A weight loss program that’s different

lthough each individual’s weight loss goal is different, the aim of treatment remains the same – to improve your health and quality of life. Here are four reasons why the medical weight management program at Houston Methodist will help you reach your goal.

1. What is medical weight management? Why is it better for me?  

Medical weight management is a physician-supervised weight loss program that allows patients with a BMI of 30 or above to safely and rapidly lose excess weight through a very low calorie diet (low carbohydrate/high protein).  

Shenese lost 105 lbs. with the help of the Houston Methodist Weight Management Center.
Shenese lost 105 lbs. with the help of the Houston Methodist Weight Management Center.

Prior to entry, a physician will review a patient’s detailed history, physical, blood work and electrocardiogram (measures heart’s electrical activity) to ensure that it is safe for them to be in the program. Thereafter, a physician will adjust the patient’s prescription medications for safety, address diet related symptoms, review monthly blood work and ECGs with every 50 pounds of weight loss to ensure continued safety. The physician will monitor medical safety as part of the comprehensive team approach to weight loss that includes weekly nurse, dietitian and counselor visits. 

2. Why is it important that I see a medical weight loss or obesity specialist?

An obesity medicine physician completed additional education, training and testing to become board certified in weight loss medicine. Certification as a Diplomate of the American Board of Obesity Medicine (ABOM) signifies excellence in the practice of obesity medicine and distinguishes a physician as having achieved a high level of competency and understanding in obesity care.  Only about 1500 physicians in the U.S. and Canada have completed the process to become board certified in obesity medicine by the American Board of Obesity Medicine. 

3. How long will it take for me to lose weight? How much weight will I lose? 

Typically, patients in the first phase of our rapid medical weight loss program, called New Beginnings, can expect to lose two to five pounds per week. Patients most often stay in this program until they achieve a reasonable goal weight. However, some may choose to enter the transition phase, called My Journey, before their goal weight is achieved, and can expect to lose one to two pounds per week, depending on the plan they choose with the dietitian.  

4. I’ve tried a lot of programs, why is this one different? How will I ensure that I am successful at this?

Numerous studies have shown that successful weight loss, and maintenance of weight loss, is best achieved through a comprehensive multidisciplinary approach that addresses the medical, nutritional, behavioral and physical activity contributors to excess weight. Through adherence to the rapid medical weight loss program, patients will achieve significant weight loss through scientifically proven methods.  However, our ultimate goal is to help patients maintain the weight loss for the rest of their lives by providing the education, support and tools necessary to sustain their new healthy lifestyle. 

Learn more about your weight loss options at our open house events. Join an open house event at one of our Houston area hospitals. Learn about your weight loss options and enjoy a healthy cooking demonstration. Attendance is free; however, registration is required.

Learn more about the Weight Management Center and the programs it offers.

Don’t be fooled by fat-free foods

It’s been said that the best things in life are free. Many people think when they see fat-free foods that they have hit the jackpot. They can eat as much as they want because the item contains no fat.

Unfortunately, foods labeled fat free, reduced fat, low fat or sugar free do not equate with calorie-free and are contain additives like salt, sugar and chemical fillers that make them less than healthy.

If you want to keep off unwanted pounds, you need to look beyond the claims on the front of the package and take a critical eye to the nutrition label and ingredients. Labeling a food item fat free is a classic bait-and-switch marketing strategy the food industry uses to try and get consumers to forget about the calories.

Kari Kooi, RD, LD, with Houston Methodist Wellness Services, says reduced-fat products often contain the exact number of calories per serving as full-fat versions.

Reduced-fat foods have a perceived healthy image that researchers have dubbed a “health halo.” Studies have shown that people tend to eat twice as much or more of these foods.

Nutrition facts
Don’t just look at fat content. You need to also pay attention to serving size and other macronutrients such as carbohydrates.

Manufacturers often set the serving size for packaged foods to be unrealistically small (a serving size of Oreos is three cookies, ha!), so it’s important to look at the number of servings per container.

For example, chips and drinks offered at the checkout lane in the grocery store appear to have one serving, but often times have two or more.

Instead of looking for products with health claims such a low fat, Kooi suggests concentrating on eating healthy fats from whole foods such as nuts, olive oil and avocados. Monounsaturated fats found in these foods have been shown to lower LDL or bad cholesterol and boost HDL or good cholesterol in the blood.

Omega-3 fats in oily fish such as salmon and anchovies also have been shown to lower LDL. She says that fat plays a strong role in feeling satisfied after eating, thereby helping with appetite control and should make up at least 30% of our daily calories.

She also recommends avoiding trans fats as much as possible as it promotes inflammation in the body. Products that contain partially hydrogenated oil in the ingredients list have trans fat.

When it comes to sugar free, it’s extremely important for people with diabetes to be smart label readers. Sugar is a carbohydrate and foods such as sugar-free cookies or candy are not free of carbohydrates. A person with diabetes may be unintentionally consuming large amounts of carbohydrates, which could lead to increased blood glucose levels.

The best way for all of us to avoid being fooled by reduced fat and sugar-free labels and putting on those unwanted pounds is to shop for nutrient-dense foods that don’t come in a package and therefore require no labeling.

Making the traditional tamale healthier

or many households of Mexican descent in the United States, the weeks following Thanksgiving aren’t only about wrapping gifts but also about wrapping tamales. The savory treats – traditionally prepared with generous amounts of lard and lots of salt – don’t have to be unhealthy. 

talames-recipeFor those unfamiliar with the delicacy, a tamale is made with seasoned, cooked pork surrounded by cornmeal, or masa, encased in a corn husk (or banana leaf). It is then steam cooked. Tamale recipes can vary greatly with the only mainstays being the masa shell and the husk. Unfortunately for those who enjoy tamales, they are often not very healthy.

“My grandmother would use an entire carton of lard when preparing the masa. The amount of salt is also extensive as salt is often added to the meat as well as the masa,” said Jennifer Pascoe, a registered nurse in the Houston Methodist Hospital Weight Management Center, who educates patients on how to eat healthier and maintain special diets. “Salt should be limited in all diets especially those with diabetes, hypertension, and congestive heart failure. The recommendation is to not exceed 2 grams per day.”

According to the American Heart Association (AHA), heart disease is the leading cause of death for Americans. Latino populations face even higher risks of heart disease as a result of their preponderance for obesity, high blood pressure, and diabetes.

There are many substitutions that can be made to make the traditional tamale healthier, according to Pascoe. In addition, you can use a healthier recipe for tamales.

“For starters you can buy a leaner cut of pork or at the very least trim the fat off the meat before cooking, and then make sure you drain the fat off the meat before preparing the mixture,” Pascoe said.

Here are more tips for healthier tamales:

  • Replace the pork with a healthier alternative such as ground or shredded white chicken or turkey meat, beans or vegetables. Popular vegetarian tamale recipes call for cooked vegetables such as serrano peppers or spinach, black or pinto beans, and low-fat cheeses.
  • Replace lard or vegetable shortening with vegetable oil.
  • Replace the pork drippings some people use to flavor the masa with chili powder since it’s the chili powder that gives the pork drippings some of its flavor.

Pascoe said the biggest challenge to removing the lard or vegetable shortening in the mixture will be spreading the masa on the corn leafs, which will take more time and patience but will be worth the fat and calories saved.

“If you know you have high blood pressure or diabetes, you probably shouldn’t eat traditional tamales,” Pascoe said. “For these people I would recommend preparing a dozen or so healthy tamales, which use all of our healthy substitutions.”

And everyone should limit the amount of tamales they eat regardless of how they’re prepared.

Healthier Chicken Tamales
Yields 16
A healthier version of the traditional chicken tamale
Write a review
Print
253 calories
26 g
60 g
5 g
25 g
1 g
216 g
358 g
2 g
0 g
4 g
Nutrition Facts
Serving Size
216g
Yields
16
Amount Per Serving
Calories 253
Calories from Fat 46
% Daily Value *
Total Fat 5g
8%
Saturated Fat 1g
5%
Trans Fat 0g
Polyunsaturated Fat 2g
Monounsaturated Fat 2g
Cholesterol 60mg
20%
Sodium 358mg
15%
Total Carbohydrates 26g
9%
Dietary Fiber 3g
12%
Sugars 2g
Protein 25g
Vitamin A
12%
Vitamin C
22%
Calcium
4%
Iron
11%
* Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs.
Ingredients
  1. Filling
  2. 2.5 pounds chicken breasts
  3. 3.5 cups water (or enough to cover chicken in pot)
  4. 1 teaspoon canola oil
  5. 1 medium onion
  6. 1 medium bell pepper
  7. 3 garlic cloves
  8. 1 tomato
  9. 2 teaspoons cumin
  10. 2 teaspoons dried chili peppers, crushed
  11. 1 teaspoon low-sodium salt
  12. 1/2 teaspoon black pepper
  13. 1/2 cup tomato paste
  14. Masa
  15. 4 cups masa corn flour
  16. 4 teaspoons canola oil
  17. 1 teaspoon baking powder
  18. 2 teaspoons chili powder
  19. 1/2 teaspoon low-sodium salt
  20. 2 cups chicken broth (reserved from cooking the chicken)
  21. 18 to 20 dried corn husks
Instructions
  1. Place the chicken breasts in a pot and add enough water to cover them. Bring pot to a low boil. Cover and simmer for 20 minutes until the meat is cooked.
  2. Remove chicken from the broth (set broth aside) and let it cool. When the chicken is cool enough to handle, shred it and chop. You may add a little broth to keep it moist.
  3. Heat the canola oil in a large skillet and sauté the onion, garlic and peppers until tender. Add the tomato, chili peppers, pepper, cumin, and low-sodium salt. Add tomato paste and 1/2 cup of the chicken broth and simmer for about 15 minutes. Stir the mixture as needed.
  4. Puree the sauce in a food processor or blender and return it to the pan. Add the shredded chicken, stir and let the mixture simmer for 10 to 15 minutes on low heat. Allow to cool.
  5. Soak the corn husks in a large bowl of hot water for about 20 minutes. Make sure they are pliable.
  6. Prepare the masa mixture by combining all ingredients and mixing until the mixture clumps together. Add broth as necessary to make the masa pliable. Turn on to a lightly floured surface and knead lightly for a minute. Divide the masa mixture into 16 equal balls.
  7. Drain and rinse the corn husks. Pat dry and keep covered with a warm damp towel. Tear two or three corn husks into 1/4 inch strips to use for ties. You will need 16 corn husks for the tamales.
  8. Flatten the corn husk on a flat surface. With a spoon or spatula spread one ball of dough over the husk leaving about a 1-inch margin on all sides. You may add a few tablespoons of warm chicken broth to the masa to make it more pliable and easier to spread. Add about 2 or 3 tablespoons of filling to the center. Roll up lengthwise into a cylinder and wrap with the corn husk. Secure the ends by tying with a strip of husk. Repeat with remaining dough, filling the remaining husks. You may freeze the tamales to cook at a later date or steam cook immediately.
  9. Place the tamales in a steamer basket and set over one inch of boiling water. Cover tightly and reduce heat. Steam the tamales between 30 to 45 minutes until cooked. Check frequently and replenish water as needed. Frozen tamales should be thawed for at least one hour and will require a longer cook time.
beta
calories
253
fat
5g
protein
25g
carbs
26g
more
Healthy Knowledge http://blog.houstonmethodist.org/

The limitations of body mass index (BMI)

 166608586A few days ago a friend on Facebook reposted a cartoon of a woman declaring that according to the BMI chart, she was too short. For those who aren’t familiar, Body Mass Index, or BMI, is a simple measurement tool used to calculate height-to-weight ratio.

Some people argue that BMI is too simple a measurement. Is BMI still useful for someone concerned about their weight?

“It can be helpful as one factor to consider in determining chronic disease risk in the general population,” explained Chelsea VanDusen, a clinical dietitian at Houston Methodist Hospital.

She explained that other factors such as age, gender, past medical history, family history and lifestyle factors including diet, smoking and physical activity levels all play a part in helping to determine risk and must all be considered in order to have an accurate picture.

The limitation of BMI as Chelsea explained it is that it’s intended as a “measure of fatness” but doesn’t actually take body fat percentage into account. “It’s therefore skewed in individuals who are highly muscular or those who have muscle wasting,” she said.

For example, a bodybuilder – whose weight may be higher than normal due to increased muscle mass – may appear obese according to his BMI number. In comparison, an elderly person’s BMI number may appear in the healthy range (<27) even though they’ve had significant muscle loss.

166596238“In fact, elderly people may have increased mortality risk with a BMI of less than 22, whereas that is considered in the ‘healthy range’ for younger adults,” Chelsea said.

Another limitation of BMI is the fact that it does not differ between men and women even though men tend to have larger frames in addition to a more muscular build. So even though a man and a woman may have the same BMI, the woman would likely have a higher percentage of body fat than the male.

BMI also doesn’t take fat distribution into account.  For example, a person’s waist circumference can be used to determine their amount of visceral fat, which is located around vital internal organs and is often associated with increased levels of inflammation and chronic disease risk.

Why do people continue to use BMI as a measurement to determine how healthy someone is?

“While other measures of body fat including waist measurement, skin-fold measurements and bioelectrical impedance are useful, they tend to be more expensive, intrusive and/or difficult to standardize due to human error,” Chelsea explained.  “Therefore, BMI continues to be widely used.”

Regardless of your BMI number, remember – it’s only one piece of the puzzle. And unless you’re planning on growing a few more inches, the best way to reduce it is by eating better and getting some exercise

Want to see what your BMI is? Try the calculator below:

The meal frequency myth

“Eating five to six mini meals a day … keeps your metabolism humming 24/7,” proclaims a Redbook article. “Have a small meal or snack every 3 to 4 hours keeps your metabolism cranking,” notes a WebMD slideshow

You’ve probably heard similar statements—all based on the assumption that food grazing increases your basal metabolic rate (BMR) or the number of calories used in a day, leading to more fat loss.

Is there any truth to this? Are six meals a day better than three? And what about fasting? Does skipping meals negatively impact your health?

Deconstructing the metabolic fire analogy

Advocates of increased meal frequency usually compare BMR to a fire. If you think of a fire, the fuel is wood and when wood is thrown on an existing fire, more fire is produced, throwing off heat.

If you apply this analogy to people, the wood is calories from food and the reaction that produces heat is the thermic effect of food (TEF), which is the amount of energy your body has to expend to process food for storage and use.

Take a look at the chart below the bulleted list. It compares TEF for three people who eat the same amount of calories and macronutrients (fats, carbohydrates and protein):

  • One eats six meals a day (breakfast, a mid-morning snack, lunch, an afternoon snack, dinner and an evening snack)
  • One eats the traditional three meals a day (breakfast, lunch and dinner)
  • One eats only two meals a day (breakfast and dinner)
Screenshot_061
This chart compares the thermic effect of food (TEF) during a day for three people who eat the same amount of calories and macronutrients, but eat in different patterns.

While the TEF spike duration and frequency is different, the total amount of TEF for all three individuals is identical. This means the amount of calories used in a day is the same, regardless of meal frequency.

Research confirms this: Studies in both 1997 and 2010 noted as long the total amount of food eaten is the same, you can gorge or nibble—neither approach promotes more or less weight loss than the other.

Returning to the fire analogy, eating less but more frequently is like continually throwing kindling on the fire all day long whereas eating more in a sitting (but less frequently) is like throwing a big log on the fire.

What about fasting?

Many are fearful to skip meals because they hear that fasting lowers your BMR, putting your body into starvation mode.

This is oversimplified and inaccurate. It may be true that fasting decreases your BMR, but with one big caveat: It takes over three days of fasting to accomplish this.

In fact, researchers have found that short-term fasting actually increases the amount of calories you burn while at rest and doesn’t affect cognitive performance, activity, sleep or mood.

Could fewer meals be better for you?

A lot of recent research has come out in favor of eating less frequently. For example, a 2014 study found that frequent snacking might stress the liver, leading to a greater risk of fatty liver disease.  

Fasting for short periods of time has been found to have the following health benefits:

And lowers the risk of:

Eat the way that works for you

There’s no reason to stress out about meal frequency. If you find it easier to make healthy food choices by eating a couple of meals a day and a snack or two, then stick to that. If you like to spend more of the day fasting so you can enjoy larger meals and because it suits your schedule, then stay with that approach.

When it comes to weight loss, overall calories matter more than meal frequency, so always keep an eye on your portions. If you have issues with blood sugar control, work with your doctor to figure out a meal schedule that works for you. 

Reviewed by Kristen Kizer, R.D.

Decoding type 2 diabetes

Type 2 diabetes is the most common form of diabetes. The disease often develops in stages, starting as prediabetes or insulin resistance. People with prediabetes have elevated blood glucose (sugar), but it isn’t high enough to be classified as diabetes.

Diabetics tend to have too much glucose circulating in their blood, which, if left unregulated, can lead to blindness, heart attacks, stroke, nerve damage, amputations and even death. Unlike type 1 diabetes, people with type 2 diabetes can still make insulin, but they develop insulin resistance. That means that the body doesn’t properly use the insulin hormone that the pancreas produces, which leads to it making more insulin.

Insulin helps the cells absorb glucose so that they can use it for energy. As the process of producing more and more insulin continues, the pancreas is unable to meet the demand as the blood glucose levels remains too high and type 2 diabetes occurs. In some instances, the cells that produce the insulin become severely impaired or destroyed and the diabetic requires insulin to help regulate blood glucose.

Blood Glucose 101

With medication and monitoring, diabetics attempt a delicate balancing act to keep their blood glucose within the normal range. If their blood glucose is too low, it can lead to injuries, coma and even death. The symptoms of low blood glucose happen quickly and can include symptoms such as shakiness, confusion, unconsciousness or dizziness. If their blood glucose is too high, then its more devastating effects usually occur over prolonged periods of time, but immediate symptoms include excessive thirst and frequent urination.

Below are the target blood glucose levels for diabetics:

  • Fasting: 70–120 mg/dl
  • After meals (1-2 hours): Less than 140 mg/dl

Are you at risk?

According to the American Diabetes Association, 25.8 million Americans have diabetes. Of that number, there are 7 million people with the disease who are undiagnosed. In addition, there are a staggering 79 million people with prediabetes.

If this trend continues, by 2050, 1 in 3 Americans will have diabetes. One of the biggest contributing factors is the rise in obesity. If you have one or more of the following risk factors, talk to your doctor about testing and prevention:

  • Age 45 or older
  • Overweight
  • Physically inactive
  • High blood pressure or cholesterol
  • Parent or sibling with type 2 diabetes
  • Had gestational diabetes
  • Have prediabetes
  • African-American, Alaska Native, Native American, Asian-American, Hispanic or Pacific Islander
  • Have polycystic ovary syndrome
  • Dark velvety hyper pigmented skin around the neck or armpits

Take control

If you suspect that you have diabetes, schedule a doctor’s appointment to check your blood glucose and to test your hemoglobin A1c, which will give you an idea of your blood glucose levels over the last three months.

“You also want to ask your doctor to check your cholesterol and blood pressure, as these risk factors many times cluster together, especially in overweight individuals,” said Dr. Manisha Chandalia, an endocrinologist at Houston Methodist San Jacinto Hospital.

If you have diabetes, check your blood regularly and consider enrolling in the Houston Methodist Diabetes Education Program.

Type-2-diabetes-infographic

Reviewed by Dr. Manisha Chandalia


Weight loss: a challenging journey

Lies. All lies. Whatever the number says on the scale can’t be right. At least, that’s what I tell myself. But my clothes are telling a different story. Getting dressed in the morning has been more like forcing toothpaste back into the tube. I suck it all in and pray that I will be able to zip up my pants.

I was doing so well after I had my gastric bypass. I was eating right and I was trying to move more despite arthritis and chronic pain. All of my progress got derailed last year with an unexpected health crisis. After that, everything fell apart. As I recovered, I didn’t just fall off the wagon; I jumped head first into emotional eating and back to my sugar addiction. Before I knew what happened, I picked up 30-plus of the 100 pounds I lost.

Weight loss isn’t easy. I know that is an understatement, but it’s true. Unlike a drug addiction, with food, you can’t live without the thing you are addicted to. It doesn’t help that all of the foods that are bad for you taste so good. Part of the problem is behavioral. I fell back into old habits when I was presented with a difficult challenge in my life.

In 2009, I had the roux-en-y gastric bypass at Houston Methodist Hospital. I truly believe it saved my life. At the time, I was 36 and plagued with a bunch health issues, including prediabetes, high blood pressure, sleep apnea, metabolic syndrome, osteoarthritis and polycystic ovary syndrome.

I went through the classes at the Weight Management Center. The instructors reminded me that bariatric surgery is a tool and that it requires lifestyle changes and ongoing support.

sheshe
Sheshe lost 100 pounds as a result of her gastric bypass surgery, diet and lifestyle habits.

I made many changes, but I chose to disregard key components, such as support. Each month, I get an email from the Weight Management Center about their meetings, but I only attended a few. I didn’t believe I needed the support because I didn’t believe that I had a problem. But then last year happened, and after I recovered from my month-long hospital stay, all will power vanished. I should have attended meetings and made an appointment with a dietitian to help get me back on track. I didn’t.

30-something pounds later and a bunch of clothes that no longer fit, I have to ask, “How well is going at it alone working for me?” I know the answer: It’s not.

“What am I going to do about it?” I’ve made an appointment with a dietitian to create a meal plan and deal with my emotional eating. The hard part will be giving up sugar all over again. I’ll also attend meetings and look into joining a support group.

I have a lot of hard work ahead. The improvements in my health and quality of life have been significant, which is motivation enough for me to acknowledge that the scale hasn’t been lying.

The Weight Management Center at the Houston Methodist Diabetes & Metabolism Institute offers treatment, services and support for the various stages of the weight loss journey. The center’s specialized programs include a medical weight management program; Step LITE, a moderate weight loss program; medical nutrition consultation; diabetes education program and weight loss surgery.

The center has locations in the Texas Medical Center, Sugar Land, Willowbrook/Northwest Houston and West Houston/Katy. To take the next step in achieving your weight loss goals, register for a free orientation session or visit houstonmethodist.org/weight-loss.

Weight loss: there’s an app for that

“I will start tomorrow” was a common phrase for me. I uttered it every day, usually as I was eating a Pop Tart or a bowl of pretzels or handful after handful of Wheat Thins.

Weight loss was just one of those things that I would get to … eventually. But as the years went by, I watched my weight continue to rise. I always vowed that I never wanted to weigh “240,” so whenever I would get within a few pounds, I would exercise or lay off the sweets for a day or two, lose a couple of pounds and breathe a sigh of relief.

On February 20, 2014, I stepped on the scale and it said “239.8,” not the dreaded “240,” but about as close as you can get. I knew it was time for a change. I was tired all the time, I had low self-esteem and I knew that 240 would eventually become 250 and it would just keep going up if I didn’t do something now.

A couple of weeks earlier, my daughter began using a food app called MyFitnessPal as a way for her to stay in shape for her upcoming soccer season. That was the spark I needed.

The app is not magic, but it does help you lose weight by simply counting calories. After you put in your current weight and then your desired weight, it gives the number of calories you can eat each day to lose the weight you want.

I put in that I wanted to lose 55 pounds, so it gave me 1,340 calories. It sounds like very little, but if you can make it through the first few days, you gain momentum and it becomes a new way of life.

3d supermarket smartphone
From automating calorie counting to assigning letter grades to foods, apps can help you lose weight and make healthy food choices.

While calorie counting is a great way to lose weight, Houston Methodist dietitian Kari Kooi says it’s important to make sure your calories count and that you are just not counting calories.

In other words, you want to be eating nutrient-dense foods such as fruits, vegetables, nuts, beans, etc., and staying away from processed foods that usually have empty calories. She says a good rule of thumb is to eat foods with five or less ingredients in them.

Kooi adds there are a couple of other apps besides My Fitness Pal. One is called Fooducate. This app assigns a letter grade, A through F, to the foods you eat. It also tells you why certain foods receive the grade they receive.

Another app is called ShopWell. It helps you pick groceries based on your health goals.

In the beginning of this quest, I did not exercise at all, but I have recently started to incorporate that into the plan.

I downloaded a workout app called Endomondo. It tracks how far and for how long you run or walk, and measures how many calories you burn. The great thing is that it connects to MyFitnessPal, so every time I exercise it automatically adds the extra calories I have burned to the daily calories I can eat.

Since February 21, 2014, I have lost 34 pounds. While I haven’t turned into Johnny Depp or Brad Pitt, I feel much better about myself and my health.

Through this journey I have found that whether you have an app or go someplace that helps you, losing weight is all in your mind. I know I sound like Tony Robbins, but it’s true. If you decide to do it, you can do it. Food apps are just great tools that will help get you there.