Inventory

It is likely that you are thinking of things that you will do differently or for the first time in 2012.  The New Year is fast upon us and has already arrived for some.  I would caution you to carefully consider your 2012 aspirations.  I would most definitely set goals but only after careful and deliberate thought of how you will achieve them and if those steps (the how) are doable. 

But really that is a post for tomorrow - or one you might find elsewhere.
Tonight's post is about what has past.
For me it is the end of the year and my most important time for journaling or reflection.  I make a point to touch in at important times, but my New Years Eve or New Years Day journal entry is a tradition.  Sometimes I write on both days.  I also weigh myself at the end of the year and midway through (that is all).  The journaling and weighing have similar purposes.  I am touching base with myself - in print.  Am I on the course I wish to be?  Are the things I want to keep stable (like weight and relationships) in good shape?  Am I on course to meet the goals I have set?  Is it time to set a new goal (it always is!)?  What important things have happened in the past year?  What obstacles have I over come?  Which have I constructed? What challenges need more attention. ETC

I strongly encourage you to explore, touch base and make peace with 2011 before you make your plans for 2012.

Obesity Epidemic Permeates

The expansive girth of Americans is not only the topic of research articles and news shows, but fodder for popular novels.  I know this because I am enjoying the rare opportunity of reading one.
During this brief break between semesters, I checked out a library book.  The novel is by one of my favorite mystery writers, Patrica Cornwell.  It is titled Port Mortuary.
As I read today, I came to a passage where the medical examiner's administrative assistant remarks about all the SUVs and men in suits in the complex's parking lot.
He was speculating on who they could be, FBI perhaps.  
He noted that the men were quite strapping and noticeably fit.  Then said this,
"I think the FBI fires people if they get fat."  Followed by, 
"Well, good luck hiring in America."

Ah, sad but true.  Perhaps the year 2012 will offer promise for reducing the number of Americans who are now overweight or obese. IF anything, maybe we can keep the children who are born in the year 2012 from ever becoming overweight.  Now that is something that is entirely possible!

What you Eat - How you think - Memory Booster

 Several popular press stories are covering the research cited at the end of this post.  The work is published in the journal Neurology.  It is a legitimate scientific study.

I think that you will get a lot from reading one of the news stories, this one for example, but let me make a few points before you go.

The scientists did a small study and they based their associations  on what people reported eating and their subsequent blood work.  Most of the time food frequency recall is fine, but people may forget some items and may list things that they think others want to hear instead of what they really ate.  
Still, the results of the study are most likely accurate, though they need to be duplicated.

The researchers found that people in the study who had certain levels of certain nutrients in their blood streams, had better brain functioning and memory outcomes.

They associated the nutrients with the intake of fruits and vegetables and the type of fat - omega 3 fatty acid - that is found in fish like salmon.  People in the study who ate more processed foods and fried foods (like burgers and fries) had worse outcomes.

The most important thing I want you to understand is this:
The results are related to FOOD - they are not about taking supplements.  When someone tries to use the study to sell you vitamins - don't be fooled.  

As January rolls around, consider eating a more plant and fish based diet.  It can be good for your waist and your brain (as long as you don't fry the veggies and add oil, fat and butter to them!)

Bowman, G.L. ND, MPH; Silbert, L.C. MD, MCR; Howieson, D. PhD; Dodge, H.H. PhD; Traber, M.G. PhD; Frei, B. PhD; Kaye, J.A. MD; Shannon, J. PhD, MPH; Quinn, J.F. MD

Title	Nutrient biomarker patterns, cognitive function, and MRI measures of brain aging.
Source	Neurology.

Misinformed or in Denial

I am not sure which it is (lack of info or aversion to restriction) but the products displayed in the pictures below are not the answer to anyone's weight problems.  Instead, the only scientifically proven safe and effective way to manage weight is through energy balance. If weight loss is necessary, and for most of us it is, then a negative balance must occur.  This means that the energy you take in is less than you need to maintain the current weight.  You can eat less (the strongest factor) or exercise more or both.  The only problem with this approach is that most people, without the help of experts (not those on TV or in fashion mags, but licensed nutritionists or health educators), do not know how many calories they are consuming now (energy in) or how many calories are burned in the exercise that they do. 
Also, the change in calories in or out has to be consistent every day.  If you are going to exercise more to lose weight, you must do the extra every day and you must not eat more because you have exercised!
Imagine that you know you are eating 2000 calories a day now - for the next year you might try eating 1800 calories a day (but you have to know the amount of calories in the food you eat) and/or, you are walking 20 minutes a day now, and to lose weight you double that to 40 minutes a day, you have to do that EVERY day. 
It is much easier to get 200 calories off your plate than to burn them so I suggest you learn about food. I also recently reviewed an article which discussed effective strategies and the ONLY commercial program on the list was Weight Watchers.
 However, for your health, mood, aging, fitness and such - I and other health promotion specialists, recommend daily exercise.
But the most important thing, for anyone is that they Do NOT get tricked into buying the scam products seen here !!

Whatever it takes??  Seriously??   It takes eating less that is what it takes!

Really Large/X Large?? Because a size small makes sense??

Magnets do NOT cause weight loss...

Winter Holiday

Taking a short break to enjoy the holiday - may you do the same ~ Deirdre

War on Cancer

I won't add much of my voice to the headlines of today - that it has been 40 years since President Nixon enacted a  law that led to much cancer research and subsequent medical breakthroughs.

But I will concur with those who attribute the decline in cancer death and cancer rates to 

• screenings (i.e. pap smears, colonoscopy, and mammograms), 
• a significant reduction in tobacco use and tobacco exposure, 
• diets that are plant based and calorie controlled and 
• to daily excercise

This is my last post for a bit - enjoy the holiday-

Menu Labeling in Action

First, I am kicking myself for not taking a picture especially because I had my camera in my purse.  
Today I had lunch with friends at a Panera Bread. Like Ruby Tuesday, it is a chain restaurant that will be required to post calorie information within the next year.
But Panera is not a sit down and order establishment so to have the information at the point of purchase, it has to post it on the menu board.  
I noticed it today as I was in line.  Next to each item, all across the walls of the menu board, behind the long double counters, are numbers.  The first number is the price and next to it, in a lighter color and in narrower font, is the calorie information.   Sometimes the numbers for calories are given in a range.  The truth is that the number is not ever likely to be the exact amount, but it is a place to start.

This is a new policy and it will need to be evaluated.  Some smaller studies have been done.  I have read them and blogged about them.  We find that if a person sees the information, knows what it means both generally and specifically to their bodies, and uses it, then caloric intake is reduced.  
The new policy includes directions and maybe funds, for education and promotion regarding calorie control.  The display that I viewed today was not prominent and there was no prompt to bring attention to the posted information.  I am not surprised that it is there but not highlighted because many restaurants are wary of posting the calorie and other nutrient information for their products, as we might find some of it shocking.
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Rollerblade - Really??

For the semi regular "really?" segment, I offer you this evidence of stupidity.

As I was running (in Florida) the other morning, I came across a woman who was rollerblading.  She was on a road, not a street, a road with a double yellow line down the center.  She was in the bicycle lane.

She was going with the flow of traffic and thus coming AT me - running in the bicycling lane (which of course, is NOT stupid :).  She may have had on knee pads, but no protective gear for her head.  AND.... wait for it......
................................................................
....................................she was talking on a cell phone.

As she and I passed, I said in my head, no, I said it out loud, "going the wrong way AND talking on the phone?!?...you're an idiot."  But a few feet later I realized, that technically she and I were both on the right side of the road because she was on wheels.
My Dad always said, (so it must be true)-

• if you are on your feet (face the traffic - i.e. walking and running)
• if you are on wheels (i.e a bicycle) go with the flow of traffic.  

He might have added,

• if you are stupid, you should have good life insurance.

Of Mice and Calories

There is a small but growing body of science that relates low caloric intake with longevity and cognitive health.  In other words, the slowing of aging and the preservation of memory.

The studies are taking place in the lab and with animals.  This science is at the molecular level - or way under the skin - in the cells and in the brain.  We don't know if what these studies show will carry over into human biology, but it is worth a shot.

Because there seems to be a correlation between caloric restriction and memory enhancement, scientists have searched for the particular mechanism that might be responsible.  Recent work has focused on a protein, CREB1 - which is also a gene and a molecule - I think.  It is a protein associated with memory.  Something happens in lab mice on a restricted diet that activates the protein.  Creb1 does not act alone and more is not known than is known.

A recent study, attributed to a Dr. Pani, showed that mice who were fed 70% of their usual caloric intake responded by producing the protein.  The production of CREB1 is at the heart of many anti-aging studies.

I wanted to mention this study in light of the one I mentioned a few days ago in which the VLCD or very low calorie diet in one study meant only 890 calories per day.

The work of Dr. Giovambattista Pani implies a more doable strategy.  Again, we do not know if the same result would occur in the human body, but most of us could stand to lose a few pounds anyway.  If someone is consuming 2500 calories a day and dropped to 1750 - that is a reasonable reduction(with a doctor's go ahead of course).

Looking the Part

I am not going to get this exactly right, but it was something close to this:

Last night, after I excitedly told my sister about the calorie information on the restaurant menu, someone at the table said, "She doesn't have to worry about counting any calories herself."  To which I replied, (as one of my favorite teaching moments), "That's because I do."  In other words, I look like I don't have to watch what I eat only because I do (watch what I eat).

Weight control and weight loss are NOT easy.  Well over 90% of all people have to be mindful of energy intake and expenditure in order to prevent overweight and obesity.  In other words, there are very few people who can eat "anything they want" without paying some price for that.

Dining Out

In preparation for a meal out tonight, I went to the restaurant's on line menu.  I was surprised to find that there were certain entrees and sides that were categorized as fit and trim and which had caloric content listed.  
I should not have been surprised because it was a chain restaurant and soon all items will have to have this information as part of a new national policy.  I love this policy.  I like to be informed when making important choices and what is more important then the food we put in our bodies?  Well - there are more important things, but this is one that is worthy of some diligence.

I was delighted to have the calorie information but also perplexed by it.  In the vegetable section, steamed broccoli had close to 100 calories.  Why is that?  If you get something steamed you do not want oils or butters, generally speaking (or you would get it sauteed).  A whole cup of broccoli has about 60 calories. 
I tell you this to remind you that healthy by default is NOT the nature of restaurants and to be certain, you should tell your server, no oil, fat or butter - if even it is a steamed item.
I had a great meal of broiled tilapia and dry steamed broccoli and even though the light dishes offered weren't perfect, they are appreciated.
The restaurant and its menu information is available here.

Staying Fit to Serve

During my travels today, I changed planes in Atlanta.  I must have seen over 100 men and women in military fatigues, returning home from war ( I assume).  Not one of them was overweight or obese.  Fit they were - though I did spot one or two in the smoking lounge and that was heartbreaking.


Seeing them - all of them - beating the odds(besides those  of surviving war)- i.e over 66% of American men and women are overweight or obese, and they are not, stimulated many research questions.


1) Do people who are more likely to take care of their bodies join the service?
2) Does being in the service 'prevent' obesity?
3) What percent of service men and women who return to civilian duty, become overweight or obese?
4) How long after leaving active military service do men and women begin to gain weight?


Those were some research questions I had - but truth be told, I was just damn glad to see these brave, fit people - predominantly young people, home where they belong.


I am not naive, I know that there will be problems and weight gain is not high among them, I just thought it relevant fodder for the blog.

Health Risks of Excess Fat

I came across a graphic that shows the outline of a body of a child next to a body of an adult.  Each figure is surrounded by text boxes with headers like lungs, throat, legs, etc and in the boxes are the risks associated with being overweight or obese for that particular body part or organ.  

The health problems of the child often carry over to the adult and are worse over time.  The bottom of the chart shows an arrow going from the words children to adults.  There is states that childhood obesity predicts adult health risks.  This information is similar to that found in the study I talked about a few days ago.  In fact, it was probably the references in that article that helped me to find this chart.  However, I cannot find it again.  I have only my one printed copy.

I wanted to make a note of the health risks for the people who continue to minimize the outcomes of being overweight or obese.  Remember, the good of the country is very much tied to the health of its people.  The public health.

I used the information in the handout to make the table below.  The graphic is attributed to Drs. Ann Prentice and Susan Jebb who are with an organization called Human Nutrition Research in the UK.  I found the authors on line, just not the document. If you are curious, here is the website. 

My table doesn't include the citations that the scientists included with the risk factors.  Everything in the table is associated with a research study, but I did not list them.

In the table, if a person has a greater risk, it means greater than someone who is not overweight or obese.  (I could have done a better job on this, but I really need to be packing for my trip to Florida in the morning, so sorry)
 

Children	Adults
Obese females have 3x the risk of asthma	Obese adults have 85% higher risk of asthma
3x risk of hypertension	6x the risk of hypertension
77% of obese children have fatty liver disease	76% of obese adults have fatty liver disease
Overweight and obese children have lower QOL scores	More than 4x higher depression
20% have sleep problems related to breathing	Most obese adults have chronic obs. sleep apnea
30% of overweight and 50% of obese have metabolic syndrome	7x the risk of diabetes for the morbidly obese
	93% higher risk for colon cancer
Increase in type 2 diabetes in all children	Twice the risk of breast cancer
7% higher risk of fractures	More than 4x greater chance of arthritis
Increase in kidney impairment	Losing weight returns ovulation to normal in many
Decreased tolerance for exercise	Higher risk for all cancer except, brain, lung, bladder and stomach
	Lower sperm counts in obese males

 

Calories and Diets in the Lab

I was reading an article earlier this week which referred to the research referenced at the end of this post.  I was curious about the study because it compared the weight loss results of three or four groups.  I searched for the study itself so that I could see the actual requirements for each of the groups.  Here are the 4 categories that intrigued me:

1. Consume 25% Less Calories per day
2. Consume 12.5% Less Calories per day and Increase Physical Activity by 12.5%
3. Consume a Very Low Calorie Diet (VLCD)
4. Consume as usual (control group)

Instead of going too much into the study, I want to share what these group assignments  meant for the people involved in the research. I think the information is relevant and interesting to people who "cut their calories."  Ironically, it was the VLCD group that got my attention.  The article I was reading mentioned 25% and 12.5% reductions but did not give any clue as to what was meant by very low calorie. 

The scientists were able to determine the near exact total energy expenditure (TEE) and total energy intake (TEI) of the participants when they signed up for the project.  This was a small study.  The participants stayed overnight (once or twice) in the lab and ate all their meals according to a strict protocol in the weeks that followed (except the control group).  Each of the reduced calorie groups had a different caloric plan, based on their individual baseline and metabolic (energy burn) needs.   

For the purpose of an example, let us say that the TEI of a person in group 1 was 1900 calories at the start of the study. That means they would then eat 475 calories less (25%)or 1425  calories a day.  I believe the person did this until they lost a certain amount of body weight and then the calories were adjusted in order to maintain the new weight.  It could be that the end caloric intake was 1600 a day.
Take a similar person in group 2.  They would eat about 235 calories less than 1900 and would have to burn the other 240 calories in exercise.  The heavier a person is, the less time they would need to burn those calories, but according to the article, the average time spent walking (or something similar) per day was between 45 and 50 minutes.  This group had to exercise 5 days a week and 3 of those days had to be under the supervision of a research assistant.
Group 3 got the worse of it to be sure.  They were given 890 calories a day until they lost 15% of their body weight.  After which, whatever calorie amount was needed to maintain their new weight was adopted.
So - all this to say that in the 24 weeks for which results are provided up until week 24 when groups 1 and 2 merged, the diet only group lost more weight than the diet and exercise group.  
The VLCD group -the 890 folks- lost the most weight and lost it the fastest, but it is unrealistic for ANYONE in a "free living" environment to manage a diet that extreme. I would not have known if the VLCD was feasible if I had not tracked down the study protocol. 

If you are interested in the study, the information to access it is below.

Effect of 6-Month Calorie Restriction on Biomarkers of Longevity, Metabolic Adaptation, and Oxidative Stress in Overweight Individuals: A Randomized Controlled Trial
Leonie K. Heilbronn, Lilian de Jonge, Madlyn I. Frisard, JAMA. 2006;295(13):1539-1548.

The Swim

It is done.  I did it.  With rare exception, I swam twice a week (indoors) during the entire fall semester - even when it got cold outside and before the pool water was warmed.   From August until now, I swam twice a week except two times when I only swam once a week (because the pool was closed).  If we go back six months, I had 3 once a weeks and the rest were twice a weeks. 
 

I did get my money's worth from the suit!

The only time that I truly dreaded the swim was in October - when the water temperature really dropped and I tended (literally) to shiver the entire time I swam.

Actually, if you look back at this September post, you'll see some of my angst as I struggled to keep my vow of swimming through to December.

And then there was this post on October 31st when my resolve was wearing thin.  I was called out for being a wimp and "torturing myself" by easing into the pool. I started to jump in the very next time and things looked up from there.

If I look back to June of this year, so roughly six months, I went from 12 laps to 20 - finishing today with 22 laps which is OVER a half mile (1100 yards).  The half mile (880 yards - or just over 800 meters) was my goal. 
Oh, and don't forget, I added the kick board for my final (extra) lap for the last month or two as well. 

I did try the flip turn one more time today, but I missed the wall on the kick off and got water up my nose.  So, well - I can't do everything I set out to do. 

I looked at the usual distances for swimming, biking and running in triathlons and I qualify for the sprint distance on all three and almost the olympic distance (the swim is .93 miles).  

Now that is something to worry about after grad school.  Maybe it will be my 50th birthday present to myself.

I really enjoy the swimming and it has gone from "something to do to rest from running" to a true stand alone fitness activity.  In fact, lap swimming has a pretty high MET value - so WOW - yay me.

That's not really all -  I made it through the entire semester without missing a day of exercise - my regular running, weight training, swimming and walking - all adhered to and all kept me sane.  I am just about as proud of that as I am my final grades!

So - I don't know - there may be swimming in the New Year after all.  The pool is officially closed until January 9th and I am off to Florida for a while - by the time I return I may be over it... however, I thought of packing my suit and maybe going to a Y while traveling :)

Childhood Obesity and Adult Outcomes

Juonala, M. M. D. P. D., Magnussen, C. G. P. D., Berenson, G. S. M. D., Venn, A. P. D., Burns, T. L. M. P. H. P. D., Sabin, M. A. M. D. P. D., . . . Raitakari, O. T. M. D. P. D. (2011). Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors. New England Journal of Medicine, 365(20), 1876-1885.

The purpose of the study that is referenced above was to determine if people who were overweight or obese as children but who were NOT overweight or obese as adults would have similar cardiovascular risk factors as people who remained overweight/obese or who became overweight/obese as adults.

I know,  a lot to wrap your mind around.  If you figured out that they were comparing outcomes between 4 groups, then you are on the right track.

It has already been established that being overweight or obese as a child greatly increases the risk of adult obesity.  It has also been established that the heart disease (cardiovascular) risk factors associated with overweight and obesity are hypertension, diabetes, low HDL, high LDL, high triglycerides and thickening of the carotid artery. It is those six outcomes that the researchers measured in this study of over 4000 persons.

The current research involved four studies that were started about 23 years ago and which took place in USA, Canada and Finland.   The average age of the student at the start of the 4 studies (when their BMIs were collected the first time) was 11.  AT the end of the individual studies, the BMIs were collected again and each study had information on the risk factors for heart disease that I mentioned above.

Here are just a couple of things from the current study that I found interesting: 

Of the students who were normal weight at the start of the study - over 14% became obese adults.
Of the students who were overweight/obese as children, over 64% became obese adults.
OF the students who were obese, as other research has suggested, 82% became obese adults.


Everyone who was obese/overweight as an adult had 2 to 3 times greater risk of all of the above outcomes with few exceptions. 

The children who were overweight or obese and became normal weight adults had the same level of risk as normal weight adults. (this is great news)

The two things that need to be done with the findings are
1) prevent our children from becoming obese
2) provide treatment to obese children so they do not become obese adults. The best chance at reversing the weight is going to come in early childhood - before age 11.

Metabolic Fuel

In the article that I referenced last night (regarding the erroneous contention that 3500 cals was the equivalent of one pound of body weight), there was a separate discussion regarding the macronutrient composition of diets. 

What?

When I say macronutrient, you should hear; fat, protein and carbs.  For as long as I have been writing about and studying obesity (ten years now), people have asked and studies have explored, which is better – low fat, low carb or  high protein diets.  My answer has been and the research supports, a calorie is a calorie.  For this truism, Dr. K. Hall and the other authors (from the study referenced in the last post) do not object.

The sub article does give three possible reasons why the composition of the diet might impact the amount of weight lost.  By this I mean, if a person consumes 70% carbs and 15% protein and fat – or any such combination, does it change the amount or the speed in which they will lose weight.

In the short term, which is all that has really been studied, there is no true difference between types.  In the end, if a person consumes less calories than they have been and everything else stays the same, they will lose weight.  This is often true of exercise as well.  IF one adds more activity to their day (consistently) and does not change anything else, they will lose weight (albeit at a slower pace).  What tends to happen with the addition of PA is that people DO eat more.   

Okay – the three points that were made in the article.

Intracellular or physiological changes take place within the body based on the amount of each macronutrient that a person consumes.  I learned today that the fat, protein and carbohydrates that we take in are mirrored in the body by what is called metabolic fuel.  In the body, it is fat, protein and glycogen.  The body maintains a balance of the metabolic fuel.  It has been shown in lab experiments that if you change your balance, say you eat more carbs and your body needs some fat, it  will then use the stored fat to make up the difference.   This is possible, but the effect to date has not been enough to unseat the calorie is a calorie stance.

Energy burn can be impacted by the foods that we eat.  Certain macronutrients have an immediate but short term effect on your metabolism in the few hours after you eat it.  Scientists are using simulation techniques to explore this phenomenon, but again, it has not been found to improve outcomes – or cause more weight loss then simply creating a negative energy balance.  (less in and more out)

The composition of a meal may have an impact on one’s satiety and reduce hunger so that over consumption (over eating) does not occur.  When discussing this area, the article author’s noted how notoriously bad “free living” folks were at reporting what they actually eat and in following the recommendations of any meal plan.  

So for us the bottom line is – a calorie is a calorie.  Now as I have said before, this is regarding weight.  For health – what you eat – i.e. what the DGA 2010 recommends – is of great consequence and importance. 

Don’t eat all your calories in chips, dip and twinkies.

Odds and Ends

Spandex:  I heard part of a story and some interviews on the radio show, Weekend Edition, this morning.  You can actually listen yourselves, and may I suggest that you do.  It is only six minutes long and can be accessed here.  The main point was that with so many women overweight, comfort was more important than style. (the statistic offered on the percent of women who are now wearing plus size clothing, was shocking)  The overwhelming use of spandex in women's fashion was highlighted in the story.  I found it disheartening.  Of course, I had my years of wearing stretchy clothes - in the 1980s.  I wish I had written down some of the comments that were made this morning, but suffice it to say, spandex might allow you to wear more clothing styles than your body type implies, but it doesn't do anything to reduce your risk of diabetes, heart disease and cancer.  The only spandex to be found in my current wardrobe is in my exercise attire! As an added bonus to hearing the story today, I became aware of this informative website as well. 

Diet Fallacy:  I am reading an article that was published in the Lancet in August of this year (my studies have winded down and now I can catch up!)  I only want to make one or two points here.  It is a complicated article on mathematical simulation for weight loss interventions.  The citation is :

Hall, K. D., Sacks, G., Chandramohan, D., Chow, C. C., Wang, Y. C., Gortmaker, S. L., & Swinburn, B. A. (2011). Quantification of the effect of energy imbalance on bodyweight. The Lancet, 378(9793), 826-837. doi: 10.1016/s0140-6736(11)60812-x 

 If you can access the article, I would give it a read. I know I just said it was complicated, but there are pieces that most would understand and find illuminating. The most important take away from this research is the proclamation that the 3500 kcal = 1 pound, weight loss rule is incorrect. The authors call it the diet myth and hold it responsible for unrealistic expectations and disappointment.  Several factors fail to be considered in the erroneous message.  First, individuals are different.  Second, when a person loses weight, metabolism and energy needs change.  Also, the less you weigh, the less calories you burn in any of the activities that you do.  Third, lean tissue burns more calories than fat tissue. Initially, a person loses fat tissue. A heavy person loses weight faster than a person with a higher ratio of lean to fat mass.
Either way, the body composition changes during weight loss and this also impacts energy expenditure.  One of the examples in the article refers to a man who weighs 220 pounds.  His baseline intake is 3000 calories a day.  He is initially put on a 1200 calorie deficit, so he is consuming 1800 calories a day.  He loses weight over six months (44 pounds) using that 1800 calorie plan.  Then he maintains that new weight with 2600 calories a day. He does not and you can NOT return to your usual caloric intake.  What happens in weight loss programs is that 1) baseline caloric intake is not accurately captured, 2) adherence to the caloric and or exercise recommendations is not 100%, 3) patients return to their baseline caloric amounts and regain their weight.  It is also worth noting that in a simulation example, the scientists state that after a certain change in intake, half the goal weight will be lost in the first year and 95% of the goal will be achieved in 3 years.  Read that again - 1 year and 3 years - not overnight.  Fast does NOT work.

Return on Investment:  Exercise.  I had a couple of challenges to work around this week - rain one day and 30 degree weather on another.  I am not one that enjoys changing my "plans," but on Wednesday when we had a cold heavy rain, I swam (yup) and did my weight training and then on Thursday I did the run.  If you cannot do what you intended, it is still important to do something.  Today it was quite cold, but I knew that the return on my investment - running - would be immeasurable and lead to a productive and balanced day.  You must believe this.  It is true.

Party Favors:  I also did a little cooking and baking for the week.  I have a couple of potlucks to attend.  First, I made a nice vegetarian chili.  As I graded papers, the house filled with a heart warming, comforting aroma.  I also made some new fruit wantons and a pumpkin cake.  It is nice to bring sweet but low calorie items to gatherings.  In fact, my wantons are coming out so good that I am going to make little treat bags for my sweet nieces in Florida.  Here is a picture. They taste like little pies.  The recipe will be posted to You Tube in the future.

Not the best photo, the wantons are in the back, YUM - I promise