Obesity, Weight Loss, and Carbs
Q. Is obesity truly a health crisis among middle-aged women?
A. I prefer phrasing it as a healthy weight-control issue rather than an obesity issue. The word obesity tends to stigmatize the extremely overweight person. And it's not just the extremely overweight person who's at high risk; it's the average person in the United States, who tends to be just a few pounds overweight, who is fueling the increasing level of adverse health outcomes.
As a country, we need to find a healthier way to live than we have now, where weight gain starts in childhood and continues through our entire life. It's better to start early, but you can still benefit by losing a few pounds at age 50 or 60 or even 70.
Q. So it's absolutely not acceptable to gain weight as you age?
A. That's my point. What we consider to be the typical increase with age, that gradual pound-or-two-a-year creep, can add up to a substantial health risk in a relatively short period of time.
The period between 20 and 55 is when many people put on most of their weight. Being obese can shorten your life by up to eight years. You need to pay increasing attention to physical activity and your diet as you get older. Fitting into your college jeans is a good standard, but even if you can't get into them, staying as close to that size as you can is a good goal.
Q. Is dieting the answer? Which diets really work?
A. Every diet works in the short run. The real challenge is to find a way of eating that is satisfying and sustainable over the long term. Aiming for a weight loss you can maintain is much better than going on a plan that loses you lots of pounds quickly. For most people a diet in the middle of the road, one that's neither extremely low-fat nor extremely low-carbohydrate, is probably optimal. The South Beach Diet is moderate in the way I'm talking about, but the Atkins Diet has been moving in that direction, too. We've seen a lot of evolution in the Atkins Diet from its original "eat all the butter, sausage, and red meat you like." The latest book backed away from that and toward healthier sources of protein and fat, as well as allowing more vegetables.
But one thing the original Atkins did do quite successfully is make people aware of adverse consequences of overeating carbohydrates, what nutritionists technically call a high-glycemic load. By cutting back on the carbohydrates, particularly refined ones, many dieters have found it easier to control their weight, reducing their heart disease risk and type 2 diabetes risk, too.
Q. Should we all be counting our carbs?
A. It doesn't make sense for a woman to be adding up grams of carbohydrates or even grams of fat on a daily basis. The important thing is to look at the quality of the carbohydrates and fats you're eating, keep an eye on the scales, and adjust up or down accordingly.
If weight control is a problem, many people find that controlling their intake of carbohydrates allows them to control their caloric intake easily, so they can lose the extra weight.
Q. But carbohydrates make up the whole base of the USDA food pyramid. What's your feeling on the pyramid?
A. It's too simple a visual and doesn't promote a healthy diet. The current pyramid, suggesting eight to 11 servings a day of bread, cereal, pasta, and rice at the bottom, with "sparing" consumption of fats at the apex, just isn't healthy.
But rather than blaming the USDA for the pyramid, my No. 1 criticism is directed at the inertia in the mainstream nutrition community. There has been such strong, almost religious, belief in the idea that fat is bad and carbohydrates are good. That is just not correct.
