Yourself Thin
Yourself Thin
Yourself Thin
Melanie W. Rotenberg, MD
With Mitch Rotenberg, PhD
Copyright 2010 by Melanie W. Rotenberg, MD
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advice of a trained medical professional. The information provided here should never be
used for the purpose of diagnosing or treating a medical or health condition. Readers should
consult their own physicians before making any decisions or taking any actions that might
affect their health.
This book is dedicated to our son.
Aaron, growing up in our joyful and off-beat household,
you have happily borne the brunt of our jokes. But, in so
doing, you have learned the ways of the humorist.
Your comedic talents and level-headed disposition have
led us to conclude “Our work here is done.”
“I can’t see my shoes.”
—Aristotle*
Acknowledgments ix
Introduction: Laugh the Pounds Away Forever xi
SIX: Eat Right, Die Anyway: What Are Good Foods? 105
SEVEN: Put the Muffin Down and Slowly Back Away:
What Are Not-So-Good Foods? 125
viii Contents
Conclusion: I Told You That There Would Be a Quiz at the End! 215
Notes 221
Resources and Further Reading 229
Index 231
Acknowledgments
The weight-loss journey, for most people, is a lot like a theme park
ride, a very stressful and scary one. It doesn’t have to be. Ideally, it
should be more like a fun, exciting adventure, with a safe and pleasant
outcome.
Although I hope you will think this book is funny, please realize that
the weight-loss concepts are serious. Healthy skinniness can’t occur
without laughs, since negative emotions undermine successful weight
loss. Laughter is the hallmark of a life lived better, a life full of pleasure
and joy.
laugh while you read, put the book down and back away. I am intent on
making the experience enjoyable for you. In my spare time, when I’m
not seeing patients, I’m writing or practicing comedy. I started doing
stand-up routines just after my 40th birthday; you could say I’m hav-
ing an unusual midlife crisis.
When I asked Mitch if he would help me write this book, his re-
sponse was “I’d rather put eye-hooks through my hands.” The man
blurts out funny stuff all day long, and then I run and write it down.
Let’s just get it straight—his blurting got him credit for co-authorship,
but I did the hard work, and that’s why the book is written from my
perspective.
I also have to tell you this: most of the stories here about my pa-
tients, friends, and family are true, but the names have been changed to
prevent unwelcome visitors to our house in the middle of the night.
does not have to happen. It will not happen to you if you follow the
scientifically based suggestions in this book.
It’s like everybody and their brother has written a diet book or a cook-
book. Even dead people and fictional characters are getting in the act.
I’m afraid it won’t be long until we see Noah Cooks for Two.
People gain back their lost weight for one very important reason: they
haven’t embraced weight loss through a thinking and behavioral whole-
life approach. For most people trying to lose weight, the word “diet”
implies a temporary state of food restriction. Either types of foods or
amounts of foods are restricted until the desired weight is achieved.
However, there are three parts to successful and permanent weight
loss: (1) thinking and behavior; (2) input, as in food and drink calo-
ries; and (3) output, as in metabolism and activity calories. Most diet
books, even those written by physicians, have an overemphasis on the
“input” part of the equation. A typical diet book will give you pages
and pages of food rules and recipes. These books rarely talk about the
behavior, attitude, and cognitive processes that go into how and what
we choose to eat. They rarely give more than a page or two to the issue
of activity and exercise. Weight loss can’t be permanent unless all three
areas are addressed in a balanced manner.
Now remember, health advice works only if you act responsibly with
the information. Which reminds me of the time my hospital offered
a breastfeeding course but had to cancel it because more men signed
up than women.
The key to weight loss is to start from a good point and go to a bet-
ter one—the joy, laughter and happiness that you develop will be all
your own.
—Melanie Rotenberg, MD
People want quick results, but there are no healthy ways to rapidly slim
down. Health spas often promise serious weight loss with only one ex-
pensive session of an exotic treatment. Usually it involves being slath-
ered, enveloped, and heated. None of those techniques really work; they
are only sucking water out of your system. However, I guarantee that
you will experience rapid and dramatic weight loss with the piranha
swim.
Laughter is the key to weight loss. Well, really, it’s those things that
cause laughter, like happiness, fun, and pleasure. But we can use laugh-
ter as a good gauge of how happy and content we are. Stress, negative
emotions, and misguided thought patterns are a leading cause of obe-
sity. Yet diet books almost never address an overweight person’s men-
tal state or level of joy. They might have pages of dietary restrictions
and recipes, but rarely is there more than perfunctory prose on reliev-
ing negative emotions. There might be a chapter or two on exercise, but
nowhere is there a description of the cardiovascular benefits of a good
pillow fight.
And we all need a good pillow fight on a regular basis. The way to
lose weight and to keep it off permanently is to lower stress, depression,
4 Laugh Yourself Thin
and other negative emotions through positive thinking, humor, fun, and
lots of laughter. A lighter approach to life leads to a lighter waist line.
A recent study by Dr. Mark Wilson at Emory University brings home
this point. He offered unlimited nutritious food to two groups of mon-
keys, high-status, contented, happy ones and their miserable, stressed-
out, low-status subordinates.1 All the monkeys ate about the same
number of calories. However, when Dr. Wilson substituted high-fat and
sugary junk food pellets in unlimited supply, the high-status monkeys
ate about the same calories as previously, but their stressed-out brethren
couldn’t stop munching. Those miserable primates continued to eat the
junk food all day long and well after sundown, similar to human snack-
food grazers. The researcher concluded that eating high-calorie foods
is a common coping mechanism to deal with daily life stressors, even
in those who don’t have a cranky boss, prolonged commute, or nasty
mother-in-law.
The biggest stress in my life is keeping house. I’m not much of a domes-
tic engineer. I was completely stumped one time when I had to wash
a black-and-white-striped sweater and the instructions said to “wash
with like colors.” To me that was a laundry IQ test, and I had to be Ein-
stein to figure it out.
And, speaking of chores around the house, I’ll never forget the pa-
tient I had who went home from the hospital with hospice care. That
nurse was so terrific, she took days to help the elderly gentleman clean
his completely unkempt house before he died. Exhausted, she finally
reached the bottom of a huge pile of junk. The last thing she picked up
was a book titled How to Clean Practically Anything.
Turn Your Head and Laugh 5
food, the less you will eat of it. (We’ll talk more about that in Chapter 9.)
Weight loss should be approached as painless. Eating is pleasurable.
Having fun and laughter around meals and playing with food are im-
portant. Additionally, exercise and activity are not burdensome but in-
vigorating. Those who are most successful with permanent weight loss
are those who consider regular physical activity an enjoyable, integral
part of their daily life forever.
Are there things that you do that feel purposeless? Realize that a role
that feels important and satisfying to you (such as work or houseclean-
ing) may feel unfulfilling to others. Examine your own values and emo-
tions while in those roles. What do you enjoy about them, and what do
you dislike? Are there responsibilities that you could eliminate, that give
you too little pleasure? Are there ways to make them more pleasurable?
Are there roles that you enjoy and would like to expand? Much of our
lives is spent fulfilling functions that we never question. One of the best
ways to decrease stress is to question assumptions that you have made
about your day-to-day activities. Examine everything you do, take a
step back, and begin to look for ways to increase your happiness and
pleasure.
Some people’s idea of work stress is different from others’. I’ll never for-
get the attendant who ran the canoe rental at my favorite remote vaca-
tion site. She sat under a palm tree and read novels in between handling
her three or four customers a day. Last time I saw her, she was com-
plaining about how she couldn’t wait to go on vacation. I wonder where
she goes to relax: Manhattan’s Friday afternoon rush hour?
Take stock of what isn’t joyous and humorous, and approach rea-
sonable ways to fix the pressures. Note that if you constantly worry
about your weight, you can take the issue so seriously you stress your-
self into weight gain. Conversely, many people who are chronic dieters
report that they feel exhilaration when they start a new diet. The excite-
ment of a new diet likely comes from the enjoyment of envisioning your
10 Laugh Yourself Thin
new body, your new energy level, and perhaps all the other things you
think a slimmer body will bring to you (perhaps an improved social life).
Unfortunately, traditional dieting is all about deprivation and discom-
fort. Abandon that mindset. But if you are the type that has gotten some
enjoyment at the beginning of a new diet because you are envisioning
what a thinner, healthier you will do, maintain that vision, but without
all the pain.
While you are examining what brings you more joy and less stress,
think about things like walking, biking, singing, dancing, meditating,
music, and sounds of the beach or the woods. I’m always surprised how
few people I see outside enjoying nature and using their muscles. Exer-
cise is an antidepressant and works as well or better than medications,
so not only will it help you to lose weight, it will also relieve stress and
improve mood.
You have coping mechanisms for each major person in your life and
each part of your life. But are they successful, positive coping mecha-
nisms, or are they self-defeating? Do they reduce stress in the long run
or add to it? If you take a drink when you get home from work and
then a couple more before you can face the kids or the spouse and make
dinner, is that the best way to treat your body and your mind? What
would benefit you both physically and spiritually and be better for you
and your family? How about stopping for yoga class on the way home,
walking in the park on the good weather days, meditating for 15 min-
utes in pure silence before the gang gets home, or dropping that extra
project at work that’s been causing you all those extra hours? Perhaps
your best coping mechanism could be setting limits for the superwoman
or superman inside of you and refusing to push yourself harder or re-
fusing to let others push you into responsibilities that you don’t want
or need.
12 Laugh Yourself Thin
stressing me and making my life less fun? ” Then start searching for
nonmaterialistic friends and have heart-to-heart talks with your family
about what your real monetary goals need to be. Consider moving to a
less fancy neighborhood if you have the opportunity to move. Even if
you can afford the luxuries and a high-end neighborhood, what unwrit-
ten messages are being transmitted to you and your family? Find places
that “fit” your personality; whether they fit your fiscal abilities should be
secondary. I truly believe that materialism is rotting the American soul
and leads to a great deal of unnecessary stress, anxiety, and depression.
And there’s nothing wrong with a modest lifestyle, most of the time. I
read about a famous director who named all three of his kids after the
locations where they were conceived. I think one was named Houston
and another, something like London. Obviously, he traveled a lot. I
wanted to do that with my own kid, but Motel-6 Rotenberg just didn’t
have the right ring to it.
Under the category of “people with good intentions doing stupid things”
would have to be the people who planned the annual fundraiser at our
local zoo. It was a big evening barbecue. They called it the Zoo-b-q.
16 Laugh Yourself Thin
They should have called it the “Let’s Celebrate Animals by Eating Them
Night.” I’m glad Habitat for Humanity isn’t doing anything similar:
“This weekend, we’re having our annual cannibalism social!”
the perverted few, the rest of us are forced to abandon physical signs of
appreciation with most of the people we interact with on a daily basis.
In the proper and acceptable setting, put physical touch back on your
“to do” list.
As a physician, I sit at the bedside and touch my patients on the arm
or hold their hand just to connect with them and make certain they un-
derstand that I care. (With the use of high-tech equipment, doctors have
almost eliminated the need to touch patients. Some of us have gotten
lazy and have forgotten that medicine is still as much an art as a sci-
ence.) Healing touch does matter. I do hug my patients and their fami-
lies often, and they appreciate and ask for it.
If you truly find that you cannot increase your hug factor with family
or other situations, then by all means get yourself a huggable pet from
the animal shelter. Do a good deed and save an animal from destruc-
tion, and watch that animal save you, as well.
nonsexually. If you believe that this may be a problem for you, avoid-
ing the issue is not going to help. Talk about this with your significant
other or make honest, frequent attempts to correct your unwanted habit
with others. Often we are our own worst enemy and undermine our own
mental health. Everyone needs to feel wanted and loved, and physical
touch is one of the most immediate ways to express this.
by getting together weekly and reciting the special things that we are
grateful for at that moment, including our freedoms, our friends, and
our community.
In terms of my own family life, I have to admit that I’m not your typi-
cal mom. I’ve never been someone who fits neatly into the traditional
mothering role. So when my son was younger, I used to teach him nurs-
ery rhymes that were a little different, imbued with my own odd sense
of humor. For example, “The queen of hearts made some tarts. She ate
them all and got the farts!” Which was great fun, that is, until the pre-
school principal called me. And then I had to pretend I’d never heard
that rhyme before.
the positive. Guard your brain from assaults by those who dwell on
the darker, pessimistic side of life, and guard your own emotions to
keep from dwelling on this. Being positive-minded in your thinking is
not improper or unrealistic any more than dwelling on the negative,
the violent, and the miserable is proper (even if it has become “nor-
mal” in our society).
• The fatter you are, the more likely that you are depressed.
• To get thin, believe that eating is pleasurable and exercise is invigo-
rating.
• There are several keys to happiness, and they impact weight loss.
• To decrease stress and anxiety, eliminate unfulfilling work and
boredom.
• Increase pleasure with music, dance, fitness, and nature.
• You are no good to those you love if you use self-destructive coping
mechanisms.
• Search out comedy, joy, giggling, friends, and spontaneity.
• Use daily nonactive moments away from energy and mood-sucking
activities.
• The way you choose to cope with life’s challenges will determine your
weight.
• Decrease negative emotions by giving up materialistic attitudes.
• Encourage your own positive health behaviors with beneficial self-
reward.
• Those who lose weight permanently lean on good social support.
• The easiest stress-reducing activity: hugs, touches, and cuddling.
• Give more of yourself to others, and practice gratefulness.
• Be positive-minded in your thinking; guard against pessimists and
self-criticism.
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TWO
I’m Allergic to Food, It Makes
Me Swell: Thought and
Mind for Success
I’m a big believer in integrating delight, fun, and happiness into every-
day life. We humans underutilize our natural abilities to enjoy life. I
bragged to my husband one day, “I have an organ whose only purpose
is pleasure and you don’t.”
He retorted, “True, but at least I have two organs for thought.”
This book is about lifestyle change; it’s not about a “diet.” Good food
choices and increased activity feel positive and are not restrictive. When
you follow the ideas of the book, you will say to yourself about your new
habits, “I choose this lifestyle because of the wonderful way it makes me
feel.” There is no guilt, nor are there any absolute restrictions or com-
mands. You will behave in a certain way because you are positively mo-
tivated to do so. Nobody will watch over you, because you will learn to
motivate yourself. That’s how permanent weight loss is achieved. As a
physician, I see myself as an advocate for my patients. I don’t command
or even cajole; I only advise. In this book, I can give you advice, but the
ultimate responsibility for your health and habit choices is your own.
Once you make positive new habits your own, you will achieve a new
level of health, happiness, and easy weight loss that is truly enjoyable,
for a lifetime.
24 Laugh Yourself Thin
new pattern of eating, exercising, and living is just the way it is, forever,
and it’s going to be terrific for you.
Daily exercise works because it decreases stress, anxiety, and depres-
sion. People who exercise as part of a weight-loss plan feel better physi-
cally and mentally and are more likely to reach their goals. And, since the
goal should be to enjoy the journey as much as the destination, I can’t
emphasize this habit enough.
People say to me, “I wish I were thinner, but I don’t have time to ex-
ercise and eat right, even though I know I should.” Do you like feeling
tired and stressed and fat and out of shape? If not, then you have time to
exercise and eat better because, in the long run, you haven’t much time
for anything else.
Throughout the book I avoid using the word “diet” as much as possi-
ble because that word implies short-term and restrictive behavior. When
talking about intake of calories, I prefer to use the term “food choices.”
This implies active, positive, lifelong behavior.
The truth is, most traditional diets do work for weight loss, but only
for a little while. And none has been proven to be superior to the others.
That’s because they all do basically the same thing; all diets make us
think about what we stick in our mouths.
But traditional diets fail eventually because we stop thinking about
what we put in our mouths. The only way to modify the input perma-
nently is to ingrain the new eating habits. But the bigger reason that tradi-
tional diets fail is that we hate restrictions and commands. When a human
feels forced to do a behavior but doesn’t learn to enjoy it, eventually the
behavior stops.
26 Laugh Yourself Thin
It’s been shown in the weight-loss literature that when you set up a
bunch of strict rules of how, when, or what to eat, the perception is that
when you break a rule (which happens inevitably), a tendency to binge-
overeat occurs. This is what researchers Janet Polivy and C. Peter Her-
man, from the University of Toronto, call the “what-the-hell effect.”2
Banishing foods from a person’s diet usually results in increased cravings
for that food. Never think of any food as forbidden; then it will never
be coveted in an unhealthy or excessive way. Eating without guilt is
the goal.
Good habits are not stressful and demoralizing; they are uplifting and
invigorating. Drop the “do I have to do this the rest of my life” thinking.
It’s self-defeating. Nope, you don’t have to do anything. But healthy
weight-loss behaviors, done right, mean you’ll want to do them the rest of
your life. They’re fun.
pressure but also became less stressed when put into an emotionally chal-
lenging situation. They dealt with the everyday stresses of life better than
those who didn’t regularly exercise. Walk every day before work, and you
will be able to handle both the difficult commute and your annoying co-
workers!
When you exercise, think about the positive changes your body is go-
ing through. Recognize the improvements that you see and feel on the
outside, and envision the improvements that are happening on the inside.
Note that the blood vessels are opening, the muscles are building up, the
fat is truly melting away every time you move. Your brain is growing
clearer and sharper. The hormones are happily signaling youthful mes-
sages to your private parts (ah, what a vivid imagination you have—keep
going with that thought . . .) Even though you need to visualize those
improvements that you can’t see, they are just as important as what you
can see.
I have a good friend who is very overweight and swings from one fad
diet to the next. Two years ago, she went on an all-fish diet and lost
60 pounds, then gained it all back, plus 20 more. Usually fish is one of
the better foods for weight loss, when eaten in moderation, except for
swordfish, which is high in mercury. It should be eaten only rarely. But
the good news is that, when cooking swordfish, you don’t have to check
the temperature—it tells you what it is.
It’s amazing how much your spirit and emotions can be detected by other
people, and sometimes in the most unusual ways. A woman who lives by
me advertises that she is a spirit photographer. She says that she can take
photos of the colors of your natural aura for you, your kids, and even
your pets. The more money you have, I guess, the greener your aura.
30 Laugh Yourself Thin
Beware, there are exceptions to the rule that exercise makes you feel
more in control. Golf is not an exercise that breeds that feeling. What
is it with golfers and those little head covers they put on their drivers?
They’re thinking, “It protects my club so it won’t get scratched.” Then
they take the cover off, whack a hard ball as fiercely as possible, hit a
really bad shot, wrap the club around a tree . . . then put the head cover
back on.
Why is control so important in weight loss? It’s because not every per-
son who succeeds does it the same way. This book is a description of the
best proven techniques that lead to sustained weight loss. However, no
program is “one size fits all.” Take what works for you and make it your
own. To keep weight off permanently, you should individualize the ideas
from this book to fit your own style so that you can maintain your suc-
cess through the years.
Persistence is the key. Keep trying different ideas from this book, until
you find the best fit for you and your lifestyle. Those who succeed keep
trying different approaches until they find the methods that work for
them. Then they stick to those methods.
There are so many dietary supplements that don’t work. People don’t
realize there’s no government regulation for checking the effectiveness
of the claims of any type of nutritional supplement. People out there
are selling supplements that are supposed to boost memory and cogni-
tive function by “increasing blood flow to your brain.” The funny thing
about that claim is the real medical research shows that the better your
brain is functioning, the less blood flow it requires. Psst, want to be
Einstein? I’ll sell you something better than a supplement. I’ll sell you a
tourniquet to put around your neck.
comes with fewer physical signs than other emotions and gets missed as
an emotion.
If you are chronically anxious, you may subconsciously feed your but-
terflies, rather than deal with your anxiety. (Chronic anxiety disorder
is the most common undiagnosed and untreated psychiatric illness.)
You should identify what makes you anxious and find ways to reduce
the anxiety either by seeking treatment or by dealing with the source.
Or you should practice reducing anxiety through breathing exercises or
meditation. Then you will succeed in avoiding this common cause of
overeating.
There’s no doubt that modern life leads to a lot of difficult emotions and
stressful situations. Did you ever wonder about Rapunzel’s reaction to
being saved if she were a modern woman? She’s locked up in a tower,
away from kids, boss, stress, and traffic. Hey, it sounds pretty good to
me. Modern Rapunzel: “Go away! I don’t want to be rescued. And get off
my freaking hair!”
Are you lonely? Get on line and find someone decent to chat with.
Join a class or a support group, or arrange to teach a skill at your local
community center. Sign up for a hobby club, exercise class, or the rac-
quetball league. Volunteer at a school, hospital, nursing home, or
pet shelter. Make yourself useful to others and they will reward you
10 times over.
What if you are bored? If you find yourself rummaging in the cabi-
nets for food and you are not hungry, you are very likely bored. Go for
a bike ride, call a friend, visit a neighbor, do crafts, grab a fun book, or
watch the educational channel on television. If you are bored at work,
ask for more challenging assignments or learn new skills. Do something
that stimulates your mind and your heart.
Take a mental health day from work and responsibilities, but not to sit
home and brood. Instead, do something positive and uplifting with your
day off. Go to the park and ride the swings. Walk in nature. Play, laugh,
sing, and force yourself to get out of your depressed comfort zone. Rec-
ognize that your mood is down and make a deliberate effort to change
it with positive activity. Read about depression on university Web sites
and ways to recognize if it’s serious enough to warrant professional inter-
vention. Depression causes most people (normal weight and overweight
individuals) to eat more, but people trying to lose weight who are de-
pressed overeat the most calories.
I believe in communing with nature to lift the spirits. But here in Florida,
the nature often comes to me. I’ve had snakes in my closets and a wolf
spider that was bigger than a tarantula in my baking pans. I’ve had large
frogs come up from my sewer akin to a biblical plague. The nickname of
Florida is “The Sunshine State,” but the motto should be “What the hell
is that in my commode?”
1. When you are about to eat, ask yourself, “Am I truly hungry? ” If
yes, go ahead and eat.
2. If not, think about why you feel the need to eat; pin down the emo-
tional triggers.
3. When you have determined the underlying cause, act on the triggers,
and ignore the urge to eat. Find another constructive outlet that isn’t
taking in calories. Remind yourself that you are in control of your
behavior and that you have the capacity to break old habits, no mat-
ter how ingrained.
4. “Groove” the habit by practicing steps 1–3 each time you are about
to eat until the process becomes automatic. Your goal is to eat only
out of hunger.
Some people use food like an addiction. Food becomes another de-
structive way to soothe the hurting soul. Dr. Mark Gold at the University
of Florida has stated that he believes hedonistic overeating is an addic-
tive disease and needs to be treated the same as other addictions.7 His
research shows that, in obese people, beef broth does nothing for brain
chemicals, but Kobe beef lights up functional brain scans as if an addic-
tive drug were being given. Food causes dopamine release like sex does.
Receptors light up in PET brain scans as they do in cocaine and alcohol
abusers. When overeaters are shown a photo of the Golden Arches, their
brain brightens like a fireworks display at Disney World.
Interestingly, the portion of the brain devoted to the sensations of
texture, taste, and feel of the mouth and tongue is also enlarged in over-
eaters, thereby reinforcing the sensual pleasures of food. In Chapter 9,
you’ll see why this isn’t a bad thing.
If you think you are suffering emotionally, get help. People with real
psychological problems that need treatment lost only half the weight of
those without emotional problems in the same weight-loss study. Don’t
focus just on your weight. You need mental and physical strength and
healing to achieve your weight loss goals.
38 Laugh Yourself Thin
The wedding day is still the most common target date for crash diets.
But due to changes in society, weddings are less common than they used
to be. On the other hand, things are looking up for the funeral industry,
as baby boomers are dying in droves. In fact, wedding planners are now
doing funeral arrangements so they can stay afloat. This is a quote from
an article in my local paper, given by a funeral director: “Other than the
fatality, what’s the difference between a wedding and a funeral?” Well,
in one case, you’re less likely to have kids afterwards.
40 Laugh Yourself Thin
Myth: If I start gaining weight, even a little bit, it will all come back.
Fact: People who successfully maintain long-term weight loss monitor
themselves constantly. As soon as they notice a slight weight gain,
they have an action plan to reverse the trend. This is a normal part
of the process, not a failure.
Myth: I can’t quit smoking because then I’ll gain weight.
Fact: If you dispose of addictive behaviors, you gain control over your
life. And the more you practice healthy habits, the more likely you
are to lose weight permanently.
I have patients who insist on smoking while wearing oxygen. I’ve been
thinking of opening Doctor R’s Institute of Patient Rocketry.
This reminds me of an 89-year-old patient of mine who explained
that she started smoking as a child when her mother forced ciga-
rettes on her. Up in the mountains, they thought it got rid of intestinal
worms. The lady is still smoking 80 years later. I said to her, “Isn’t it
funny that worms are smarter than people? They know to leave when
tobacco is around.”
playing in your head. Think about how differently you feel when you
say to yourself that you are in a “fight” rather than a “learning ex-
perience” about your weight. Reframe the words and thoughts that
you use, to yourself and to others, when thinking about eating, exer-
cise, and your approach to weight loss. You are not “avoiding” cer-
tain foods; rather, you are “choosing” more of this food or less of that
food. When things don’t go quite right, it’s another “learning oppor-
tunity,” not a “failure.”
Remember, no matter how bad life is, it can always be better with choc-
olate. Unless, of course, you are severely allergic to chocolate; then it
will be over.
Not every vacation is full of fun and joy. The last cruise I went on, the
economy was at its worst. For many people on board, they were looking
at a lifetime of investments and retirement savings suddenly gone. Ev-
eryone was so depressed that at the muster station, the crew was teach-
ing people how to take their life jackets off.
Be careful with focusing on negative body image; this can lead to self-
criticism and unhappiness. Overweight people often delay socializing or
having enjoyable experiences, like going to their high school reunion,
waiting until they have their idealized body. Take steps to say and be-
lieve that you have a positive body image now and always. Have those
42 Laugh Yourself Thin
special experiences now, as that will lead to more happiness, which leads
to more success in weight loss. Buy the clothes that make you feel beauti-
ful and handsome now, not when you are a size whatever smaller. Enjoy
them; this will bring you closer to thinness and to mental and physical
health. Misery, self-deprivation, and neglect certainly won’t. Take the
time to make yourself look your best now, every day. Do what you can now
to improve your self-image, both inside and out. Don’t wait until some
nebulous future time.
Chinese fortune cookie: “Over every mountain there is a path although
it may not be seen from the valley.” You may feel like you are looking
upward at a very steep mountain to reach your weight-loss goals. If so,
redirect your view. Start looking at the lovely foothills right in front of
you. Then you can enjoy the path along the way.
People who are fat have fat kids. We know that. The argument is whether
that is the effect of nurture (environment) or of nature (genes). Since fat
families also tend to have fat pets, I’m betting it is more nurture rather
than genetic predisposition. Unless, of course, you are related to your pets.
If you have been blaming your obesity on your lousy genes, it’s only go-
ing to make your ancestors feel bad, and it’s not going to help you get
healthy and skinnier. Leave Aunt Tillie out of this.
However, if Aunt Tillie was the one who taught you to always eat din-
ner at 8 p.m. and never to leave the table until you clean your plate and
that exercise is only for athletes, then Tillie is in the doghouse after all.
If you are not certain which actual foods are the best for your body,
don’t worry; we’ll discuss that in the “good food choices” section of
the book. However, I can give you a few hints here. If you buy most of
your foods at Nutrition Whorehouse, you’ve got a problem. If you fre-
quently visit restaurants with names such as Seat’s Up Bar & Grill,
Crème de la Phlegm, or the Poached Roach, you definitely need help.
And don’t be afraid to get educated if your favorite diner has a sign
outside that says, “Try our rib-eye steak, our black-eyed peas, and our
blue-eyed waitress.”
A great resource for anyone aiming for permanent thinness is the Na-
tional Weight Control Registry.1 The brainchild of two researchers at
Brown Medical School and the University of Colorado Health Sciences
Center, it collects stories of successful weight losers and analyzes their
behavior. What makes their research important is the size and perma-
nence of the weight loss among the participants. Registry members, so
far, have lost an average of 66 pounds and kept it off for more than five
years. About half the participants lost weight without any outside help
or formal program. Almost all modified their food intake, and 94 per-
cent increased their activity (most of them still walk, exercising about an
hour a day). The majority eat breakfast regularly, get on a scale weekly,
and watch less than an hour and a half of television a day. These peo-
ple changed their behaviors and continue to follow their new practices,
years after they originally lost weight. They developed permanently good
habits and eliminated their bad ones. That’s the way to get thin and stay
thin forever.
You can call bad habits anything you want, but they are still bad be-
haviors that lead to rotten outcomes for your health. Not that long ago,
Minnesota passed a law that banned smoking in public places, except
for actors on a stage. Some bars got the wise idea to set up stages and
began calling their patrons “actors” to get around the ban. One estab-
lishment said the patrons were performing The Tobacco Monologues.
Gee, I’d hate to think where they were puffing from. “Oh, look, smoke
rings!”
Tossing Your Cookies 47
That’s the thing about following advice. You have to choose wisely
whose sage advice you follow. I remember once being told, “Whatever
doesn’t kill you makes you older.” I’m still not certain how useful that
was. Perhaps a more relevant quote here is what FDR said: “The only
thing we have to fear is fear itself—and cupcakes—cupcakes are evil.”
Look, okay, just follow my advice.
Thin people may not have a naturally higher metabolism than those
who are fatter. But they may be more active on a daily basis and stop
eating when they are no longer hungry. They may naturally practice all
the behaviors of successful permanent weight losers; they just never got
fat to begin with. Thus, next time you think about someone who is thin
and has never had a weight problem, realize that the person may have
a metabolism just like yours but a behavior pattern that is different. Un-
derstanding this message will change your life.
also ate what everybody else ate (and you didn’t complain if you knew
what was good for you). You cleaned your plate of whatever was served
to you or you would not get dessert. Take a moment to think about each
one of those eating behaviors and the dangerous assumptions that go
along with them.
It’s like we’re all giant starfish. In order to eat, the starfish must throw
up its entire stomach. The stomach then grabs lunch by surrounding it
and the organ and meal then return inside the animal to digest. Imag-
ine if humans did that—the cafeteria line at work could get very en-
tertaining. That’s one way to clean your plate.
Beyond the age of five and for the rest of our lives, we humans turn to
external cues (our environment) to tell us when and how much to eat.
We learn to ignore our stretch receptors in our stomach that tell us to
stop before we have had a second helping of turkey on Thanksgiving. We
become oblivious to our hormonal levels that tell us our calorie intake
is already sufficient and there is no need for dessert at that fancy anniver-
sary meal. It may even become routine to eat until stuffed, instead of
80 percent full because that is what we were taught as children. Eventu-
ally, those extra daily and routine unnecessary calories add up. We start
to fatten.
People eat for all sorts of reasons, hunger being just one of them. Get-
ting back to eating because you are hungry and stopping when you are
full will go a long way toward your goal of permanent weight loss.
Deepak Chopra once said that we need to get quiet and listen to our
bodies. Unfortunately, most people can’t hear their bodies over the
scream of a Krispy Kreme donut.
I have a T-shirt from a vacation that says, “I’m on island time.” Eat like
you are on island time. Better yet, eat like you are on contractor time;
it’s even slower.
It really is the case that people in Western societies are eating more
calories than they used to. It sneaks up on us in ways we don’t know. Ac-
cording to USDA food data, the average American eats 300 calories
more in an average day than he did several decades ago. Since it takes only
about 3,500 excess calories to add a pound of fat to the hips, belly, or
buttocks, that’s less than two weeks of overeating. It doesn’t take many
months of routine excess calories before the pants get too tight to button.
There are a host of simple tricks that can keep you from overeating.
Most of them cut the number of calories you eat in a painless manner. I
recommend incorporating as many of them into your life as you can.
If you really want to slow down eating to permit time to lessen the
hunger pangs, eat with a utensil you don’t know how to use, like
chopsticks. Better yet, eat with only one chopstick. If nothing else, I
guarantee it will keep your eating partners entertained.
A word of caution: my husband finally switched to smaller forks
recently. Not only has he lost weight, but he’s gotten much more col-
orful clothing as a result. He spends more time feeding his shirts
Tossing Your Cookies 55
than his mouth, which has made him smaller but his shirts bigger.
They like my cooking, apparently.
Smaller plates and tall, thin glasses also do the trick. Over the past 50
years, the plate industry has caught on to our rapidly increasing appe-
tites. It has obliged us by creating larger and larger dinner plates. It is the
case that the salad plate of today is almost as large as the dinner plate
of our grandmother’s china set. What do most people do when presented
with a large plate? Fill it up, of course! Brian Wansink, MD, of Cornell
University, one of the nation’s most famous food researchers, has pub-
lished extensively on this subject. If you switch to seven-inch plates for
dinner (instead of the common nine-inch plates), you may reduce your
caloric intake without even feeling it. Have you ever been to a fancy res-
taurant where they scribble edible designs all around the edges of your
dish? That’s just a form of optical illusion to make the portion size ap-
pear larger (and your bill appears more reasonable). Using tall, thin
glasses when you drink a calorie-laden liquid will reduce how much you
drink. Even bartenders fall for that old optical illusion. Take away those
short fat mugs for your beer or cola. Better yet, drink water or unsweet-
ened green tea.
socializing. Keep away from the dessert and food tables, and don’t be
afraid to tell the wait staff “no” to offerings for certain courses or hors
d’oeuvres. Save yourself for the really special stuff, and skip the rest.
box of donuts that sits on the counter in the kitchen? Can you brew your
coffee at home before work to avoid the convenience store line? Can
you record your favorite television shows and zip through the mouth-
watering food commercials?
The food industry has done a great job of creating all sorts of innova-
tive ideas and combinations. One night, I was eating this new type of
“all natural” sausage for dinner. But it was kind of a strange food item,
chicken sausage in pork casings. I imagine the chicken parts were in
there talking to each other: “You know Bill, this just doesn’t feel right.”
seemed a good idea to the busy family, but it has resulted in grave risk.
Nutrition research repeatedly shows that if you give people a large con-
tainer of food and ask them to help themselves to a portion size, that por-
tion will be much larger than if they had started with a smaller original
container.7
Those crazy but fun researchers at Cornell University did a study of
unsuspecting moviegoers in which the patrons were offered free popcorn
in medium or large buckets.8 Yes, those who had the larger buckets ate
more during the film, 45 percent more. But the real catch was that some
of the participants got 14-day-old stale popcorn that tasted horrible. The
moviegoers still ate a third more if they were given the larger bucket, even
though the food was downright unpalatable! In other words, don’t serve
yourself out of huge family-sized cereal boxes, and don’t eat out of the
one-pound packages of chips. You will eat a lot more than you need.
Don’t serve food family style, passing the giant bowl of mashed potatoes.
People around the table will take a much bigger glop than they other-
wise would have taken.
This is a big problem on cruises. Not only can you eat anytime, as
much as you want, but the buffet lines have enormous platters of delec-
table delights. By the end of our last cruise, my husband had eaten so
much that he claimed he would be thinking outside the pants. The truth
is, most men would benefit from thinking outside their pants.
Just as you don’t want to serve yourself from huge bowls of food,
don’t eat directly out of the package of chips, cookies, or pretzels, ever.
Always take the portion you want and place it on a small plate first;
never dip back into the package. An easy alternative is to divide up snack
food into small portions as soon as it is bought. Or buy the individually
wrapped limited portions of junk food. Even ice cream now comes in
very small individual packages, for a reasonably sized snack.
Get in the habit of serving yourself smaller portion sizes than you are
currently doing, at every meal and snack. Automatically cut out at least
a fifth to a third of your usual portion. The bigger the serving, the auto-
matically larger amount that people eat, ignoring their own internal sig-
nals that they are no longer hungry. If you are overweight, there is no
getting around the fact that you are eating too many calories for your
body and ignoring your internal signals.
counselor being paid by the hour. Hang out in places that encourage
healthier behaviors. Meet a friend by the lake or in the park for a walk af-
ter work, rather than at the usual happy-hour bar or restaurant.
GOT BRAINS?
There are many diet and weight-loss books on the market. There are
many fads and many programs. People who lose weight but then gain it
back later are more likely to have been in a structured diet program or
on a fad diet or a fasting diet. They are also more likely to restrict whole
categories of foods and to eat more fat and sugar in their diets. They are
unlikely to exercise regularly. Finally, people who gain the weight back
are less likely to eat fruits and vegetables but more likely to have used diet
pills or hypnosis to initially lose the weight. Don’t do what they do.
It bothers me when I see the number of ridiculous fad diets that have
come and gone and the number of desperate people who have been vic-
tims of these ideas. Fad diets are never based in good scientific or medi-
cal knowledge. I’m surprised some shyster hasn’t published the Eye Color
Diet (“If one eye is a different color than the other, eat the blue-eye diet
until noon and the brown-eye diet until bedtime.”). I’d like to try out the
Phrenology Diet on some of those fad-diet authors. That way I can
whack each one of them on the head and tell them it’s for their own good:
“Look, a new lump. Now you can eat broccoli on Wednesdays!”
The recommended behaviors described here are the best-known
methods that work permanently. They ask a lot of the reader. A person
who wants to lose weight forever must change the behaviors that led to
the weight gain in the first place. There is no instant solution that will
last. Use the suggestions here to enact healthy behaviors that work, per-
manently, for your lifetime.
Tossing Your Cookies 65
I’m really glad that the tourist industry is designing more ways to stay
physically active while on vacation. But not all the ideas are so well
thought out. I was on a cruise ship with an ice rink. Let’s take an in-
stance where people normally fall down and hurt themselves and then
take away normal ground stability. I’m surprised there wasn’t a sign
that said, “This activity sponsored by Earth, Wind & Lawyer.”
Strangely, video gaming hasn’t been found to have the same relation-
ship. Perhaps it’s the fact that the games don’t suggest that you eat
food, and your hands are busy doing things other than feeding your
mouth. My son is working on the design of an action video game,
but I told him it couldn’t have any sex or violence in it—Grand Theft
Stroller.
It isn’t just workers from home who get into self-esteem problems.
Gee, even doctors can suffer from ego issues, as well. The American Col-
lege of Physician Executives sent a letter asking me to join. It came
from their president, a woman whose name was followed with, “M.D.
M.M.M. F.A.C.R. C.P.E. F.A.C.P.E.” I threw it away. Personally, I’m se-
riously suspicious of anyone who feels the need to put 17 letters after
her name. Perhaps she is having a bit of a self-esteem issue. Or maybe
she’s discovered that people will treat her with more respect with all
those extra letters. So I’m going to try it. You may now call me Melanie
Rotenberg, MD XYZ PDQ *€ §»¥. I’m thinking of changing my name
to an unpronounceable symbol (looks like sunset over a beach with
the Greek letter theta with two slashes through it). This loosely means
“I’d rather be walking the beach than parallel parking.” You must now
refer to me only as “the physician formerly known as Dr. R.” I’ve come
up with new categories of trailing letters that you might want to give
your own physicians: MD JRK, MD STU PID, and MD PUTZ. I believe
many of our physicians in the medical community deserve more let-
ters, so please be generous.
But let’s get back to the subject at hand, self-esteem and work. I’m not
suggesting that you have to get a job outside the home to lose weight, but
you need to be aware of a tendency to suppress your self-esteem if you
spend lots of time at home. This is true for men and women. In addition,
people who work at home just don’t need to move as much to do their
daily responsibilities, so they are more sedentary. I’ve been at home with
my kid, and it certainly didn’t seem like I was getting less exercise than
when I worked outside the home, but, overall, it was. Getting out, socializ-
ing, and interacting with others does increase confidence and self-esteem.
It also increases physical activity. Finally, interacting with others, espe-
cially with those less fortunate and people from all walks of life, takes the
focus off one’s own problems and helps to increase one’s feeling of grate-
fulness. If you work at home, you need to concentrate on finding time to
exercise outside the house and also to interact with people separate from
your own small social circle. Increase your volunteer or social connec-
tions, or join clubs and exercise groups, or develop hobbies that will
bring you into conversation with more than the usual suspects.
70 Laugh Yourself Thin
sports channels. But what if you took one of those staid activities and
livened it up a bit? This is one of the keys to permanent successful life-
style change. The reason that regular exercise behaviors extinguish (go
away) is that most people don’t associate exercise with something fun or
positive. Okay, loaded guns might be fun, but they’re not very positive.
My son and I used to play a game we called “toaster chess” where the
pieces, once captured, were flung far and away about the room. This
brought a whole new level of physical exertion to a generally sedentary
game. If activity is just another chore or responsibility, it will be ignored.
If you list physical activity on your “to do” list, it will be an item to be
avoided. Rather than make it a “to do” item, make it a “want to do” item
by always designing the physical activity to be fun and pleasurable. In
the same way, you should associate all positive health behaviors with
pleasure, joy, and laughter.
The more you link positive health behaviors with pleasurable things,
the more you will succeed in changing your life and slimming down.
When you decide to eat the lower-calorie menu item, when you leave
food on your plate because you feel “80 percent full” instead of com-
pletely stuffed, when you park on the opposite side of the parking lot at
Wal-Mart instead of in the closest space, make certain that you imme-
diately link that behavior to something that is emotionally pleasurable
to you. For me, that might be something as simple as imagining myself in
a pair of new skinny jeans that turns heads or playing my favorite mu-
sic in my car when I get back from the store. Make certain you select
thoughts and behaviors that are truly pleasurable for you. Avoid any-
thing that might inadvertently make you anxious. Go for real rewards
in thoughts and behaviors, and you will succeed in turning good health
habits into lifetime habits.
Don’t just tell yourself, “I’m not going to do that bad habit anymore.”
Create an acceptable and pleasurable substitute. It must become “I
will do this instead of that.” If you remove behaviors and foods that are
pleasurable to you (for example, “I won’t eat chocolate donuts for break-
fast anymore”), your new behavior (no chocolate donuts) will not win
out in the long run. In that example, all you did was take away some-
thing that gives you pleasure without substituting another pleasurable
72 Laugh Yourself Thin
behavior. It doesn’t have to be the same type of behavior; you don’t have
to substitute one food for another. It is very difficult to find a food that
gives as much immediate short-term pleasure to a carbohydrate addict
as a chocolate donut. So, instead of trying to find a healthier alternative
food that gives the same pleasure rush as the donut, find another accept-
able behavior that can get those brain chemicals dinging on the pleasure
centers.
It’s not like physicians are much better. I don’t know why people are
always suing doctors. Hey, we admit we’re not very good. That’s why
Laugh Your Butt Off 73
PUSH UP OR SHUT UP
Here’s the next big take-home point: exercise is the single biggest factor
in losing weight and keeping it off forever. Those who do it regularly re-
main slim, with no more yo-yo dieting. This is according to data obtained
through the National Weight Control Registry. Even the Mayo Clinic
lists 30 to 60 minutes of daily exercise as its number one recommenda-
tion for permanent weight loss. Your mission is to find activities that
you love and to do them regularly, and never stop. Later on in this book
we discuss specific exercises that are most effective for permanent weight
74 Laugh Yourself Thin
loss. The key, though, is to do something enjoyable just about every day,
forever.
Increase your activity at the office, not just during your free time.
Work more motion into your work day. Chuck, a tall, skinny physical
therapist who sees some of my patients, mentioned that he once meticu-
lously counted the number of paces he took in a typical work day at the
hospital. When he added them all up, he figured out that he walks an av-
erage of three to five miles a day during his work hours! I walk close to
that number during my work day but also put in an additional three to
four miles daily during my morning walk with my husband. No, I don’t
feel tired; I feel invigorated. In fact, I become antsy and frustrated if I
don’t get my usual physical activity at work or home. Chuck mentioned
that he could retire soon but is hesitant to do so because he fears he
would get out of shape and become disabled without all that work activ-
ity to keep him moving.
Now I’m not saying that you need to quit your desk job and become a
ski bum. However, there is something to be said for gradually working
more and more regular activity into your life, night and day. We’ll discuss
the ways you can do that in more specifics in Part III, the metabolism
and exercise section of this book.
One leading professional golfer claimed that his stretching and exer-
cise program was so successful that he got taller. He claims he got so
76 Laugh Yourself Thin
much taller he needed a new putter that was an inch and a half longer.
I’m wondering what exercise machine he was using—the rack? In that
case, he’s better off leaving his exercise equipment in the dank base-
ment. I’m afraid we’ll be seeing ads someday that say, “Top Pro Golfer
endorses the Medieval Beach Diet.”
reason is that healthy weight loss is really “adipose loss” (fat cells). When
you eliminate calories, eat well, hydrate yourself properly, and increase
activity, you might very well gain weight, but it’s good weight. It’s the
lean muscle weight that will serve you well in the long run. If you follow
my advice, you are likely to get thinner but heavier at first before you lose
actual weight! We’ll discuss why this is the case in Part III, on metabo-
lism and exercise. For now, understand that if you are following good
health behaviors, the scale may just upset you. That’s why I recommend
using clothing as your feedback mechanism. Pick your pants as care-
fully as you do your friends. Then enjoy them as they grow loose on you
(your pants, not your friends). Let them be your guide if the scale is too
anxiety-producing.
When you listen to your pants, avoid scrubs or elastic drawstring
pants, as they do lie. Avoid baggy clothes that allow you to hide your fig-
ure to yourself and to others. Those are the clothes that will let you ex-
pand your size without notice. Insist on wearing a fitted waistband on
most days. Dress nicely to impress yourself, your lover, and your friends.
Baggy clothing is often a sign of someone who is hiding from the world.
Stop hiding, and dive right in.
The men’s sensitivity final exam: You are presented with the inevita-
ble question from your significant other. She asks you, “Does this make
me look fat?” Please choose the correct answer: (a) No, darling, you
look wonderful; (b) No, but it does make my eyes thicken; (c) Excuse
me while I go TASER myself; (d) What do you say we go get ice cream?
drink and activity/exercise log for at least one to two weeks. Some peo-
ple stick to their logs permanently. Many formerly obese people use this
technique, either forever or when their weight creeps back up. A recent
study by Victor Stevens, Ph.D., at the Kaiser Permanente Center for
Health Research, showed that people in a weight-loss study who wrote in
their logs daily lost twice as much weight as those who kept their logs
one day of the week or less.3 Be honest, and mark all exercise and every-
thing that you eat and drink. No one else has to see it unless you want
them to. It’s not meant to be fascinating reading or to be published in the
Congressional Record. However, use it to carefully evaluate your intake
and how many minutes of nonroutine activity you accomplish.
For many people, the act of logging changes their behavior. People
avoid bad habits when they make a written record. If this is the case, you
may need to continue the log indefinitely, either to pinpoint problem be-
haviors or to encourage yourself to move toward healthier ones. If you
find that the act of writing down your food, drink, and exercise is chang-
ing what you do, that in itself is an important clue. This gets back to the
idea that most of our eating and exercise choices should be in the front of
our awareness, not mindless afterthoughts. Once we do that, it becomes
much easier to reach our goals for normalizing our weight.
Perhaps the most important reason for this log is that people tend to
distort their memory of their behaviors. Often, when I ask patients about
their nutrition or exercise and activity level, they are very inaccurate, even
for recent events. When I ask them to focus on specific examples or in-
clude family or spouses in the conversation, I frequently get a very dif-
ferent scenario. Take away your reliance on memory and the emotional
underpinnings that you might attach to your behavior, and jot it down.
Then periodically go back and review this log. Are you really working in-
creased activity into your daily habits? Are you including more of the
good foods and eliminating the frequency and amounts of the not-so-
good foods? Can you see a pattern to behaviors that needs attention?
Do you find that you are making real strides in a healthier lifestyle? Be
objective; don’t be overly critical. Be constructive and honest. You are
Laugh Your Butt Off 81
your best friend and biggest supporter when it comes to weight loss.
Use the logs to help yourself into your new permanently thin body.
You don’t need to become the world’s strongest person. And you
don’t need to get in perfect shape anytime soon. Aim for multiple small,
new habits. Each new positive routine encourages more changes as you
see great results. Each habit gradually added in will result in permanent
success. Don’t ask yourself to perform an overnight complete overhaul.
Pick one or two small changes that are easy to enact at first, and, as
they become ingrained and habitual, add one or two more. This will en-
sure life-long results. This chapter gives you the activities and behav-
iors for permanent weight loss. Remember to laugh, sing, dance, and
enjoy every moment.
82 Laugh Yourself Thin
Some female spiders are so hungry that they eat their mates. Very
aggressive fishing spiders sometimes eat their intended mates before
actually mating, a definite disadvantage in the Darwinian Olympics.
Scientists blame the lady spider herself for being genetically too as-
sertive. But maybe it isn’t her fault; maybe he just didn’t take out the
garbage again.
Hunger is normal; it’s part of being human. People who are overweight,
unfortunately, have come to think of hunger as the enemy. It’s not the
enemy, and “fighting hunger” isn’t a battle.
Satiety (pronounced “say-tie-et-tea”) is the medical term for the oppo-
site of hunger, for feeling full. As I mentioned earlier, it takes the body
about 20 minutes to register fullness after you have taken in enough cal-
ories. Thus, if you are eating quickly, you might overeat. This is an im-
portant concept. If we understand how our body registers hunger and
satiety, we can meet its needs without overeating. We can feel happy, sat-
isfied, and well cared for and become thin. No need for deprivation, ever.
Dr. Barbara Rolls of Penn State estimates that obese people begin
eating due to hunger only 20 percent of the time and finish eating a meal
due to internal signals of satiety less than 40 percent of the time. If you
are overweight, it is very likely that you eat beyond when your internal
84 Laugh Yourself Thin
signals should have told you to stop. Relearning your body’s own signals
may be the most important step you ever take to permanent thinness. The
nice thing about this approach to weight loss is that self-deprivation and
starvation aren’t necessary.
So you don’t think that you are a person who judges how much to eat
by your eyes, rather than your stomach? Cornell’s Dr. Brian Wansink
performed an extremely clever research study on multiple groups of av-
erage adults.1 He rigged up soup bowls on a table to refill automatically
by hidden hoses under the table. The test subjects were then told to
eat until full. The adults who had the specially rigged soup bowls ate
75 percent more than those who had normal soup bowls! Both groups
claimed they felt the same amount of satiety at the end of the meal. Thus,
Dr. Wansink was able to demonstrate that most people, even those who
aren’t fat, decide to stop eating not when their body tells them to but
when the plate or bowl is empty.
I like reading Dr. Wansink’s research, he always seems like he’s having
a lot of fun in his lab. I never had that much fun when I was a medi-
cal researcher. Of course, it might have been because I spent my time
sitting in a walk-in refrigerator injecting tiny bits of DNA into maggot
butts (really, that’s what I did). I used to go home at night and dream
about wriggling maggots. Recently I heard about a research study that
was done to determine if penis size truly is related to foot size. Now
that sounds like fun medical research. I hope it was a female scientist
doing the study: “Okay, gentlemen, put your feet and your organs up
on the counter and let’s get you measured!”
People who are externally driven by signals to eat are more likely to be
overweight. I strongly feel that this process can be relearned, however,
and that, once a person realizes that this is a problem, he can retrain him-
self to pay attention only to his internal signals—it takes time and real ef-
fort, but it’s worth it.
Talk to your stomach, and wait for it to answer on fullness level. Just
remember, when in a restaurant, always use a low tone of voice when
talking out loud to your stomach, and try very hard to act like you are
speaking on your cell phone if you are sitting alone. Otherwise, your
next meal may be psychiatric hospital food.
Consider yourself successful when you stop eating earlier than you
used to—because you no longer attend to the external signals and are
back to listening to your body.
Once you have relearned the sensations of hunger and satiety and feel
pretty certain you can regularly monitor yourself, you will want to keep
your hunger level within a certain range. It is best for your mental and
physical state to never allow yourself to be very hungry or very full. Cul-
turally, Americans are more prone to eat “until stuffed” than other peo-
ple in the world. It is not uncommon for us to eat until we are suffering
physical signs of reflux or regurgitation, like belching or coughing at the
end of a meal.
Eat until mostly full, not stuffed, and get in that habit. You don’t have
to starve, but there is nothing inherently wrong with practicing feeling a
little hungry. Societally, we’ve grown to accept that hunger is a bad thing
and to believe that we need to appease it immediately. Rethink your
thinking about this; then do what is comfortable for you. But don’t let
hunger impair your ability to function or worsen your mood.
Good nutritional foods, like vegetables, satiate you and make you
feel full, but foods lacking in nutrition make you hungrier through
several mechanisms. Good foods ameliorate the desire for nutrients
you might be missing. Yes—and this is common—you can be extremely
overweight and still be malnourished! Junk food lacks nutrition and
won’t stop a malnourished body from searching for minerals or vita-
mins that it is missing. I believe that’s why some people become food-
obsessed despite being extremely obese and chronically overeating.
Strangely, it’s well documented that people who are malnourished will
eat the wrong things (even nonfood objects like paint, paper, and paste)
in a compulsive search for the nutrients their body is missing. In my
own clinical experience with thousands of overweight patients, I have
found many who had severe protein, vitamin, and mineral deficiencies.
Their malnutrition explains why they came to me: serious wounds,
infections, neurological problems, or broken bones caused by osteo-
porosis. Once they started eating more nutritionally sound diets, they
lost their compulsive hunger and lost weight! They felt better, and they
healed.
When I go visit my friends, I like to bring a gift. In the old days, I used
to bring a bottle of wine, but a lot of people are alcoholics in recovery.
So then I was giving candy. But I found that so many of my friends are
diabetics. Then I was stuck bringing a nice loaf of bread. But seems
like everybody has a gluten intolerance. So now I just give something
that everyone needs—health insurance.
apple or a snack bag of carrots helps immensely and is great for your
body. Increasing soups, stews, fruits, fish, casseroles, vegetables, and
natural fibers cuts calories and increases satiety.
A glass of water by itself doesn’t help reduce your appetite unless
you are truly thirsty instead of hungry. But water, when mixed in with
other foods, is very helpful, especially when it is warm and part of the
dish being served. Water mixed in with a food increases satiation and
lowers the calorie density of what you are eating. On the other hand,
foods that are dry and sugary or full of fat or alcohol increase calorie
content and intake.
Interestingly, warm foods and drinks may stick around in the stom-
ach longer than cold foods and drinks. Cold foods and liquids have
been shown in some studies to stimulate thermoreceptors in the stom-
ach to empty the meal early. I’ve been postulating that Asians may tra-
ditionally be thinner than Westerners because there is a strong cultural
bias against eating cold foods and drink—perhaps they just fill up faster
on less food because it’s warm. Americans and other Westerners who
insist on cold food and drink with meals are more likely to empty their
stomachs prematurely and eat more food at each meal. Warm food
makes the stomach muscles relax and retain the food, thus giving peo-
ple a feeling of being fuller on fewer calories. That may be only one of
the reasons that hot oatmeal fills up the tummy with far fewer calories
than a cold bowl of cereal (besides, it’s a whole-grain product). Finally,
there is a little bit of research that shows capsaicin (the chemical that
makes hot peppers taste hot) may decrease appetite, but the thermal
heat produced in the stomach may have more to do with it than the
peppers.4
I don’t want you to think I hate pharmaceuticals. That’s just not true. I
prescribe other types of drugs every day for my patients and take some
medicines myself. My allergies get to me a lot. I get sneezy and itchy.
Then I take medicine and become hungry and sleepy and dopey from
the side effects. And, since I’m already doc, I’m practically the whole
damn crew of seven dwarfs, all at once!
94 Laugh Yourself Thin
Another weight-loss drug that has held a lot of promise but that
hasn’t really delivered is sibutramine, also known as Meridia, Reductil,
or Sibutrex.6 It was designed to be an antidepressant but failed miser-
ably. However, during the drug trials, subjects were noted to complain
of anorexia (feeling like they would rather not eat). Thus was born a
new diet drug. According to the British Medical Journal,7 you will lose
about 7 to 10 pounds more than if you took a placebo, but you stay on
the medication continuously for half a year. Its main side effect is heart
rate increase.
Another, more successful antidepressant, fluoxetine (best known as
Prozac or Sarafem), is thought to produce weight loss of between 2 and
20 pounds if you take it for six months.8 The problem is that this drug
has a lot more side effects, including nervousness, sweating, tremors,
nausea, vomiting, fatigue, insomnia, and diarrhea. Oh, and let’s not for-
get one of my favorite ignored side effects of this drug class, sexual dis-
interest. With all those delightful symptoms, I’d choose the placebo
section.
Speaking of sexual side effects, I’ve always wondered what the emer-
gency room does with all those guys who take Viagra, Levitra, or Cia-
lis and end up with that infamous side effect, the four- hour erection
that won’t go down. Are the nurses in the back room playing ring
toss?
And, on that note, the average dose for Viagra used for erectile dys-
function is 25 milligrams. But that same exact drug is used for a
lung condition called pulmonary hypertension at much higher doses,
around 60 milligrams.9 It turns out that’s convenient in Florida,
where I live. On sunny days, the patients can double as beach um-
brellas.
into the body and so has limited effects on organ systems outside the gas-
trointestinal system. It will help you lose about one extra pound a month.
It blocks fat absorption, and the result is that fat gets flushed through
your intestines, resulting in diarrhea, flatulence (farting), bloating, pain,
oily stools, and regurgitation.10 Oh, and if that weren’t enough, there’s al-
ways the very popular bowel incontinence and anal leakage. I know I
want to worry about that when I go to parties.
Which reminds me of the rumor that I heard: that the drug companies
are also working on a diet drug that combines that appetite-reducing
hormone leptin and the stool softener FiberCon to produce a medicine
called Lepricon. You do realize that gold is not the only thing you’re
gonna find in that pot.
So now you know how I feel about diet drugs. They are only for short-
term use and generally are more trouble than they are worth. None of
these are “happy pills” for dieting. They are not adding to your plea-
sure or joy, and the weight loss that results is very minimal. Finally,
most research shows that you will gain the weight back as soon as you
go off the medication if you haven’t developed other ways to deal with
overeating and underexercising. Personally, I don’t see the point to us-
ing them.
There are a lot of different names for surgeries, and it gets confusing,
even for physicians. I had a patient who had a diagnosis on his chart of
“failed sex change operation.” I wasn’t sure what that meant. so I did
an Internet search for that phrase “failed sex change operation.” All I
got was an ad for Valentino’s Pepperoni.
The complication rates from bariatric surgeries range from less than
1 percent mortality to as high as 14 percent for other types of complica-
tions (e.g., nonhealing wounds). This is more common in the old-style
“open” surgeries,” where a traditional scalpel incision is made, than with
laparoscopic procedures (the bigger the incision, the more risk of com-
plications).
They aren’t doing incisionless surgery yet for bariatric surgery, but I
have read about gallbladders coming out through vaginas (those two
organs are nowhere near each other). I’m not certain of the advan-
tage of that procedure, except that you can return to the beach in
your bikini the next day. I’m waiting to hear about the testicular can-
cer biopsy being done through the ears. This is the major reason that
98 Laugh Yourself Thin
hospitals have doctors’ lounges—so that surgeons can sit around and
say things like, “Hey, I bet you can’t do this one. . . .”
beneficial to weight loss. Since I’m a big believer in sex (and other forms
of exercise), I strongly recommend it. However, you might find that you
need to plan the timing of your exercise to get the most appetite sup-
pression. Sexercising and other activities might just work best before
bedtime, at least to decrease hunger and the evening munchies.
HARDLY DAVIDSON
One of the problems here where I live is that, until recently, you could
call yourself a nutritionist and not have any real training at all. Florida
is a place where they practice the separation of state and knowledge.
high in calories as “energy foods,” implying that they’ll give you a boost
of energy. In reality, they’ll give you a boost to your hip size.
Manatees eat 16 hours a day and feed exclusively on plants that are like
lettuce. They weigh up to 3,500 pounds. Imagine how much they would
weigh if they ate fried chicken.
Calories are the way that we measure quantities of energy. The more
calorie-containing a food, the more fuel you get. Eat too much fuel, and
your body stores it for later use. It’s an exquisite system that was de-
signed at a time when humans suffered long periods of drought and
famine. When there was relative plenty, people ate as much as possible
to store fuel for the lean times. Evolution hasn’t caught up with the ap-
pearance of the convenience store. Even in developing countries, obe-
sity is becoming a bigger health threat than starvation and famine.
The more you know about nutrition, the more you realize that eat-
ing “nasty” foods is true deprivation. Your body thrives on fruits, veg-
etables, and low-salt, low-sugar, and low-fat foods. When you serve it
anything else, your body lets you know that you have deprived it of what
it really needs. Listen to your body. If you feel tired after a meal, it
wasn’t the right food, or you ate too much. Food, like exercise, should
make you feel energized, not sleepy.
Older studies examining Eastern cultures where people are thinner
than Americans find that rural Asians tend to eat more calories than
people in the United States, yet the Asians are thinner. Why is that?
Dr. Dean Ornish, the proponent of a very low-fat diet, said it’s because
thin Chinese eat less fat. He didn’t mention that, per capita, they also
have fewer televisions, cars, and convenience stores than Americans.
Presumably, a thin, rural Asian has to walk to get places, buy food, and
work his farm. There’s a good chance he might exercise more than the
typical American. The Chinese farm worker probably eats more fresh
fruits and vegetables grown in his own backyard.
Eat Right, Die Anyway 109
leafy things to eat. One thing we do know is that cavemen weren’t eat-
ing goose liver spread or potato chips.
and other health care workers when it comes to dietary advice. For in-
stance, according to a 2007 article in the Journal of the American College
of Clinical Nutrition, although a high-fat diet may actually promote
faster weight loss initially, it contributes to an increase of C-reactive
protein, a well-known marker for inflammation and cardiovascular
risk. If you are a cardiologist, this matters more than the rate of weight
loss. If you are someone like me, who sees a lot of people disabled by
stroke and heart disease, it matters a lot. If you are one of those pseu-
do-“nutritionists” working in a storefront weight-loss clinic and all
you care about is the quick result, you might advise someone to be on
a high-fat diet; you are not worrying about being around when your
patient has a stroke or heart attack.
Interestingly, the hard scientific evidence about nutrition in people
is really pretty lousy. That’s because nutrition is incredibly compli-
cated and foods are made up of thousands of various chemicals. That
doesn’t give us permission to throw our best guesses out the window.
I will say that the jury is far from done deliberating on the ideal type
of diet to follow. Since I have to make some decisions today that are
based on questionable and incomplete data, I do recommend that peo-
ple who are seeking sound weight loss eat lots of fruit and vegetables
and limit excessive salt, fat, and sugar. I believe in limiting processed
grains, also. This advice comes from my personal experience as a phy-
sician and the best synthesis of the medical data. It seems to work for
people all along the health spectrum and for all ages, from the elderly
to young children.
And, speaking of kids, I don’t understand why people name their chil-
dren after food. You just can’t take that person seriously. Take the name
Candy, for instance. What are parents thinking when they name their
kid Candy? What if Adam and Eve’s kids were named Candy and Cain?
People wouldn’t have read the rest of the Bible! I know a couple of Candys
who have important administrative positions, but you can’t help but
doubt their abilities. You might as well name your kid Flapjack. An-
nouncer’s voice, “And the winner of the Nobel Peace Prize—Flapjack
Jones.”
Along those lines, I get complaints that healthy foods result in gas. Flatu-
lence is a favorite topic of mine. We didn’t spend a lot of time talking
about it in medical school, but we should have. In fact, given the inter-
est that the average patient has in avoiding gas, you’d think there would
114 Laugh Yourself Thin
be at least a semester spent on this topic. Two courses that should have
appeared on our transcripts at graduation: “Farts and Belches 101”and
“Write Indecipherably, Like a Doctor.” I would also have liked a course
called “Screaming Effectively at Insurance Executives.” That one I would
have passed with flying colors.
exercise program that you enjoy, and you will have significant perma-
nent weight loss without pain, starvation, or feelings of self-neglect. I
like that. You should, too.
Tomato juice, unlike other fruit juices ( yes, tomato is technically a
fruit) is low in calories and is a great suppressor of appetite, without the
sugar high and rebound that other fruit juices give. One eight-ounce
glass of tomato juice or V8 (low-salt preferably) has about 50 calories
and likely will cause you to eat hundreds of calories less. They are also
packed in serving sizes that are convenient for work and travel. Bring a
six-pack to work with you, and keep them in your desk or in your car.
As if calorie-losing isn’t a good enough reason to drink them, tomato-
based juices are rich in nutrients and lycopene, a natural chemical
thought to be associated with health benefits ranging from eyesight
improvement to cancer prevention. Interestingly, the research seems
to point to the fact that lycopene in tomato products works for cancer
prevention but not when taken in pill form.4 Again, all the more reason
to choose healthy foods and drinks.
If it’s cold or if you just can’t bring yourself to do the fruit thing,
soup is a great alternative as a starter for meals. It’s best to use a thin
soup, not creamed or thickened, since they tend to be calorie or fat-
laden. To suppress the appetite, use chicken rice, vegetable, or tomato
soup or just a plain broth. Have a cup before sitting down to your meal;
you will notice a difference in how much you want to eat of everything
that follows. There is research to prove that the protein and vegeta-
bles combined with the fluids and broth in soups trigger the satiation
signals early in the meal.
the first course, but make certain you eat it all before you eat anything
else. The salad takes work for you to chew and for your stomach to
grind up, giving your body time to decrease its hunger signals. Also,
the volume in salad, particularly of the greens, helps the stretch recep-
tors in the stomach to work with fewer total calories in a meal. It’s
very important that your salad be based on dark green lettuce and not
be covered with a calorie-laden dressing or snuggled up to a mound of
mayonnaise-based creatures like potato or pasta salads. I’m astounded
how often I see overweight people eating “salad,” which they think
will help them lose weight and which they’ve drowned in a high-calorie
dressing or that’s accompanied by some god-awful mushy lump that
was once identified as a food item. I’ve always found those mayo-laden
dishes to be true misnomers. In my mind, a salad should be something
fresh, crunchy, and good for you. If it can’t sit in your garden for the
afternoon without spoiling, it shouldn’t be called “salad.”
the vegetable mantra. And, by the way, frozen vegetables are almost
as good as fresh, in terms of the nutrition, if you don’t have access to
fresh.
Good eating doesn’t have to be complicated. If you just want a
steamed plate of a simple vegetable instead of salad before your meal
(or something raw and crunchy), that’s fine. Just avoid the butter,
salt, and not-so-good toppings that will negate the positive choice that
you’ve made.
Watermelons are called that because they are round and full of water.
Humans are round and full of water, so why aren’t we called water-
melons?
The exception to the rule about limiting your entrée size is when you eat
fish. You shouldn’t eat more than about a deck-of-cards-size amount of
meat, pork, or poultry. But the research has not shown that we need to
limit how much fish we eat. Certainly, bears don’t do that. When I was
up in Alaska, I saw a salmon hatchery. When salmon swim upstream,
they make huge leaps into the air, sometimes right into a grizzly bear’s
mouth. I bet the salmon feel pretty stupid when they do that. Their last
thoughts: “Hey, I guess I should have paid more attention in school.”
the snack and bakery aisles. Use what you now know to your advan-
tage, and modify your behavior accordingly. That way you will be suc-
cessful, and healthy, without feeling deprived.
Some animals naturally eat only one food. Scientists discovered an un-
dersea worm that feeds exclusively on deceased whale bones at the bot-
tom of the ocean. The give-away to the new discovery was the little sign
that said “Eat at Willy’s.”
The reason the monotonous diet plans are so popular for quick
weight loss has to do with sensitization. In a monotonous diet, we be-
come desensitized to the interesting taste of most foods and we desire
less of them. Essentially, we bore ourselves into weight loss. However,
it doesn’t always work for comfort foods and high-calorie sweets. Our
taste buds don’t get bored with them. I can personally attest to that.
When I was 19, after my freshman year in college, I had the Job of My
Dreams: I worked in a hand-made chocolates store. Although I earned
only minimum wage, I was allowed to eat any of the store’s products to
my heart’s content. For three months, I ate exquisite hand-made choc-
olates all day, every day, and never got bored with it. I still daydream
about that job when I’m having a particularly bad day at the hospital.
Really.
• Don’t be perfect, but aim to eat food that is mostly good for you, and
have a good relationship with what you eat.
• You should eat a diet based on fruits and vegetables, less on every-
thing else.
• There is so much confusion in nutritional advice because foods are
complex.
• Healthy food is as tasty as the nasty stuff and makes your body feel
better.
• High-fiber and healthier foods can be harder to digest, for good
reason. Increase them slowly, and find ways to make eating them
comfortable.
• Start every meal with one of the “four great choices”: tomato juice, a
whole fruit, a cup of thin soup, or a salad. This will decrease hunger
and increase nutrition.
• There is no excuse for a boring salad or vegetable dish.
• You can, and should, eat as much fresh or frozen fruit as you want.
• Cut the processed starches and meat/ poultry part of each meal, and
fill up more of your plate with produce.
• Monotonous (one-food or restricted diets) are popular for quick
weight loss because they bore you into weight loss. For most people,
they don’t work in the long run, and they are dangerous to health.
• Always have healthy snacks at hand so you don’t resort to not-so-
good-choices.
SEVEN
Put the Muffin Down and
Slowly Back Away: What
Are Not-So-Good Foods?
You have to watch the food labels carefully. In New York, there’s a
food company that sells something that they label as “real vegetarian
liver.” Now, I don’t pretend to be a vegetable anatomist, but I’m fairly
certain that there aren’t ANY vegetables that grow livers.
Our bodies want good nutrition. Often our bodies will tell us when we
are not eating correctly or if we are lacking in a certain important min-
eral or vitamin. However, we might not know how to correct the prob-
lem. Strangely, though, in many cases our bodies might not even give us
a hint. As mentioned in chapter 5, it is not uncommon for people, both
children and adults, who are nutritionally deprived to eat nonfood items
like paper or paint chips in the subconscious search for the nutrient their
bodies are missing. Don’t send your body down the wrong path looking
for poor food substitutes because you haven’t fed it the right foods. I be-
lieve a well-balanced nutritionally sound diet will help you avoid many
cravings for junk foods, not just paint chips. If you judiciously spend
your calories on proper food, your spouse won’t need to restrain you
from a late-night run to Dairy Queen or find you chowing down on the
morning paper.
126 Laugh Yourself Thin
Listen to your body; it will often give you clues to nasty food and
drink. If you are nauseous or have an upset stomach after eating some-
thing, that’s an important hint. Perhaps the food was bad, as in old and
stinky, or perhaps it wasn’t meant to be ingested by you. Your body will
feel better when it eats food that energizes it.
Animals are pre-programmed with cures for bad food that results in an
upset stomach. People, unfortunately, are clueless. Dogs know to eat grass
if their stomach gets upset. Why don’t humans do stuff like that? If we’re
the top of the evolutionary ladder, we should inherently know these sim-
ple cures. Wouldn’t it be cool if a guy is at work and he says to his buddy,
“Man, my stomach is upset from this hangover. Hey, Joe, watch my monitor
for a second. I’ve got to go outside and eat some grass”? Even NASA ought
to get in on stuff like that. Space crews should take a patch of sod with them
on every mission. Hey, space dude, don’t forget the fork—and a putter.
In general, the simpler the ingredient label, the better, as the food is
less likely to have chemicals you don’t want. However, if the list looks
like “fat, sugar, salt,” that food item probably isn’t good for you, either.
(The label is required by law to rank ingredients in order, with the main
ingredient first and the rest in descending order according to quantity.)
I was eating salad with low-cal dressing, and I made the mistake of read-
ing the label. It had a list of ingredients too numerous to count, the last
one being titanium dioxide. Which means, I guess, if I eat enough of it,
I’ll have buns of steel.
Put the Muffin Down and Slowly Back Away 127
Fats have gotten a bad rap. I think it has to do with the word. People
have come to believe that you get fat by eating fat. The truth is you get
fat by eating too much and not moving. Fats are not the only culprit, but
they’ve certainly taken their hits by health professionals and the media.
Don’t eliminate fats, but choose them wisely and you can leave your fat
buttocks behind.
Did you ever wonder why, when you eat an animal, it gets a different
name, like cow becomes beef and pig becomes pork? Deer is suddenly
called venison, but chicken is still chicken. It should be called something
like shlemiel. “Here, have some grilled shlemiel.”
There is research that shows that on our planet, cow belching and fart-
ing are among the biggest producers of that highly volatile gas, meth-
ane (a major cause of global warming). Using that knowledge, I have a
new idea that would solve two major international problems at once. The
next time there’s a mad-cow outbreak, instead of slaughtering all those
innocent bovines, pack them up and send them to the war zone du jour.
Then simply use the methane that the cows produce as a new weapon—
moooo—BOOM!
LIVING LARD
I’ve got some really good medical research to back me about the relation-
ship between high-protein diets and kidney disease. The Nurses’ Health
Study from the Harvard Medical School looked at 1,600 middle-aged
women with mild kidney disease.2 Those who ate the most protein faced
a risk of losing kidney function that was 350 percent greater than the risk
of those who ate the least amount of protein. (If you lose enough kidney
function, you end up on dialysis or a transplant waiting list.)
The Third National Health and Nutrition Examination Survey, done
at Stanford University, looked at both men and women ages 20 to 80,
a much broader population. What they found is that those who ate the
most protein didn’t necessarily develop more kidney disease, unless they
also had hypertension and diabetes.3 Since overweight people are the
most likely to have those diseases, it may very well be dangerous to you
to eat large amounts of protein.
130 Laugh Yourself Thin
Are you still with me? This is where the data get more interesting.
When the authors of Harvard’s Nurses’ Study looked at what types of
protein were being eaten, they could find a correlation only between pro-
gressive kidney damage and animal flesh protein, not vegetable or dairy
protein.4
Why does protein matter to you? Because people who are cutting
calories to lose weight tend to cut calories uniformly, resulting in pro-
tein malnutrition. Your body needs as much protein now as it did when
you were younger, to build muscle and keep body processes flowing.
In fact, chronic dieters (and the elderly) are some of the most protein-
malnourished people in the developed world. If your body doesn’t get
enough protein from your food, it resorts to breaking down its own mus-
cles to continue body functions. Thus, if you don’t eat enough protein,
you’ll actually cause muscle wasting and weakness, which is the last thing
you want! But, unfortunately, an animal-protein diet might promote a
three-day-a-week schedule on dialysis. Luckily, there just might be a
solution.
can have up to five teaspoons of added sugar in each cup or added chem-
ical sugar substitutes. Get the plain or natural versions, and add your
own fresh or frozen fruit—it’ll taste much better that way.
Sugar is another area that’s gotten a bad reputation. Our bodies natu-
rally crave sugar and are programmed to want and eat it, even if we can’t
taste it! A study published by Duke University in 2008 looked at mice
that had been genetically altered to be unable to taste or smell sweets.5
Yet, when those mice were given real sugar water, their brains responded
with a burst of the neurotransmitter dopamine, the same chemical that is
released in the brains of addicts when they get their favorite drug. When
presented with an artificial sweetener, sucralose, in the water, the mice’s
brains didn’t respond. This means that the brain centers that are involved
in reward and pleasure respond to both calories and sugar separately,
whether the sugar is tasted or not.
What’s interesting about the study is that the normal animals that
could taste the sucralose artificial sweetener also had a brain surge of
chemicals in their pleasure centers of their brains, even without the calo-
ries. Both types of animals wanted more of the sugar-type taste (when
they could taste it) and wanted the calories (when their bodies had time
to register the calories). This has many implications, the most obvious of
which is that sugar taste (real or artificial) may drive people to want to
eat or drink more calories. It may explain why drinking diet sodas and
eating artificial sweeteners does not result in weight loss.
product. The syrupy canned product is more likely to have additives and
preservatives and is not as safe to eat as a simple whole fruit. You like
sweets? So do I. Get them naturally, and your body will thank you, for
a lifetime.
All right, I’m willing to admit it; “natural” does not necessarily mean that
something is good for you. The black plague is all natural, and so are
cobra venom and pond muck—mmmm, want some?
I eat frozen fruit frequently, pretty much daily, since I make my son’s
smoothies from frozen fruit. I usually sneak some of the fruit, popping
the pieces directly in my mouth while I’m preparing the smoothies. It
gives the same yummy brain chemical rush as any other sweet dessert,
without the guilt. Buy big bags of your favorite fruits already frozen, and
prepare bowls whenever you want. A cup of frozen blueberries has about
80 calories and is a to-die-for delight. Peel bananas and throw them in
bags in the freezer, then microwave them briefly and munch on down. It’s
so much cheaper and healthier than any other dessert, and you can eat
it all day long! Fantasizing about eating three scoops of rich ice cream?
Eat a huge bowl of frozen blueberries, strawberries, and cut-up bananas.
Top it with a little bit of chocolate syrup and chopped nuts, and you have
the best-tasting sundae on the planet. (Better yet, drizzle the chocolate
syrup on your significant other and eat the fruit off him or her. Just give
a warning before you do it. Oh, and don’t use frozen fruit or you’ll be
facing shriveled, unhappy parts and an unhappier partner.)
Medical researchers have explored the headache that you get from ice
cream, better known as “ brain freeze.” It turns out that it runs in fami-
lies; if your parents suffer from it, you are likely to get it, as well. (Which
brings up the delicate subject of genetic counseling.) There is another
term for brain freeze; it’s called video games. As in when my son’s mouth
is going at 100 miles an hour: “ Here kid, have this video game control-
ler.” Ta daa, instant brain freeze.
134 Laugh Yourself Thin
Dried fruit isn’t as good as whole fresh or frozen fruit because you
are missing the water, which is what’s so helpful. Eat grapes instead of
raisins, plums instead of prunes, and give the kids cut-up cantaloupe in-
stead of fruit roll-ups. Sugar is everywhere, and it’s something that we
naturally crave. Eat it with gusto, just the way nature gave it to us, in the
purest form. Enjoy!
Sugar really is everywhere, even in places you don’t expect it. According
to the National Radio Astronomy Observatory, an eight-atom sugar mol-
ecule has been found in an interstellar gas cloud near the center of our
celestial Milky Way. The Mars confectionery company may have been
onto something when it named its candy bar the Milky Way.
more fresh fruits, vegetables, and unprocessed items and less of the nasty
stuff, the salt drops away.
Chinese food factories have been caught putting all sorts of nonedible
contributions into their products: chemicals, plastics, parts of animals we
don’t want to eat. Perhaps they thought that when we name our product
Bob Evans, we mean it. As in, “Oh, look, there’s Bob now.” Their motto
could be “We stand in each and every one of our products.”
The reason whole grains help with weight loss is that they hold water,
and processed grains (often called refined grains) do not. Notice that
theme again of increased water content in food? When the water is mixed
into the food item, you feel full on fewer calories, and you never starve.
Traditional breakfast cereals, pizzas, bagels, breads, pastries, cookies,
cakes, pies, crackers, chips, and pretzels are usually made from refined
grains, and that’s why they have a bigger calorie load and won’t satisfy
the appetite. White rice is stripped of its nutrition; brown rice is fiber-,
vitamin-, and mineral-rich. Unprocessed oatmeal is a whole grain and
absorbs a bunch of water, and it’s heavy in the stomach. Eat a big bowl
of steaming fresh-cooked old-fashioned oatmeal (about 300 calories in
a double serving) and you’ll be full for hours. Eat too many take-out
muffins from a typical chain bakery shop (about 600 calories each), and
you’ll still be hungry while you’re waggling your tush right into the emer-
gency room.
While we’re on the subject of protein and food myths, let’s talk about
eggs. The poor misunderstood egg. I never really questioned what I had
been taught in medical school about the bad effects of cholesterol from
the egg yolk, that is, until I met my patient, the “Egg Man.” Mr. Egg
Dude was addicted to eggs; he ate them morning, noon, and night. On
an average day, he had a six-egg omelet for breakfast, several egg-salad
sandwiches for lunch, and up to a dozen hard-boiled eggs for dinner. (As
Dave Barry likes to say, I am not making this up.) Yet the man had low
total blood cholesterol, was thin, and was in the hospital due to trauma,
not because of any heart or medical illness. His mother insisted that I do
a thorough medical and blood evaluation because she wanted some
138 Laugh Yourself Thin
Did you know that French fries were invented in Belgium by the Flemish?
I guess Flem fries just didn’t sound appetizing.
Instead, when ordering and at home, use lean meats, poultry, fish,
tofu, and soy products that are boiled, baked, or slow-grilled (lower
temperatures). Lower-temperature cooking is thought to be safer; it
Put the Muffin Down and Slowly Back Away 139
produces fewer toxins in the animal protein. Again, this may have to do
with keeping the moisture in the animal flesh, so try not to dry out the
meat or poultry when cooking (and it will be more filling that way). Try
to avoid smoked meats and fish, since the nitrites (or nitrates) haven’t
been proven to be safe.
At home or away from your kitchen, look for salsa, marinara, olive
oil, lentils, hummus, guacamole, beans, legumes, vegetables, and fruits.
Get the noncreamed soups, the plain eggs, and the crunchy salads. Use
salsa and hot and sweet peppers for flavorings on potatoes, eggs, or veg-
etables or as a salad dressing.
Even at home, understand that those granola and energy bars that
you buy at the convenience store to eat on the run or for breakfast—big
buzzer sound—they’re really not so good for you. The advertisers love to
produce commercials with buff models on mountain bikes at the edge of
cliffs munching on those “health bars” so that you’ll believe you’re eating
something more than candy bars dressed up in Halloween costumes.
A funny thing about pizza, pasta, bagels, and dessert items is that they
are often a comfort food, brought out in times of strong emotions or
stress. Comfort foods don’t have to be bad for you, although they do
tend to be high in calories and fat and are often simple carbohydrates.
Determine what your comfort foods are and don’t abandon them, but
do use them more judiciously. Pick your comfort foods and save them
for special times, and always pair them with healthier foods, like a salad
before the pizza. Then you will literally be able to have your chocolate
cake and eat it, too, without stress, guilt, or undue physical or mental
costs.
Which brings me to the last point, whether to eat sweets and yummy
desserts at all? Of course you should! Just realize that it is my sincere
belief that it is better to eat a small amount of the authentic item (reg-
ular cookie, real ice cream, or rich high-quality chocolate) than larger
amounts of the imitation stuff. Fat-free foods are not necessarily better
for you, as they are often high in sugar. Low-sugar foods are often loaded
with bad-tasting chemicals. The real thing tastes better and is more sat-
isfying. You’ll end up eating less junk food and feeling better about it
in the end. My favorite food, high-quality chocolate, is something I eat
often, in small amounts, and completely enjoy. No deprivation neces-
sary, and no binging. Because I know I’ll be eating it again soon. How
beautiful is that?
• Not all fats are bad for you; vegetable and olive oils are beneficial.
• Animal protein leads to a wide range of health problems in the
overweight.
• Vegetable-based proteins, dairy, and eggs are safer and will get you
thinner.
• Added sweeteners, either sugar or high-fructose corn syrup, make
you fat.
• The natural sweetness in whole fruits is safe.
• We eat way too much salt for our health; eliminate excess salt by lim-
iting processed, prepared, canned, and restaurant food.
• Read the labels and avoid MSG, artificial sweeteners, and colors.
• A true whole-grain diet will get you to slimness and keep you there
permanently.
• The lactose intolerant can train their bodies to eat dairy again.
• Use everything you’ve learned for better restaurant ordering and meal
planning.
• Eat small amounts of your favorite authentic sweet or comfort food
regularly so you don’t feel deprived.
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EIGHT
Water Intolerant:
The Right Drinks
Occasionally I will debate with other health care workers which organ
is the most important one in the body. Personally, I think it’s the colon.
It stores stuff and absorbs water. Without it, you’d be dehydrated and
incontinent. It’s a maligned organ; you don’t know how much you
need it until you lose it. This is unlike the brain, which is totally over-
rated. We’ve all known people who seem to get along just fine without
their brains—they often become bosses.
diets. The main way to slip extra calories into the diet of a person who
is not very hungry is to give the person high-calorie liquid supplements
between meals. Did you know that the body does not register most liq-
uids as extra calories? So when the next meal rolls around, my patient is
hungry again and the weight comes back up. Conversely, liquid “secret
calories” are often the easiest target to eliminate in a person who is over-
fed calories.
In the person who is overweight, the secret calories may come in the
form of colas, sweetened coffees or teas, juice, alcohol, energy drinks, or
sports drinks. I’m a strong believer in eliminating all high-calorie bever-
ages from the diet permanently.
Coca-Cola is used for all sorts of things other than drinking it. In the
hospital, we use it to unclog feeding tubes. Mechanics use it to get rid
of gunk on engines. I’ve even heard of women trying to give themselves
abortions with it. That doesn’t work. The gynecologist: “Well, you’re still
pregnant, but you don’t have any rust.”
I went to a dermatology lecture where the doctor said that duct tape
works to eliminate warts. Diabetes is largely reversible with weight loss;
its treatment is the same as for warts. Use duct tape, just in a different
place.
146 Laugh Yourself Thin
Artificial sweeteners are not the solution. Harvard has said on its
public health Web site that the beverage industry needs to get more re-
sponsible and develop attractive sweetened drinks with fewer calories,
preferably without zero-calorie sweeteners. However, a lot of health pro-
fessionals have been counseling people to switch to saccharine, sucral-
ose, aspartame, and the other low-calorie chemicals. I’m not sure that’s
a good answer. The reason lies in new evidence suggesting that ingestion
of artificial sweeteners may also create obesity.
Purdue University psychologists Drs. Susan Swithers and Terry Da-
vidson found that rats exposed to diet sweeteners are more likely to con-
sume excess calories than those who drink sugar-containing beverages!4
Their saccharine-fed rats gained more weight and put on more fat than
those fed a simple sugar. Those fatter rats never cut back in their eating
habits later. The researchers believe that the use of artificial sweeteners
causes a break in the body’s ability to regulate intake and metabolism.
Since the substances are sweet, the body believes it’s about to get a lot of
calories; when it doesn’t, it actually spurs feeding to get those calories it’s
anticipating. This would explain why other studies of artificial sweeten-
ers have not conclusively demonstrated that they help in weight loss.
People think that the Japanese live so long because they drink green tea
with antioxidants. But it’s really all the exercise they get running away
from Godzilla.
I’m amazed that people will spend four or five dollars for a cup of espresso
or cappuccino, which is essentially coffee with a fancier name. In a recent
study, people thought a wine labeled as inexpensive tasted worse than a
costlier one, even though it turned out to be the same wine in both bot-
tles. This is known as the Ripple Effect.
Many people have no idea that their daily whipped flavored coffee
or latte from their favorite coffee shop adds up to 500 or more calo-
ries a day, with none of those calories doing anything beneficial for the
body. Plain black coffee with a little skim milk has 450 fewer calories
and gives the same caffeine jolt. Talk about avoiding secret calories!
Save your money and brew your own; then be judicious with what you
add to it.
I’ll never forget an interview that I read. A famous singer was extolling
the virtues of coffee enemas. I’m thinking to myself, “You’re supposed to
drink it, not stick it up your ass.” Are there different types of coffee en-
emas, based on the day that you’re having? Does the therapist give you
a double espresso when you have a deadline looming? A flavored latte
when you’re feeling down? Decaf when you’re stressed? I’m wondering
if drive-through colon therapy isn’t too far behind (pun intended). The
drive-through attendant: “All right, back it up here!”
Water Intolerant 149
I was on a cruise ship in Croatia, and it had a sign over the toilet on how
to flush and what not to flush. There was one of those universal sym-
bols of a red circle with a line across it, only it was a drawing of a person
tossing a champagne bottle into the commode. You’d have to drink the
whole bottle to be that stupid, right?
Professional football player LenDale White learned the hard way how
much alcohol can affect body shape. According to an Associated Press
article, when White decided his pudgy physique was affecting his perfor-
mance and that it was time to lose weight, all this NFL player did was
cut out tequila. In six months in 2009, he lost more than 35 pounds. He
admits he did nothing else to lose the weight but cut out his favorite bev-
erage. By the beginning of the next pro season, he felt he was in the best
shape he had been since high school.
There are those who insist that daily alcohol intake is important to
health since moderate alcohol ingestion decreases the risk of heart dis-
ease and diabetes. But that same amount increases your risk of breast
and colon cancer. So don’t imbibe purely for your health.
People fall into one of three categories for the ability to process alcohol.
Most people can drink moderate amounts before getting drunk. People
who imbibe heavily rev up their enzymes and can process more, until
their liver starts to fail. My liver is essentially decorative; I get drunk on
nonalcoholic beer. I like to say that my liver is a placeholder waiting for
a better organ to come along.
Cut back on the liquor along with the food, and you will be much
safer, as will those around you. Finally, and this is a very serious issue
medically, obesity can lead to fat in and around the liver, which may
change the way the liver processes alcohol (and other toxins and medi-
cations) over time, even sometimes leading to permanent liver damage.
Thus, simply being overweight can cause a person to stop being able to
handle liquor. Being fat is never a benign condition, and it should never
be accepted as medically safe. Obesity (without alcoholism) is now one
of the biggest causes of cirrhosis, from fatty liver, and of the need for
liver transplantation.
A good rule of thumb for all beverages, alcoholic or not, is that they
should never have more than about 50 to 100 calories in them for an
eight-ounce glass. And you should try to limit your total drink calories
to no more than 200 calories (for a small woman) to about 300 calories
(for a tall man) a day at the most. That helps to limit your intake of those
surprise calories that add nothing to your body except fat tissue. Drink
water, skim milk, simple tea or coffee, or tomato or vegetable juice prod-
ucts (and watch the salt). There are plenty of opportunities and varieties
152 Laugh Yourself Thin
They are cold all the time, appear listless, and have very little muscle
strength and lousy sex lives.
In a study done at Washington University of St. Louis, participants
on a two-year caloric restriction diet lost plenty of weight (some were
overweight), became food obsessed, and lost bone mass.1 But they
had much better blood pressure and cholesterol. It’s too early to tell
whether humans live longer on fewer calories.
Most diet books surreptitiously encourage yo-yo dieting since they have
you starve and restrict yourself up front, frequently in “phases.” I just
finished reading a weight-loss and exercise book written by a retired
lawyer. It was full of really bad health advice. This was just another in
a series of self-hurt books.
television, or desk jobs. I bet that kept them burning fuel, too. (I’d
hate to think that Dr. Campbell spent so much time thinking about
vegetables that he started to imagine that his subjects were as active
as vegetables. His book is a brilliant compilation of some very impor-
tant research, but he completely missed a big issue in weight loss—
exercise. This gets back to my point about the problem with nutrition
and obesity research. Everybody has his own very different agenda,
background, and point of view, which then skews his interpretation of
the data.)
That’s assuming you have a sex life. When I was in medical training,
the doctors were forced to work 80 to 100 hours a week. I’d come
home completely exhausted. When my husband would indicate he was
in the mood for a romp, I’d tell him the only feel he was getting was
necrophilia.
including the experts, are usually very far off in their estimates of their
calorie intake! In a New England Journal of Medicine article from the
early 1990s, 10 overweight people were asked to estimate their calorie
intake. They were off by about 50 percent, estimating that they were
eating about 1,000 calories a day when they were actually eating 2,000
calories. That’s a remarkable difference. In fact, overweight people tend
to be more inaccurate in estimating calories than normal-weight indi-
viduals. This may be due to denial, or a lack of practice, or the fact that
obese people eat more calories, so their margin of error is greater.
However, even professionals, like dietitians, are usually off by around
20 percent, about the same amount that normal weight people mis-
estimate.
Calorie counting isn’t difficult, but if you need help, there’s lots of ways
to get it on line. For instance, wolfromalpha.com allows you to get the
answer instantly to the question “How many calories are in a cubic
light year of ice cream? ” You can even specify if your cubic light year
is made up of Breyer’s French vanilla or Healthy Choice pralines and
caramel.
enough as they age, and this causes middle-age spread. As the body
ages, it has less lean muscle mass and tends not to move as much. When
was the last time you rode your bike, walked to work, played tennis,
or jogged a few miles? Maybe you used to do that when you were
younger, but you are very likely more sedentary now. Interestingly,
spontaneous movements (fidgeting) decrease as we age. So, between
the reductions in our planned exercise and unplanned movements, we
get less activity. This results in reduced caloric needs. Meal portions
need to go down or activity must go up so that the intake and output
equalize.
There’s been a new theory floating around that viruses cause obesity.
It just reinforces the denial syndrome and lack of responsibility that
many people have toward their health. It’s so much easier to blame a
virus than one’s own habits. “Oh, great, it wasn’t the triple cheese-
burger with supersized fries I’ve been eating for lunch every day for
the past three years; that’s a relief.” I love those people suing the fast-
food franchises over their obesity because they don’t know how to shut
their mouths and walk out the door. What’s next, suing the Centers for
Disease Control for not curing my “fat virus”?
And, speaking of bulk food clubs, there was a recent Harvard Univer-
sity economics study that found that people sometimes spend exces-
sively when they go to wholesale stores. The reason is that consumers
160 Laugh Yourself Thin
purchase stuff in bulk that they don’t really need. Somewhere in Amer-
ica, right now, a husband is explaining to his wife why he needed to
buy the 100-quantity package of puppy butt corks.
Fruit roll-ups are so popular among kids that it seems there ought to
be an adult equivalent: Carnivores’ quick snacks, new Cow by the Hoof.
Some thin people are an exception to the “eat frequently” rule. They
do better if they eat only two meals a day and have no problem skip-
ping meals. What I do know is that most people will not eat with con-
templation and proper meal preparation if they have let themselves
get too hungry. Making decisions about proper “good-for-you” foods
and proper amounts are best made when one isn’t starving. Dr. Ancel
Keys found, in a famous study done years ago, that people who chroni-
cally fasted and felt very hungry tended to then binge-overeat and be-
come food-obsessed.5 Interestingly, when I worked on an adolescent
eating disorders ward, the anorexics and bulimics loved to talk about
cooking and the recipes that they would make for others. Then they
would skip meals and starve themselves.
I’m not a big fan of meal skipping; however, there has been some re-
search showing that people who routinely fast will lose weight. People
who skip eating for an entire day will make up some, but not all, the
skipped calories the next day. When fasting on a regular basis, such as
every other day, most people will end up eating fewer calories overall.
I can’t concentrate when I’m hungry, and I don’t think most people
function well when extremely hungry, so, if you are like most people,
you are better off losing weight and keeping it off by eating small meals
regularly. If you are the exception and don’t mind skipping meals, you
might succeed with less frequent feedings. The key is to remain func-
tional and pleasant to be around, without binging later; most people
can’t do that when they are chronically severely hungry.
You are better off if you don’t go more than five hours without eat-
ing during the day, because it reduces the risk you’ll overeat at the
next meal. Snacking is not linked to obesity, but what you snack on
Living Extra Large 163
is. If you snack on fresh whole fruits or veggies, low-fat cheeses, a cup
of soup, unprocessed low-fat meats, all-natural yogurts, a handful of
nuts, or tomato juice, you will be fine. If your snacks are cold pizza,
pretzels, chips, bagels, donuts, or half a can of nuts and 20 ounces of
juice or cola, you will likely become (or stay) obese.
People are always talking about how vending machines are causing
obesity in schools and the workplace. I have a solution: vending ma-
chines should be rigged up with a camera that measures waist circum-
ference before it dispenses the treat. If you’re fat, you get your money
back but no snack. Suddenly, in break rooms all over America, you hear,
“Hey, Dave, come over here, stand in front of this machine.” If the cam-
era needs a fish-eye lens to see both sides of your body, you’ll hear a
machine voice say, “Access denied.”
Fatigue is what drives us to eat at night. A recent study found that one
ounce of dark chocolate will help improve chronic fatigue syndrome
almost as much as being chased by a very large lion. So, both must be
good for you, right?
I don’t always get to enjoy my meals in peace. I’ve got this neighbor’s
kid who insists on practicing the trombone in the evening, badly, at his
house, with all the windows open. He is truly awful. Why can’t his par-
ents insist that he go out in the garage and close all the doors—and
leave the engine running?
I have another neighbor’s kid, who comes home from high school
every day and practices on his bass guitar for two or three hours so
loudly it actually makes my house vibrate. I finally went over the other
day and asked him if the name of his band was Crack the Paint.
Living Extra Large 167
has shown that people instinctively eat faster (and therefore are prone
to eat more) in a bright and noisy environment. That’s why fast-food
places look and sound the way they do.
Nurses’ stations are very noisy places: lots of activity, buzzers, talking,
and alarms ringing. Our local hospital’s administrators got the genius
idea of putting a noise meter at each nurses’ station to discourage noise
so that the patients can rest easier. Guess what happens if we surpass the
acceptable noise level? Yep, a piercing alarm sounds! This explains why
a hospital administrator has never won the Nobel Prize in medicine.
• Don’t skip breakfast, and eat frequent small meals all day long. Stop
after dinner.
• Snacking isn’t related to obesity, but what you snack on is.
• Nighttime snacking is related to fatigue, not hunger, and leads to re-
flux disease.
• There is no better way to truly enjoy eating than to meditate on it.
• Turn down the lights and noise, play soft music, and eat mindfully,
and you will eat less.
• Improve your internal and external environment and you will im-
prove your joy and health.
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PART III
Output—Metabolism
and Activity
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TEN
That Which Doesn’t Kill
You Makes You Fatter:
Increasing Metabolism
Practically every diet book, plan, and product on the market prom-
ises quick weight loss. But that isn’t the kind of weight loss that you
want; it’s only water weight, not fat tissue. That’s why quick-weight-
loss programs aren’t sustainable and are unsuccessful. You can dehy-
drate your body only so much, and eventually you will reabsorb that
water back into your tissues. The next time you see a promise of quick
weight loss in any type of diet plan or product, run like heck in the
other direction. That program or supplement won’t help you in the
long term, and it could very well hurt you.
Slow, sustained, and permanent weight loss is what you should want
because that’s the type of weight loss that results in adipose tissue loss.
Permanent, healthy weight loss involves shrinking fat tissue and oc-
curs through slowing calorie intake and increasing metabolic rate. If
you try to lose weight too quickly, you will damage yourself by losing
muscle mass (that’s the stuff you want to keep) or causing electrolytes,
such as sodium or potassium, to be imbalanced.
174 Laugh Yourself Thin
of thick thighs and not enough time contemplating how to move those
thighs. Yes, twin studies and adoption studies show that people are
more likely to have a metabolic rate that is similar to those of their bi-
ologic parents than one like their adoptive parents’. So your quick or
slow metabolism is somewhat determined by genes. However, this can
be modified by nurture, by what you do to speed up your metabolism.
Heredity is not destiny.
You can control your own metabolism, and you have a lot of power
in this regard. We’ve discussed a little bit in earlier chapters about how
metabolism is affected by such things as starvation and eating cycles
and also perhaps by ingested chemicals like artificial sweeteners. In
addition, metabolism is affected by exercise, sedentary activities (like
television watching), temperature, foods, hormones, medicines, and
muscle and adipose tissue.
By now, you are probably getting the idea that exercise is the pre-
dominant way to increase your metabolism. I go into specifics in the
next chapter, but suffice it to say that the more that you move your
body, the more you can increase your metabolism—to a limit.
You’ve probably heard or read about the advice to park your car
further away from your destination or to take the stairs on a regular
basis, rather than the elevator. Yes, these do increase activity in little
bits (plus, you can test whether you are developing improved exercise
tolerance). But what about those hours that we spend in sedentary
activities, like when we’re tied to our computer desk, reading chair,
or couch? Amazingly, research on fidgety and quiet kids reveals a tre-
mendous difference in the energy people expend in a typical day.
NEAT, or non-exercise activity thermogenesis, is the energy that a
person expends in activities not usually thought of as exercise. This is
the fuel that you burn every day when you are standing up and holding
your posture while talking to a friend or fidgeting in your chair during
a boring television show or lecture. Some people move a lot more than
others every day; they are more fidgety. Those people, it turns out, may
have an advantage in metabolism.
We solved our problem with the annoyance factor with my son on long
car rides. When he gets really fidgety, we just make him get out and run
alongside the car. That way he gets his exercise.
Research has looked at both children and adults and their NEAT
expenditures and has found that those who fidget more (measured by
motion sensitive devices) lose weight or prevent weight gain more eas-
ily, even when deliberately overfed. So now the question you need to
ask yourself is: how do I learn to fidget more, all day every day?
That Which Doesn’t Kill You Makes You Fatter 177
continued to move less than naturally thin people. (So now you know
why television watching is directly related to obesity. Studies show
that the more you watch, the less you move and the more you weigh.)
This might explain why formerly obese Americans eat almost half
the number of calories daily that thin rural Asians eat. I believe those
Chinese farmers move more all day, every day, although I haven’t
strapped any special underwear to them to prove it. (If you remember
the Cornell scientist Dr. Campbell from The China Study, he asserted
that eating vegetables makes you burn more calories and implied that
perhaps you might even move more! I have yet to find any research to
show that veggies make you wiggle, but it’s an interesting idea.) Eat
more beans. It isn’t just the gas that might propel you forward.
The great thing about being a scientist is that, if you play your cards
right, you can get people to do all sorts of ridiculous things in the name
of science. I’ve been meaning to call Dr. Levine and ask him where he
got his special gyroscope-equipped underwear. Think of the uses! But
it’s not just those literally smarty-pants geeks in ivory towers who can
do great experiments in the name of progress.
True story: one of my friends has a husband who is a contractor by
trade, but his dream was to become a scientist. Shortly after they had
their last baby, her physician gave her a free box of sample condoms. She
took it home and threw it in a drawer and forgot about it. Unfortu-
nately, her hubby didn’t. He had a peculiar interest in trying a novel ex-
periment, his curiosity having been piqued by an article about a concept
the Chinese are using—biogas. They are converting methane from sew-
age into useful energy. Mr. Science Wanna-Be decided to measure the
amount of methane the trap produces in his house. Picture this—my
friend driving up to her suburban home with a minivan full of kids,
only to find fully inflated condoms attached to her roof, flying in the
wind, in full regalia.
By the way, the last time I saw a photograph of Dr. Levine, the Mayo
Clinic researcher, he was cruising the Web on his computer while walk-
ing gently on his treadmill. That’s right, his treadmill. He doesn’t even
have a seat in front of his computer in his office! And, yes, that geek
researcher is one skinny dude.
That Which Doesn’t Kill You Makes You Fatter 179
What’s fascinating is that the type of food isn’t the only thing that
is responsible for how much fuel you burn when you eat. There’s now
evidence that your health determines how many calories you expend
to break down your food—the more fit you are, the more your body
burns fuel to process the same exact lunch. Your level of fitness might
account for up to 40 percent of the thermic energy expended. This is
an amazing finding and helps explain why fat and unfit people gain
weight at a faster rate than people who are in shape. No, it’s not all in
your head; if you are a couch potato, that bag of chips you’re eating
will stick to your butt more than to Mr. Super Jock’s. You may have
suspected it, but now you know the truth: your own adipose tissue is
working against you.
The good news is that you can destroy the fat cells that are work-
ing against you with exercise (and perhaps with regular doses of
vitamin C, which seem to increase thermogenesis in sedentary folks).4
That Which Doesn’t Kill You Makes You Fatter 181
When you burn energy, you generate a lot of heat. That’s why exercise
makes you warm up and sweat. Sweating is your body’s mechanism for
dissipating heat. This fact makes me wonder whether that whole story
about the Land of Oz might just have been a fantasy. Look, even if the
Wicked Witch of the West never exercised, why didn’t she just melt
on a high-humidity day? Really, if the Munchkins had thought about
it, they didn’t need Dorothy. They only needed a decent humidifier.
My son’s school library has one couch that’s always occupied by sleep-
ing students. They fight to get it on their breaks between classes. I think
it ought to be reserved through a reward system, like what businesses
do for special parking spaces. A sign above it should say, “This couch
reserved for Jane DoGooder, student of the month.” Annually the dean
announces, “And the winner of the Golden Cot award is. . . . ”
ing to insulin. If your muscles and organs no longer “hear” the insulin
your pancreas is putting out, eventually you develop diabetes. Impor-
tantly, there’s new research to show that fat cells may also release hor-
mones that make muscle cells deaf. (Picture those adipose cells stuffing
cotton in the ears of the muscle cells. The cells become like an old mar-
ried couple: “I can’t hear you, I don’t wanna talk to you. Leave me
alone, I’m having a bad day.”) Unfortunately, that bad day can trans-
late into a lifetime of pills and injections, not to mention amputation
and blindness.
A study at Washington University in St. Louis bred fruit flies to be
insomniacs. The resultant flies show symptoms of chronic sleep de-
privation.6 The fruit flies sleep only an hour a day, as opposed to the
normal 12 hours, and as a result have poor memory, fall over a lot, and
are fat. (Since I read that article, I’ve been envisioning some frustrated,
underpaid researcher sitting in a lonely lab trying to measure an obese,
staggering, stupid fruit fly on a teeny-tiny scale . . . and you think
your job sucks.)There are easy things that you can do to improve your
sleep. Proper rest is important not just to lose weight but to improve
your immune system. There are no short cuts. Get enough sleep, at
least seven hours a night. As a pain physician, I strongly believe that
chronic pain diseases like fibromyalgia are directly related to too little
and poor-quality sleep. I see a lot of chronic pain syndromes in over-
weight patients.
If you are having difficulty falling asleep or staying asleep, you
might need to improve your “sleep hygiene.” That’s the environment
that you rest in and where you prepare yourself to rest. It’s more im-
portant than you realize. Don’t watch television or stare at computer
screens before bedtime; the light from the monitors causes insomnia.
Don’t read or listen to stories that are too exciting or frightening be-
fore bed; it’s better to listen to quiet music to calm the brain. Sleep on
a good bed in a dark room.
Avoid alcohol before bedtime. It will make you fall asleep, but dur-
ing the night you’ll wake up more easily, and your deep sleep will de-
crease. As mentioned earlier, avoid caffeine and chocolate in the late
afternoon or evening. Avoid taking medications late that may stimu-
late you to stay awake, like theophylline, Prozac, or Ritalin. Sleeping
pills do the same thing as alcohol; they may get you to sleep more
quickly but not improve the quality of your sleep. Nicotine is a stimu-
lant, too. Do I need to tell you again? Please quit using tobacco, and
never smoke close to bedtime.
For many people, exercising right before bed produces too much
adrenaline to fall asleep, so plan your vigorous activity for earlier in the
day. Daily aerobic exercise of at least 35 to 45 minutes will improve the
quality of your sleep. I find that when I walk every day for about three-
quarters of an hour, I sleep better, but for shorter amounts of time,
closer to seven hours than eight. The end result is that I don’t use up
any more free time between my exercise and my sleep. So there, now
you truly have no excuse not to exercise. Don’t tell me that you don’t
have time!
Finally, on the subject of sleep, I need to mention sleep apnea. That’s
the syndrome that results in a lack of oxygen from not breathing prop-
erly during sleep. Often overweight people don’t sleep well and they
don’t know why, when the reason is that they aren’t getting enough
oxygen to their brains. Obese people have a much higher rate of sleep
apnea than the general population. There is now research to show
that if you snore (a common sign of sleep apnea) or have known sleep
apnea, losing just 10 percent of your body weight may cure you of the
condition.7
Putting more emphasis on your rest may be one of the most useful
things you do to improve your health and one of the most effective
steps toward permanent thinness. Don’t underestimate how important
it is to sleep well.
That Which Doesn’t Kill You Makes You Fatter 185
I have an idea for a new type of wall clock. It doesn’t tell time or even the
moon phases or the ocean tides. It’s an estrogen clock. Get one for every
woman in your life or for that special person who is tied to her. The
clock runs on a four-week cycle. At what would be the noon position, it
says, “Oh, crap.” At three o’clock, it says, “All better now.” At the six o’clock
position on the dial, it says simply, “Getting close.” And at nine o’clock,
it declares, “Just leave chocolate and tiptoe quietly out of the room.”
A research study by a psychologist says that men also suffer from post-
partum depression, and that it’s due to changes in family structure,
economic pressures, and a lack of sleep after the baby is born. He claims
that women don’t get depressed for those reasons. The only reason we
get depressed, he says, is that women are hormonal. I tried to contact
that psychologist to discuss his findings, but his wife answered the
phone. She said she had a bad case of PMS and her husband was tied to
the couch, and he would have to call me back later.
That Which Doesn’t Kill You Makes You Fatter 187
Not only is it important to get the right medication, but it must be taken
the right way. Recently, the nurse screwed up giving my patient the two
shots I ordered. He got the right medicine, just in the wrong place: the
flu shot in the forehead, the Botox in the butt. Okay, he won’t get the
flu, but now the man has no crack.
The funny thing about the Mayo Clinic is that its own endocrinol-
ogy department recently published research showing that most aging-
related changes in muscle result from inactivity, not true aging.9 The
number of mitochondria, the individual powerhouses of cells, declines
only in inactive muscle but can be increased if the subject exercises.
This was demonstrated by an elegant study done more than a decade
ago in the United Kingdom, at the University of Newcastle upon Tyne.10
The researchers compared muscle function in young and old, in sed-
entary and in active people, and were able to conclude that in those
older folks who stayed active, the metabolic markers for “aging mus-
cle” were absent. Build those muscles, maintain them, and make them
work for you, even when you are resting, by burning off your fuel.
And then you can have your cake and eat it, too!
190 Laugh Yourself Thin
Well, it turns out that deep thought might just burn more than a
few calories. According to reports, television watching uses as little as
5 calories an hour, but doing the crossword puzzle burns up to 90 cal-
ories during that same time. If you eliminated much of your passive
thinking time, you might stave off Alzheimer’s disease, become more
interesting to your friends, and help yourself fit into a slimmer ward-
robe. Keep this idea in mind. As Winnie the Pooh likes to say, “Think,
think, think.”
Sweat lodges fascinate me. They are very popular in a community just
south of where I live. Even some physicians have them in their back-
yard, for spiritual communion. They’ve become a New Age phenom-
enon, mimics of Native American rituals. I’ve never quite understood
the desire to force oneself to dehydrate to the point of hallucinating in
order to have a spiritual moment. It seems like God wouldn’t want us to
go to all that trouble. If you’d like to teeter on the brink of brain injury,
it’s less trouble to just slip a plastic bag over your head, but remember
to pull it off before you kill yourself. If you don’t, there’s a chance
you’ll get to heaven and find out that God is the check-out person in
the great grocery store in the sky. His first words to you are, “Paper,
plastic, or brimstone? ”
• To get good rest, you may need to improve your sleep hygiene.
• Stress itself produces hormones that damage the body’s normal me-
tabolism.
• Female hormones affect metabolic rate, weight gain, and fat dis-
tribution.
• Thyroid gland problems can cause weight gain but isn’t the issue for
most people.
• Medications can affect the metabolism or cause weight gain for other
reasons.
• Even when resting, muscles burn a lot of calories, much more than fat.
• Age-related slowing of metabolism is a result of inactivity, not true
aging.
• Intense thinking burns a lot more calories than passive intellectual
activities.
• Purging behaviors don’t work and are very dangerous.
• Someday we might be able to let bacteria in our gut speed our me-
tabolism.
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ELEVEN
Dinosaurs Refused to Exercise
and Look What Happened to
Them: The Right Activity
The only way to lose weight is to burn up more energy than we take in.
Exercise is the easiest and healthiest way to do that.
I am astounded, when I read diet books, including some of the most
popular books, at how few pages are devoted to the behavior of moving
our bodies through space. Both Dr. Atkins and Dr. Ornish were cardi-
ologists when they wrote their bestseller diet books, and both devoted
fewer than 10 pages to a conversation about exercise and behavioral ap-
proaches to losing weight and keeping it off. However, both devoted
more than half their books to recipes for their eating plans! This is akin
to trying to empty a bathtub by letting less water run into it but never
removing the stopper from the drain.
I like the analogy of the bathtub. I think it is a useful one when it
comes to thinking about calories and exercise approaches in weight loss
and weight maintenance. Your body is the water in the bathtub. If you
want there to be less water in the tub, you should try to slow the amount
coming out of the faucet. That’s your food and drink that goes into your
196 Laugh Yourself Thin
mouth. But, in addition, you had better unclog the hairball in the drain.
The hairball is a sedentary lifestyle. Most traditional diet plans and
weight-loss centers place almost all their emphasis on food and calories.
They concentrate on the spigot. They ignore the hairball.
Walking is one of the safest and most effective regular exercises. I rec-
ommend regular walks in nature parks to improve mood and overall
Dinosaurs Refused to Exercise 197
I’ve been wondering why most of the great marathoners come from
Africa. I think I’ve figured it out: it’s a different lifestyle there. They
are all lean muscle, they eat right, and they are constantly on the
move. When a marathoner comes here to compete, he risks his career
ending when someone hands him a remote control. Suddenly he can’t
get farther than the minibar.
A friend of mine said that she was going to get dumbbells to exercise,
but she had been too busy to shop. I suggested she start with a 16-
ounce can of beans in the meantime. That way, if she drops the can on
her head, she can put a steak on her eye and have a ready-made meal.
If you aren’t very active, you can build muscle simply from walking,
swimming, or other aerobic exercises (like walking in water, one of my
favorite exercises to prescribe). I find it funny how often doctors will say
200 Laugh Yourself Thin
water exercises are not resistance training. Have they ever done a water
aerobics class? Think about how much a gallon of water weighs (about
8–9 pounds). Now imagine trying to push through all that water by jog-
ging or using a water aerobics paddle. There’s a lot more resistance
than you get holding a light dumbbell out of the water! I like exercises
done in the water because you can get a great cardiovascular workout at
the same time you are doing resistance training. I’m always encourag-
ing my patients to get in the pool because water supports an overweight
body more easily than air and warms and supports arthritic knees and
backs. But always exercise with a buddy, or have someone watching
you exercise when you are in water.
should make you feel that you are working hard or very hard and that
you will fatigue quickly. This is for the more fit and in-shape or those
who are being medically supervised. Leave the harder exertion to those
who are experienced in their exercise, because that’s where the trouble
usually comes in.
Some competitive sports are more dangerous than others. Ice hockey
is pretty violent. It’s the only sport where there’s an actual penalty
for causing an amputation. You have to carry the limb around for
two minutes.
My son thinks that exercise and hygiene work the same way. If you
can exercise once a week for 60 minutes or three times a week for 20
204 Laugh Yourself Thin
minutes and get the same benefits, then, he assumes, you can do the
same with hygiene. In his mind, a shower taken once every three days
for 45 minutes must be the same as a daily shower of 15 minutes.
There are some things to focus on after you start your exercise pro-
gram to ensure it is effective and helping you. Ask yourself, “Do I sleep
better, do I have more energy, or do I hurt afterwards? ” A little ache is
okay, but real soreness or hurt is unnecessary and a warning sign. I don’t
believe in the philosophy of “no pain, no gain.” Be careful of advisers who
push that mantra. Ask yourself, “Do I feel more in control, less stressed,
and happier after doing this?” or “Do I find myself smiling during or af-
terwards, or am I bitchier?” Don’t be afraid to question “Do I feel better
physically, and can I do things now (like climb stairs easily) that I couldn’t
do before?” Use these newfound skills to remind yourself why you ex-
ercise. Modify your program if you aren’t getting enough positive feed-
back from your body and your mind.
What if sports teams were named after common medical diseases, like
the Peoria Psoriasis or the Hyannis Hypertension? They could have
numbers on their uniforms like 160/90 or 200/80.
til they are having a near-death experience (men more than women do
this), telling people to “check with their doctor” throws a huge hurdle in
front of couch potatoes. Those potatoes are more likely to stay on the
couch; it gives them a great excuse to procrastinate.
What I’d love to see is blaring television ads and front-page headlines
screaming, “Check with your doctor if you want to stay a couch potato.”
Believe me, in our modern culture, inactivity kills many more people than
exercise.
Remember, use some common sense when exercising. There are ac-
tivities that aren’t safe and aren’t smart. For example, Canadians have
never won an Olympic diving competition—ice diving doesn’t have
many survivors.
You should also seek medical advice if you are exercising and notice
chest pain or pressure, arm pain, jaw or back pain, nausea or unusual
sweating, or overwhelming fatigue. In those cases, you need to call 911 or
get medical help immediately. Those are all signs of a lack of blood flow
to the heart’s arteries and can result in a heart attack or sudden death if
ignored. Also, if you find that you are wheezing or having more lung
symptoms, call your doctor. Finally, if it hurts, stop doing it! If walking
on concrete is too tough on the knees, start bicycling or water exercise.
Find a form of movement that makes you and your body feel good.
206 Laugh Yourself Thin
total knee replacements shows that a regular exercise program can de-
crease pain sufficiently to avoid surgery. In fact, in overweight middle-
aged women with disabling knee pain, exercise and a 10- to 15-pound
weight loss resulted in large improvements in pain and function.
It doesn’t take much to walk that far. If you play golf, just get out of
your cart. Recently, I was playing on a municipal course near my house
and the sign said, “Beware of water moccasins.” As if the alligators
weren’t bad enough, now I have to fear the attack shoes.
Exercise has been shown to decrease the risk of multiple cancers, par-
ticularly colon cancer. In 1995, the brilliant Walter Willett, MD, chair of
nutrition at Harvard, and his group published an article looking at the
health of more than 47,000 male health professionals. What they found
was an inverse relationship between the amount of activity and the like-
lihood of developing colon cancer (the more you exercise, the less likely
you are to get cancer).7 In addition, they found a separate direct relation-
ship between the amount of abdominal fat and colon cancer risk.
Thirty minutes of daily walking is known to decrease breast cancer
risk.8 Are you like many women, terrified of breast cancer? Stop thinking
that regular mammograms are the only thing you can do to prevent dy-
ing of that dread disease. Eat more fruits and vegetables, consume fewer
animal products, and get moving. I’m amazed every year that, dur-
ing Breast Cancer Awareness Month, doctors drone on and on about
208 Laugh Yourself Thin
SEXERCISE, ANYONE?
I’ve already told you that aerobic exercise will improve sleep and cure
insomnia, but did you know that a daily exercise program might help
with that other bedroom activity? Yep, regular physical activity helps
men avoid impotence and gives you better stamina in the bedroom, not
to mention makes you more flexible.
Our greatest fear is not dying; it’s not even getting up in front of an
audience and doing stand-up comedy. It’s becoming a burden to those
we love. The surest way to become just that burden is to be sedentary.
Get fat and stay fat and you will become disabled; eventually you and
I might meet in a nursing home (I’ll be the one writing the orders on
your care). If you don’t want that, then get going. What are you doing
sitting there? Drop the book and march!
Dinosaurs Refused to Exercise 209
There’s an inane sport called chess boxing; it’s popular in Europe. Op-
ponents play four minutes of chess, followed by a round of boxing. I’d
like to see more outrageous sports like that. For instance, leaf blower
hockey. It’s also real, played in the street with wiffle balls. I think we
should make it more challenging. We’ll call it Electric Air Hockey. Put
it on ice, with skates. And use electric leaf blowers with extra-long ex-
tension cords. ZAP! AAAAH! Now that’s competition. Run your skates
across the cords and you won’t care about the penalty box. Television
announcer: “Today in electric air hockey, the Chicago Charred take on
the Cincinnati Cinders . . . ”
Get rid of your old memories of the gym class (and P.E. teacher) from
hell and of not getting picked for the team. If you were in the military, you
might remember exercise as punishment, taking laps or doing push-ups
for infractions. Discard all those associations, all the negative feelings
that you have about exercise. They keep you from healthy thinness.
People often push back emotionally when others tell them what to do.
If you are constantly being told by others, “You should exercise,” then
you might dig in your heels and put your own health in jeopardy.
In the past, if the only time that you ever exercised was when you were
attempting to lose weight and then you didn’t succeed, you may have
very negative feelings about exercise. If you starved yourself of calories
as part of a diet program, then tried to exercise, you probably felt lousy.
The body needs calories, particularly from carbohydrates, to do activi-
ties. If you were on a low-carbohydrate diet and then exercised, you felt
like crap, even if you were taking in enough calories. My approach is very
different. Exercise to feel good. Eat enough calories to feel good. Eat
your complex carbohydrates, too. Follow the suggestions in this book
and you will feel and look wonderful. Exercise will become something
that you look forward to doing.
I was on a cruise ship that had a rock-climbing wall. One of the crew
members told me that they had a 75-year-old woman get to the top.
It’s amazing what you can do with Denture Grip.
If you truly can’t fit exercise in to your schedule, then you need to ask
yourself the hard question “What are my priorities in life, and how can
I get them on track?” If your health isn’t a priority, then you are screwed
up. If you are that time pressured, start by scheduling 10 minute blocks
daily. Gradually increase as you see the emotional and physical ben-
efits.
If you aren’t getting support from your friends or relatives, surround
yourself with those who are supportive. Join groups that encourage your
activities, and avoid those that demean your efforts.
paying for your indecent exposure ticket. (Hey, if you get jail time for
being naked, where do they grab you to haul you away?)
3. When you are trying to lose weight, what’s the most important part
of your body?
A. your mouth
B. your anus
C. your brain
(Hint: it’s the part that doesn’t have a hole in it, we hope)
18. Nighttime snacking is related to fatigue, not hunger, and leads to:
A. nightmares about carnivorous manicotti
B. frequent light-bulb replacement
C. unexpected dips in the swimming pool
D. reflux disease
CHAP TER 1
1. Holly Jarrell et al., “Polymorphisms in the serotonin reuptake transporter
gene modify the consequences of social status on metabolic health in
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2. Debra L. Franko et al., “Does adolescent depression predict obesity in
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3. Chiadi U. Onyike et al., “Is obesity associated with major depression?
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5. Neil E. Rowland and Seymour M. Antelman, “Stress-induced hyperphagia
and obesity in rats: A possible model for understanding human obesity,”
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6. S. Kayman, W. Bruvold, and J. S. Stern, “Maintenance and relapse after
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Nutrition 52 (1990): 800–807.
7. Ibid.
8. Kathleen C. Light, Karen M. Grewena, and Janet A. Amicob, “More fre-
quent partner hugs and higher oxytocin levels are linked to lower blood
pressure and heart rate in premenopausal women,” Biological Psychology
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222 Notes
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1. Bruce S. Jonas and Michael E. Mussolino, “Symptoms of depression as
a prospective risk factor for stroke,” Psychosomatic Medicine 62 (2000):
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2. Todd F. Heatherton, Janet Polivy, and C. Peter Herman, “Dietary re-
straint: Some current findings and speculations,” Psychology of Addictive
Behaviors 4 (1990): 100–106.
3. K. A. Brownley et al., “Sympathoadrenergic mechanisms in reduced
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4. Rena R. Wing and Suzanne Phelan, “Science-based solutions to obesity:
what are the roles of academia, government, industry, and health care?”
American Journal of Clinical Nutrition 82 (2005): 222–225.
5. “People who were obese tried diets but felt they needed ongoing support
to empower them to make lifestyle changes,” Evidence-Based Nursing 12
(2009): 92, http://ebn.bmj.com/content/12/3/92.extract.
6. James A. Blumenthal et al., “Effects of exercise training on older pa-
tients with major depression,” Archives of Internal Medicine 159 (1999):
2349–2356.
7. Mark Gold, “Addictions and eating disorders,” lecture presented at the
U.S. Psychiatric and Mental Health Congress, Orlando, FL, October 11,
2007.
CHAP TER 3
1. Wing and Phelan, “Science-based solutions to obesity.”
2. D. Craig Willcox et al., “Caloric restriction and human longevity: what
can we learn from the Okinawans?” Biogerontology 7 (2006): 173–177.
3. Ana M. Andrade, Geoffrey W. Greene, and Kathleen J. Melanson, “Eating
slowly led to decreases in energy intake within meals in healthy women,”
Journal of Nutrition Education and Behavior 108 (2008): 1186–1191.
4. Brian Wansink, “Environmental factors that increase the food intake and
consumption volume of unknowing consumers,” Annual Review of Nu-
trition 24 (2004): 455–479.
5. Brian Wansink and Jeffery Sobal, “Mindless eating: The 200 daily food
decisions we overlook,” Environment and Behavior 39 (2007): 106–123.
6. W. M. Beneke, C. H. Davis, and J. G. Vander Tuig, “Effects of a behav-
ioral weight-loss program food purchases: Instructions to shop with a
list,” International Journal of Obesity 12 (1988): 335–342.
7. Wansink, “Environmental factors.”
8. B. Wansink and J. Kim, “Bad popcorn in big buckets: portion size can
influence intake as much as taste,” Journal of Nutrition Education and
Behavior 37 (2007): 242–245.
Notes 223
CHAP TER 4
1. L. Stahre and T. Hallstrom, “A short-term cognitive group treatment pro-
gram gives substantial weight reduction up to 18 months from the end of
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10 (2005): 50–58.
2. David M. Eisenberg et al., “Unconventional medicine in the United
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3. Victor J. Stevens et al., “Design and implementation of an interactive
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CHAP TER 5
1. Brian Wansink, Mindless Eating: Why We Eat More Than We Think
(New York: Bantam Dell, 2007); see the section titled “The Bottomless
Soup Bowl,” pp. 47–52.
2. Gary D. Foster et al., “A randomized trial of a low-carbohydrate diet for
obesity,” New England Journal of Medicine 348 (2003): 2082–2090.
3. Gary J. Schwartz et al., “The lipid messenger OEA links dietary fat intake
to satiety,” Cell Metabolism 8 (2008): 281–288.
4. Mayumi Yoshioka et al., “Effects of red pepper on appetite and energy
intake,” British Journal of Nutrition 82 (1999): 115–123.
5. Nicole Martinelli, “Jelly in the belly: A diet pill that expands so you
don’t,” Wired.com, June 08, 2007, http://www.wired.com/medtech/health/
news/2007/06/dietpill.html.
6. Paul Crane Arterburn and David Veenstra, “The efficacy and safety of
sibutramine for weight loss,” Archives of Internal Medicine 164 (2004):
994–1003.
7. John Wilding, “Science, medicine and the future: obesity treatment,”
British Medical Journal 315 (1997): 997–1000.
8. David Goldstein and Janet Potvin, “Long-term weight loss: the effect of
pharmacologic agents,” American Journal of Clinical Nutrition 60 (1994):
647–657.
9. S. C. Mathai et al., “Addition of sildenafil to bosentan monotherapy
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10. H. Cavaliere, I. Floriano, and G. Medeiros-Neto, “Gastrointestinal side-
effects of orlistat may be prevented by concomitant prescription of
natural fibers (psyllium mucilloid),” International Journal of Obesity 25
(2001): 1095–1099.
11. Lars Sjostrom et al., “Life style, diabetes and cardiovascular risk factors
10 years after bariatric surgery,” New England Journal of Medicine 351
(2004): 2683–2693.
224 Notes
CHAP TER 6
1. Gary D. Foster et al., “A randomized trial.”
2. B. J. Venn and T. J. Green, “Glycemic index and glycemic load: mea-
surement issues and their effect on diet–disease relationships,” European
Journal of Clinical Nutrition 61 (2007): 122–131.
3. Alan W Barclay et al., “Glycemic index, glycemic load, and chronic dis-
ease risk—a meta-analysis of observational studies,” American Journal
of Clinical Nutrition 87 (2008): 627–637.
4. Edward Giovannucci, “A review of epidemiologic studies of tomatoes,
lycopene, and prostate cancer,” Experimental Biology and Medicine 227
(2002): 852–859.
CHAP TER 7
1. M. B. Schulze et al., “Processed meat intake and incidence of Type 2
diabetes in younger and middle-aged women,” Diabetologia 46 (2003):
1465–1473.
2. Eric L. Knight et al., “The impact of protein intake on renal function
decline in women with normal renal function or mild renal insufficiency,”
Annals of Internal Medicine 138 (2003): 460–467.
3. E. Wrone et al., “Association of dietary protein intake and microalbumin-
uria in healthy adults: Third National Health and Nutrition Examina-
tion Survey,” American Journal of Kidney Diseases 41 (2003): 580–587.
4. Knight et al., “The impact of protein intake.”
5. Ivan de Araujo et al., “Food reward in the absence of taste receptor sig-
naling,” Neuron 57 (2008): 930–941.
6. Lydia A. Bazzano et al., “Intake of fruit, vegetables and fruit juices and
risk of diabetes in women,” Diabetes Care 31 (2008): 1311–1317.
7. “Chemical cuisine,” Nutrition Action Health Letter, Center for Science
in the Public Interest, May 2008, p. 4, http://www.cspinet.org/nah/05_08/
chem_cuisine.pdf; Morando Soffritti et al., “Life-span exposure to low
doses of aspartame beginning during prenatal life increases cancer effects
in rats,” Environmental Health Perspectives 115(9) 2007: 1203–1297;
M. M. Andreatta et al., “Artificial sweetener consumption and urinary
tract tumors in Cordoba, Argentina,” Preventive Medicine 47 (2008):
136–139; M. R. Weihrauch and V. Diehl, “Artificial sweeteners—do they
bear a carcinogenic risk?” Annals of Oncology 15 (2004): 1460–1465.
Notes 225
CHAP TER 8
1. Diane M. DellaValle, Liane S. Roe, and Barbara J. Rolls, “Does the con-
sumption of caloric and non-caloric beverages with a meal affect energy
intake?” Appetite 44 (2005): 187–193.
2. Y. Claire Wang, Sara N. Bleich, and Steven L. Gortmaker, “Increasing
caloric contribution from sugar-sweetened beverages and 100% fruit
juices among U.S. children and adolescents 1988–2004,” Pediatrics
121(2008):1604–1614.
3. For more information, see The Nutrition Source, http://www.hsph.harvard.
edu/nutritionsource/healthy-drinks/.
4. Susan E. Swithers and Terry L. Davidson, “A role for sweet taste: Calorie
predictive relations in energy regulation in rats,” Behavioral Neuroscience
122 (2008): 161–173.
5. Yung-Hsi Kao, Richard A. Hiipakka, and Shutsung Liao, “Modulation
of endocrine systems and food intake by green tea epigallocatechin gal-
late,” Endocrinology 141 (2000): 980–987.
6. Dirk Johnson, “Some see big problem in Wisconsin drinking,” New York
Times, Nov. 16, 2008, page A16.
CHAP TER 9
1. Edward P. Weiss et al., “Lower extremity muscle size and strength and
aerobic capacity decrease with caloric restriction but not with exercise-
induced weight loss,” Journal of Applied Physiology 102 (2007): 634–640.
2. S. M. Shick et al., “Persons successful at long term weight loss and main-
tenance continue to consume a low-energy, low-fat diet,” Journal of the
American Dietetic Association 98 (1998): 408–413.
3. T. Colin Campbell and Thomas M. Campbell II., The China Study: The
Most Comprehensive Study of Nutrition Ever Conducted and the Startling
Implications for Diet, Weight Loss and Long-term Health. Dallas, TX:
BenBella Books, 2006.
4. A. Keski-Rahkonen et al., “Breakfast skipping and health-compromising
behaviors in adolescents and adults,” European Journal of Clinical Nutri-
tion 57 (2003): 842–853.
5. A wonderful article on this famous World War II study is Leah M. Kalm
and Richard D. Semba1, “They starved so that others be better fed: re-
membering Ancel Keys and the Minnesota Experiment,” Journal of Nu-
trition 135 (2005): 1347–1352.
6. Wansink, “Environmental Factors.”
226 Notes
CHAP TER 10
1. Gary D. Foster et al., “A Randomized Trial.”
2. James A. Levine et al., “The role of free-living daily walking in human
weight gain and obesity,” Diabetes 57 (2008): 548–554.
3. M. S. Westerterp-Plantenga et al., “Energy metabolism in humans at a
lowered ambient temperature,” European Journal of Clinical Nutrition 56
(2002): 288–96.
4. Christopher Bell, Nicole R. Stob, and Douglas R. Seals, “Thermogenic
responsiveness to ß-adrenergic stimulation is augmented in exercising
versus sedentary adults: Role of oxidative stress,” Journal of Physiology
570 (2006): 629–635.
5. J. E. Gangwisch et al., “Inadequate sleep as a risk factor for obesity:
Analyses of the NHANES I,” Sleep 28 (2005): 1289–1296.
6. Laurent Seugnet et al., “Identifying sleep regulatory genes using a
Drosophila model of insomnia,” The Journal of Neuroscience 29 (2009):
7148–7157.
7. Kari Johansson et al., “Effect of a very low energy diet on moderate and
severe obstructive sleep apnoea in obese men: A randomised controlled
trial,” British Medical Journal 339 (2009): b4609, http://www.bmj.com/
cgi/content/full/339/dec03_1/b4609.
8. Ian R Lanza and K Sreekumaran Nair, “Muscle mitochondrial changes
with aging and exercise,” American Journal of Clinical Nutrition 89
(2009): 467–471.
9. E. J. Brierley et al., “Effects of physical activity and age on mitochon-
drial function,” QJM: An International Journal of Medicine 89 (1996):
251–258.
10. Francois-Pierre J Martin et al., “Probiotic modulation of symbiotic
gut microbial–host metabolic interactions in a humanized microbiome
mouse model,” Molecular Systems Biology 4 (2008): 157.
11. Donald Hensrud, “Slow metabolism: Is it to blame for weight gain?”
www.mayoclinic.com/health/slow-metabolism/AN000618.
12. William Thompson, “Terri’s Law: The limit of the Florida legislature to
decide an individual’s right to die,” New England Journal on Criminal and
Civil Confinement 31 (2005): 485–490.
CHAP TER 11
1. Caroline R. Richardson et al., “A meta-analysis of pedometer-based
walking interventions and weight loss,” Annals of Family Medicine 6
(2008): 69–77.
2. Jason L. Talanian et al., “Two weeks of high-intensity aerobic interval
training increases the capacity for fat oxidation during exercise in women,”
Journal of Applied Physiology 102 (2007): 1439–1447.
Notes 227
And a special mention goes to the Center for Science in the Public
Interest and its very informative Nutrition Action Health Letter. I am
a big fan of executive director Michael Jacobson and his efforts to im-
prove the safety and health of the public. Go to www.cspinet.org, and
get a real education.
Index
mechanisms; Eating; Exercise; exercise, 207–8, 213; fat and, 106; with
Habits; Laughter; Overeating green tea, 147; with lycopene, 115;
The Best Life Diet (Greene), 209 obesity and, 5; by restricting calories,
Bicycling, 10, 179, 197, 198, 205 153; salt and, 134; with vegetarian
Binge eating (binging), 27, 30, 60, 85, diet, 128
140, 160 – 62 Carbohydrates: complex, 90; energy
Body image, 41 – 42 from, 105 – 6, 123; fat and, 106 – 7;
Boredom: calories and, 179; emotional low-carb diets, 174, 210; natural,
eating and, 33 – 35, 42, 51, 68 – 69, 85; 109; pleasure from, 72; simple, 127,
meditation and, 167; stress and, 21; 140; weight loss and, 87, 90, 164
taste and, 121 – 22, 152; weight loss Cardiovascular disease: alcohol and,
and, 5, 8 150; eggs and, 137 – 38; exercise and,
Borg exertion scale, 201 – 2 205, 213; preventing, 3, 111, 153, 207;
Brain factors, 5, 28, 37, 50, 52, 72, 131, risks for, 24, 128, 135, 150; salt and,
185 134; saturated fats and, 106; trans fats
Breakfast: energy bars for, 140; foods and, 127
for, 61, 87, 115, 136; juice with, Celiac disease, 89
115; regularity of, 46, 48; skipping, Center for Science in the Public Interest,
160 – 61, 169 123
Breast cancer, 112, 128, 207 – 8 Centers for Disease Control (CDC), 24
Breast Cancer Awareness Month, 207 – 8 Childhood eating, 6, 49, 50, 53, 162,
Breathing exercises, 27, 34 – 35 190
British Medical Journal, 94 The China Study (Campbell), 156
Cholesterol levels: calories and, 154;
C-reactive protein, 111 eggs and, 137 – 38; exercise and, 205;
Caffeine: from coffee, 148, 152; diets lowering, 161, 207; metabolic syn-
and, 174; from green tea, 123, drome and, 201
146 – 47; sleep and, 181 – 82 Chronic anxiety disorder, 35
Calcium deficiency, 96, 136 Cirrhosis, 151
Calorie intake: aging and, 158 – 59; from “Clean your plate” command, 49
alcohol, 91; boredom and, 179; cho- Clothes, as self-monitoring technique,
lesterol levels and, 154; counting, 77 – 78, 82
158 – 60, 168; emotional eating and, Coffee, 148, 152
51 – 52; empty calories, 100, 139, 149; Cold vs. warm foods, 92
energy and, 105 – 7, 123; estimating, Colon cancer, 150, 207
157 – 58; habits and, 51 – 52; high / Colonics, 191
low-calorie dense foods, 48, 90; Comfort foods, 122, 140, 141, 163
liquid calories, 143 – 44; from liquids, Complex carbohydrates, 90, 106
143 – 44, 152; metabolism and, 146, Contentment. See Art of contentment
154 – 58, 173 – 74; reducing, 54 – 55, Control: exercise and, 206; over habits,
114 – 15, 153 – 54, 157, 168; salads 36, 40; over hunger, 93, 160; impor-
and, 117; “secret calories,” 144, 148; tance of, 7 – 8, 31, 175, 192; medita-
with varied diets, 121. See also Diet / tion and, 167
dietary choices; Exercise; Food/ food Coping mechanisms: for anger, 34;
choices eating as, 4, 36, 43; effectiveness
Campbell, T. Colin, 156 – 57 of, 10 – 11, 13, 21; heredity and, 65;
Cancer prevention: alcohol and, 150; improving, 6, 12 – 13; laughter and,
artificial sweeteners and, 135; with 19; self-defeating, 12
Index 233
Dairy products: dietary needs of, 108; Eating: binging, 27, 30, 60, 85, 140,
lactose intolerance and, 136 – 37, 141; 160 – 62; in childhood, 50 – 51; child-
milk, 149; protein from, 130 – 31 hood issues with, 6, 49, 50, 53, 162,
Dancing, 10, 12, 21, 41, 57, 70, 79, 81, 190; as coping mechanism, 4, 36, 43;
82, 197, 209 disorders, 190–91; enjoyment of, 7, 10;
Davidson, Terry, 146 fasting, 164; frequency of, 161 – 63;
Department of Agriculture (USDA), 54 hara hachi bu concept, 50; before
Depression: emotional eating and, meals, 47–48; meditation and, 166 – 67;
33; exercise and, 25; lowering, 3 – 4; mindful eating, 165 – 67; “nibblers,”
stroke risk from, 24; treatment for, 161; obligatory, 57 – 58; purging and,
35 – 36; weight gain and, 21 190–91, 193; skipping meals, 161, 169;
Desserts, 47 – 51, 58, 119, 133, 139 – 40 social eating, 63 – 64; speed, 53; stop-
Diabetes: alcohol and, 150; develop- ping, 84, 87; triggers for, 42. See also
ment of, 128, 129; glycemic index Breakfast; Calorie intake; Diet /
and, 112; insulin and, 112, 113, 161, dietary choices; Digestion; Drinks/
182 – 83, 185; natural sugar and, 132; drinking; Emotional eating; Food /
preventing, 153; sleep problems and, food choices; Healthy eating; Hun-
182 – 83, 192; sweetened beverages ger / hunger triggers; Overeating;
and, 145 Snacking
Diabetes Care (journal), 132 Eggs, 137 – 38
Diet /dietary choices: exhilaration Emotional eating: avoiding, 34 – 35;
with, 9 – 10; fasting as, 64, 155, 162, boredom and, 33 – 35, 42, 51, 68 – 69,
164 – 65; health and, 110; hunger and, 85; calorie intake and, 51 – 52; causes
85; as lifestyle change, 23; low-carb of, 33 – 34; music therapy for, 34, 70,
diets, 174; metabolism and, 154 – 56; 71; negativity and, 38; treatment for,
negative connotation of, 26 – 27; 36 – 38
obesity and, 3 – 4; plateaus, 155 – 56; Emotional Eating (Abramson), 33
primate studies and, 4; restricted, Emotions: anger, 7, 33, 34, 40, 42; bore-
26 – 27, 106 – 7, 120 – 24, 154, 174; self- dom, 8, 33 – 34; hugging and, 16 – 18,
esteem and, 28, 32; vegetable-based, 21; materialistic attitudes and, 13 – 14,
117 – 19; weight gain and, 64; “yo-yo” 21; positivity/positive thinking, 4, 21,
dieting, 38, 155, 157, 168. See also 29, 78 – 79; as triggers, 33. See also
Drinks /drinking; Eating; Food /food Depression; Happiness; Laughter;
choices; Healthy eating; Junk food Negativity/negative emotions
Diet pills, 93 – 95 Empty calories, 100, 139, 149
Dietary supplements, 32, 144, 173 Endogenous opioids, 185
Digestion: of dairy products, 136 – 37; Endorphins, 206
healthy foods and, 113 – 14, 124, 149, Energy: basal temperature and, 179;
156, 180, 192; of hydrogel pill, 93; from caffeine, 89, 123; calorie intake
indigestion and, 48; metabolism and, and, 105 – 7, 123; from dieting, 10;
154; process of, 165, 192 exercise and, 195, 202, 204, 212; fats
Dopamine release, 37, 131 and, 105 – 6, 123, 180; from food, 105,
Dried fruit, 134 140, 179 – 81; laughter and, 24; from
Drinks /drinking: energy drinks, 144, protein, 105, 106–7, 115, 123. See also
147, 152; fruit juice, 115, 132, 145, Metabolism
147, 149, 152; green tea, 24, 55, 123, Energy drinks, 144, 147, 152
146 – 47, 152; milk, 149. See also Environmental influences, 167 – 68, 183,
Alcohol consumption; Caffeine 192
234 Index
Escapist /avoidance tendencies, 36 – 37, Fats: in dairy, 119, 123, 130, 136,
43 148 – 49, 161, 163; energy and, 105 – 6,
European Journal of Clinical Nutrition, 123, 180; fat-free foods, 140; good
160 – 61 fats, 127, 141; high-fat diets, 109,
Evidence-Based Nursing (journal), 32 111, 118; low-fat diets, 108, 115, 138,
Exercise: activity log, 79 – 81, 82; aero- 156; from meat, 47, 128; in meat,
bic, 197–98, 200, 208, 212; anxiety 128, 138 – 39, 163; satiety and, 89 – 91;
and, 25, 202, 206, 213; appetite and, saturated, 106, 137; trans fats, 127,
98–100, 101; before bed, 184; bicycling, 138; types of, 106 – 7, 108, 127 – 28
10, 179, 197, 198, 205; breathing as, Female hormones, 185 – 86, 193
27, 34 – 35; depression and, 35 – 36; Fiber-rich foods, 88, 90
effectiveness of, 25, 67, 73 – 75, 82; Fibromyalgia, 183, 206
enjoyment of, 7, 10, 70 – 71, 209 – 10, Fidgety people, 86, 176 – 78
212; equipment for, 75 – 76; excuses Fish oil benefits, 127
for, 211–12, 213; frequency of, 204 – 5; Flatulence, 113 – 14
intense levels of, 202; interval train- Fluoxetine (diet pill), 94
ing, 200 – 201, 212; jogging, 159, 196, Food /food choices: air in, 91, 101;
198, 200, 203, 206; necessity of, cold vs. warm, 92; comfort foods,
195 – 96; resistance training, 199 – 200; 122, 140, 141, 163; desserts, 47 – 51,
self-esteem and, 27, 206, 210; sexer- 58, 119, 133, 139 – 40; diet vs., 23 – 25,
cise, 99, 208; for stay-at-home work- 42; enjoyment of, 6 – 7, 37; good-for-
ers, 69; strength training, 199, 203, you foods, 31, 61, 75, 121 – 22, 162;
212; stress and, 25, 27 – 28, 42, 206 – 7; intake modification, 46, 101; label-
swimming, 198, 199, 201; walking, ing, 126; leftovers and, 49; log for,
10, 12, 196, 197 – 98; weight loss and, 79 – 81, 82; nutrition and, 100 – 101,
196 – 97, 210, 212. See also Energy; 123, 125 – 26; portion sizes, 61 – 63,
Metabolism 65, 120, 159 – 60, 168; in restaurants,
138 – 39, 141; satiety and, 89; shop-
Fad diets, 64 ping for, 60, 65; thermic effect of,
Family time: emotional eating and, 34; 180; variety in, 120 – 22; water in, 91,
enjoyment of, 12, 14, 16 – 19, 47 – 48, 101, 136; weight gain and, 58, 59;
79; meals, 47 – 48 weight loss and, 26, 87. See also Diet /
Famine, 52, 107, 154 dietary choices; Drinks /drinking;
Fast-food restaurants, 59 – 60, 168 Eating; Healthy eating; Junk food;
Fasting, 64, 155, 162, 164 – 65 specific foods
Fat (adipose tissue): artificial sweet- Food pyramid, 108, 112
eners and, 146, 152; belly fat, 188, Foreyt, John, 206
207; breaking down, 28, 164, 200; Fructose, 88, 131 – 32, 141
dangers of, 5, 45, 63, 186; depres- Fruit juice, 115, 132, 145, 147, 149, 152
sion and, 17, 21, 24; from food, 51, Fruit nutrition, 115, 119, 124, 132 – 34,
54, 56, 64, 106 – 7, 123; hormones 141
from, 183, 193; hunger and, 59; in
liver, 150, 151, 164; myths about, Gallbladder disease, 112
38 – 40, 87; shrinking, 173, 174, 181, Gastric bypass, 96 – 97
192, 200 – 201; sleep and, 181 – 82; Gastric emptiness, 91, 137
from sugar, 144; TV and, 67 – 68, 82. Gastroesophageal reflux disease
See also Metabolism; Weight gain; (GERD), 164 – 65
Weight loss Genetics and obesity, 45, 65, 174 – 75
Index 235
Gestational diabetes, 112 185 – 86, 193; ghrelin, 99, 182; happi-
Ghrelin hormone, 99, 182 ness and, 28; insulin, 182 – 83; leptin,
Glucose, 131 – 32 182, 185; metabolism and, 186; oxy-
Gluten, 89 tocin, 16; stress and, 185; weight gain
Glycemic index, 112 and, 186, 193
Gold, Mark, 37 Hugs / hugging, 16 – 18, 21
Good-for-you foods, 31, 61, 75, Hunger/ hunger triggers: control over,
121 – 22, 162 93, 160; exercise and, 98 – 99; fat and,
Grains: diet based on, 108, 109; pro- 59; food shopping, 60; frequent eat-
cessed, 89, 110 – 12, 136; whole, 87, ing and, 161 – 63; overeating vs., 59,
92, 100, 106, 112, 135 – 36, 141 85 – 86; satiety vs., 83 – 84, 86, 100;
Gratitude rituals, 18 – 19, 21 signals of, 85; starvation and, 49,
Green tea, 24, 55, 123, 146 – 47, 152 53, 60, 78, 84 – 85, 154 – 55. See also
Greene, Bob, 209 Starvation
Hydrogel pills, 92 – 93
Habits: behaviors and, 45 – 47, 71 – 72; Hypertension, 129, 134
breaking bad ones, 72 – 73; calorie
intake and, 51 – 52; choices and, 23; Infant eating, 50
control over, 36, 40; social support Insomnia, 94, 163 – 64, 183 – 84, 202, 208
for, 49, 57, 63 – 64 Insulin hormone, 112, 113, 161, 182 – 83,
Happiness: behaviors for, 70, 72, 79, 83, 185
204; empathy and, 18; endorphins Interval training, 200 – 201, 212
and, 206; hormones and, 28; impor-
tance of, 33, 42, 166; junk food and, Japanese longevity, 50
185; keys to, 3 – 9, 16, 20 – 21; unhap- Jenkins, David, 161
piness vs., 41 – 42, 202; weigh loss Jogging, 159, 196, 198, 200, 203, 206
and, 5, 23, 70 Joseph, Jenny, 57
Hara hachi bu concept, 50 Journal of the American College of Clin-
Healing touch, 16 – 17 ical Nutrition, 111
Healthy eating: assumptions about, Juices. See Fruit juice; Vegetable juice
123; calories and, 114 – 15; digestion Junk food: alcohol and, 149; happiness
and, 113 – 14, 124, 149, 156, 180, 192; and, 185; limiting, 31, 61, 62, 65, 140;
enjoyment of, 112 – 13; flatulence nutrition vs., 105, 108; overeating
and, 113 – 14; nutrition and, 107 – 10; and, 61, 88, 185, 192; primate stud-
snacks and, 90 – 91, 123, 138, 160 – 61, ies and, 4; rat studies and, 126; stress
163. See also Breakfast; Cancer and, 185
prevention; Hunger / hunger triggers;
Nutrition/nutritional concerns;
Protein; Vegetable-based diet Kaiser Permanente Center for Health
Heart disease. See Cardiovascular Research, 13, 80, 197
disease Karolinska Institute, 70
Herman, C. Peter, 27 Keys, Ancel, 162
High-fat diets, 109, 111, 118 Kidney disease/damage, 90, 128–30, 205
High-fructose corn syrup, 88, 131 – 32,
141 Lactose intolerance, 136 – 37, 141
High-protein diets, 128 – 29 Lap band procedure, 96 – 97
Hormones: as appetite suppressants, Laughter: as coping mechanism, 35 – 36;
99; from fat, 183, 193; female, eating and, 10; exercise and, 203; as
236 Index
healthy, 71, 77, 81, 82, 145; stress and, Montessori, Maria, 177
12, 19; as weight loss key, 3 – 8, 19 – 20 Motivation. See Self-motivation
Leptin hormone, 182, 185 Muscle mass/weight, 78, 188–89, 198 – 99
Levine, Jim, 177 – 78, 179 Music therapy: for emotional eating,
Liquid calories, 143 – 44 34, 70, 71; exercise and, 75, 79, 211;
Longevity experiments, 153 – 54 for insomnia, 183; for stress, 10,
Low-calorie foods, 48, 90 12 – 13, 16, 21, 168, 169
Low-carbohydrate diets, 174, 210
Low-fat diets, 108, 115, 138, 156 National Research Council, 92 – 93
Low-temperature cooking, 138 – 39 National Sleep Foundation, 181
National Weight Control Registry
Malabsorption syndrome, 89 (NWCR), 32, 46, 70, 73, 121, 156, 197
Malnutrition, 88, 89, 95, 96, 119, 121, Natural carbohydrates, 109
130, 149 Negativity/negative emotions: body
Mayo Clinic studies, 76 image and, 40 – 42; elimination of,
Meat diet: at breakfast, 115; fats in, 19 – 20; emotional eating and, 38;
128, 138 – 39, 163; food pyramid and, exercise and, 209 – 10; medical issues,
108; Mediterranean diet and, 110; 187; meditation and, 167; in obesity,
reducing, 120, 124, 130; satiety and, 3 – 4; self-reward and, 13 – 15, 18, 21,
92; traditional, 47; vegetarian 29, 72; weight loss and, 32
diet vs., 109, 128 – 29 Nestle Company, 192
Medications, 187, 193 New England Journal of Medicine, 158,
Meditation: for depression, 79; eating 161
and, 166 – 67; emotional eating and, “Nibblers,” 161
34 – 35; enjoyment and, 10, 13, 165, Non-exercise activity thermogenesis
167 (NEAT), 76, 176 – 77
Mediterranean diets, 112 – 13 Nurses’ Health Study, 129, 130, 132
Menstrual cycle hormones, 186 Nutrisystem (weight loss program), 32
Mental health, 5, 6, 18, 36 Nutrition Action Newsletter, 123, 160
Metabolic syndrome, 201 Nutrition /nutritional concerns, 89;
Metabolism: aerobic exercise and, 188, approaches to, 107–10; carbohydrates,
197 – 200, 212; artificial sweeteners 106; controversy over, 110 – 11;
and, 146; calories and, 146, 154 – 58, energy, 105 – 7; fats, 106, 127; food
173 – 74; cold temperatures and, 179; choices, 100 – 101, 123, 125 – 26; junk
control over, 192; of endurance ath- food vs., 105, 108; malnutrition vs.,
letes, 198; fat and, 173 – 74, 180 – 81; 88, 89, 95, 96, 119, 121, 130, 149;
fidgety people and, 86, 176 – 78; proteins, 106; salads and, 87, 117 – 18,
genetics and, 158, 175; hormones 119, 130, 132, 139 – 40; scientific stud-
and, 186; medication and, 187, 193; ies on, 111 – 12; in tomato juice, 115.
muscle mass and, 188 – 89, 198 – 99; See also Calorie intake; Fats; Protein
probiotics for, 192; thinking and, Nuts, benefits, 90 – 91, 127, 130
190, 193; thyroid gland and, 187;
weight gain and, 155, 187. See also Oats /oatmeal, 135 – 36
Energy; Exercise; Weight loss Obesity: artificial sweeteners and, 146;
Milk protein, 149 bariatric surgery for, 56, 95 – 98, 101;
Mindful eating, 165 – 67 behaviors and, 65; factors in, 3 – 4,
Monosodium glutamate (MSG), 135, 20; food availability and, 61; genetics
141, 174 and, 45, 65, 174 – 75; health problems
Index 237
Social support /socializing, 15 – 16, 21, Varied vs. restricted diets, 120 – 22
49, 57, 63 – 64, 73 Vegetable-based diet: benefits of, 88,
South Beach diet, 107 117 – 19, 128 – 29, 156, 180; meat diet
Spot reduction exercises, 200 vs., 109, 128 – 29; metabolism and,
Starvation: with binging, 85; eating 156; protein from, 130, 141; variety
slower and, 53; exercise and, 210; in, 113; weight loss and, 120, 123,
guilt over, 49; as habit, 78, 85, 87; 124. See also Salads
metabolism and, 154 – 55, 175; Vegetable juice, 114 – 15, 152
nutrition and, 60, 90, 130, 162; purg- Visual food triggers, 59 – 60
ing and, 190 – 91, 193; sleep and, 163; Vitamin C therapy, 180
water and, 136; weight loss and, 84, Volumetrics (Rolls), 91
100, 115
Step aerobics, 198 Walking, 10, 12, 196, 197 – 98
Stevens, Victor, 80 Wansink, Brian, 51, 55, 58, 84
Strength training, 199, 203, 212 Water in foods, 91, 101, 136
Stress: anxiety and, 7 – 8, 21; eating Weight gain: behavior and, 64; depres-
and, 51; exercise and, 25, 27 – 28, sion and, 21; diets and, 64; fidgeting
42, 206 – 7; hormone levels and, 185; and, 176; foods and, 58, 87; hor-
housekeeping, 4; junk food and, mones and, 186, 193; metabolism
185; laughter and, 4 – 8, 12, 19; and, 155, 187; monitoring, 40, 77;
music therapy for, 10, 12 – 13, 16, muscle weight, 78; stress and, 9
21, 168, 169; in obesity, 3 – 4, 6, 20; Weight loss: behaviors, 109; carbo-
obesity and, 3 – 4, 6, 20; weight loss hydrates and, 87, 90; exercise and,
and, 8 – 9; from work environment, 196 – 97, 210, 212; fidgety people and,
10 – 11 86; laughter and, 3 – 8, 19 – 20; myths,
Stroke, 24, 138 38 – 40, 43, 87; as ongoing process,
Sugar: artificial sweeteners and, 131 – 32, 30, 40 – 41; passion and, 8, 16 – 18;
135, 141, 145 – 48, 152, 175; brain programs and, 31 – 32, 173; reasons
processing and, 131; glucose, 131 – 32; for, 20; rewards for, 78 – 79; starva-
high-fructose corn syrup, 88, 131 – 32, tion tactics and, 100; stress and, 8 – 9;
141; processed, 88 – 89; sweetened surgery for, 56, 95 – 98, 101. See also
beverages, 144 – 46 Diet /dietary choices; Exercise; Food /
Swimming, 198, 199, 201 food choices
Swithers, Susan, 146 Weight Watchers (diet program), 32
“What-the-hell” effect, 27
Talk test, 201 – 2 White, LenDale, 150
Tea. See Green tea Whole grains, 87, 92, 100, 106, 112,
Television (TV), 67 – 68, 82 135 – 36, 141
Thermic effect of food, 180 Willcox, Bradley, 50
Thinking and metabolism, 190, 193 Willett, Walter, 50, 207
Third National Health and Nutrition Wilson, Mark, 4
Examination Survey, 129 Winfrey, Oprah, 209
Thoughtful eating, 165 – 67 Wing, Rena, 121
Thyroid gland, 187, 193 Work environment, 9, 10 – 11, 177 – 78
Tomato juice, 114 – 15
Trans fats, 127, 138 “Yo-yo” dieting, 38, 155, 157, 168
About the Authors
Melanie and Mitch live with their son, Aaron, on the beach.
For more great comedic health advice and free audio downloads, go
to doctorRcomedy.com.
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