it just isn’t worth the calories. If you see two shirts at the department store that look absolutely identical but one costs $25.00 and the other costs $35.00, which one do you buy? American cheese runs about 100 calories per slice. Kraft Free American is 20 calories per slice. So you try the Free American. Maybe you like it; maybe you don’t. If you do, you just saved 160 calories per sandwich. I don’t put people on diets because I can’t tell them what they prefer to eat. All you have to do is shop by the calories and let your taste buds do the rest.

I like ice cream. Breyer’s Vanilla is 150 calories per ½ cup. No one I know eats ½ cup of ice cream. I eat 2 cups. So that’s 600 calories per serving. Eddy’s light Vanilla is 100 calories per ½ cup or 400 calories per a Dr Stein sized serving. I happen to think it is great ice cream so I am thrilled to save 200 calories every time I have a bowl. There are only two questions you need to ask about a given food. The first is: how many calories per serving is it? The second is: do I like it? NOTHING else matters.

The next topic is how many calories are you burning. This is way more important then what you are eating. Why you ask? The largest caloric deficit you can create in a day by dieting is between 1600 and 2300 calories per day depending on your gender and size. That is by eating absolutely NOTHING. You can’t eat fewer then zero calories and if you keep it up you will eventually get SERIOUSLY ill. On the other hand, it is perfectly possible to burn 5000 calories in a day exercising. In other words you can loose weight a lot faster by burning it off or, rather, it is much easier to control your weight with exercise then it is with diet alone. Many of us get fat as we get older not because we eat more but because we slow down. If you see a fat person who got skinny and stayed that way, you probably see an exercising fool.

It is still all about calories. Basal metabolic rates do vary to some degree but women can assume they burn 1600 calories per day and men can assume 2000 calories per day. To this we can add whatever we burn exercising. Unfortunately, getting to this number can be a little challenging. What we burn exercising depends on how long we exercise and how hard we exercise. I know that at my usual cycling pace I burn 800 calories per hour; if I am pushing hard about 1000 calories per hour. I know this from experience with using computerized indoor exercise machines. Many treadmills, exercycles, stairmasters, etc. will tell you how many calories you are burning and, with use, you get to learn how hard you have to work to burn so many calories. If you are an inexperienced exerciser the best way to start is by joining a club and calibrating yourself on these machines. You have to learn what it is like to burn X number of calories per hour and there is no other way I know of to do it other than buying one of these machines yourself.

The one universal trait that all indoor exercise devices seem to share is that they are all horrifically boring. Most people buy these things with good intention but the end result is usually a dusty machine and as fat a person as ever. Join the club—both literally and figuratively. Most will have it all figured out in a few months for much less then the dusty machine costs. THEN find some way to exercise that you enjoy. I cycle, both mountain and road. In the winter I cycle, cross country, and downhill ski. I used to run on occasion but my right knee will not tolerate that any more. Outdoor sports are far more enjoyable then indoor machines. The only important factor from a weight control perspective is the total number of calories burned. The three big calorie burners are cross-country skiing, cycling and running. All three are good for 1000 calories per hour if you are in good shape. Swimming is good for about 600 calories per hour and walking only about 300 and that is at a pretty good clip. It all depends on how fast you go for all these exercises. Walking can be as little as 100 calories per hour. Hiking up mountains can burn an easy 1000 calories per hour if you go fast. In the end, we all need to be committed to an average of at least one hour of aggressive aerobic activity daily.

Unfortunate Facts:
1) If you stop exercising you will get fat again
2) If you won’t exercise you are doomed to eating nothing or being fat for the rest of your life.
3) Humans won’t eat nothing. They can’t—and survive.

On the Bright side
1) Exercisers have 1/3rd the heart attack rate of non-exercisers.
2) Exercisers have lower all cause mortality (including cancer) than non-exercisers.
3) Exercisers appear to have lower rates of Alzheimer’s disease.
4) Exercisers maintain far more functional ability as they age.
5) Exercisers are more active sexually as they age ;-}

It is all a matter of balance. The more you exercise the more you can eat and “get away with”. I like to eat so I have to exercise a lot. Take one day at a time. I know when I get up and have a look at the weather how much exercise I will get that day. That tells me how many calories I have to spend. If I am in a weight loss mode, I shoot for at least a 1000 calorie deficit. So, if I know I will burn 3600 calories that day I won’t eat more then 2600. If the weather is bad and I won’t be riding that day I’m limited to eating 1000 calories. I hate those 1000 calorie days.

Every individual is different. Let’s say you are a 40 year old female who exercises by walking an hour on most days at 200 calories per hour. That means on days you walk you burn 1800 calories. Let us also assume you want to lose one pound per week. That means you want to create a deficit of 500 calories per day. So, on days you walk you do not want to eat more then 1300 calories. On days you don’t walk you are limited to 1100 calories. If you are at your goal weight you can then eat 1800 calories on days you walk and 1600 on days you do not walk.

DO NOT WEIGH YOURSELF DAILY. You can bounce 3 pounds of water around on a day to day basis and make yourself very frustrated. Step back and look at the big picture. Weigh yourself once monthly knowing that value is not absolute but + - 3 pounds. If you go up over the 3 pound tolerance limit then you fall back into weight loss mode until you beat it back. If you want to lose weight faster do not cut back on your eating; rather increase your exercise. If your intake falls below 2000 calories per day, you should be on a multivitamin which I recommend anyway. As for the low carb craze, I tell people to avoid products made with refined flower and sugar such as spaghetti and bread. These foods are calorie intense without much additional nutritional benefit. But to avoid all carbohydrates is unwarranted and eliminates many great nutritional sources of fiber, vitamins, minerals, etc. I also tell people not to eliminate all fat in their diet. A little fat slows gastric emptying keeping you full longer. The end result is that you eat less. On the other hand high fat foods have very high calorie content so you can’t get carried away.
Just pay attention to the calories and you can’t go wrong.

Dr Mike

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