Watching Women's Health

Spend more of your day moving, having fun

More than two-thirds of adult Americans are overweight or obese, according to a recent national survey. Approximately 10% of children are also above a healthy weight. Fortunately, among both adults and children, the percentage who are overweight and obese is no longer increasing.

One way to address this national public health challenge is to get Americans moving again, through both individual and societal changes. Here are nine ways an individual can be more physically active.

1. Find physical activities you truly enjoy. This is the most important suggestion of all. If you are doing something you like to do, you are not working out, you are having fun. It takes planning, but not really discipline, to make an enjoyable activity part of your day.

2. Find ways to be active in all seasons. In Minnesota, staying active in the winter is a challenge. Many women occupy the summer with gardening, yard work, walking and cycling, but these activities fall by the wayside in the winter. It is actually not hard to dress for the weather and continue usual activities or switch to winter sports. Even in my state, only a handful of winter days are unbearable.

In other parts of the country, a hot and humid summer limits most outdoor exercise to early morning. Be realistic about where you live and either find ways to be out in all kinds of weather or move your activities indoors for part of the year.

3. Be active with friends. I first started exercising as a young adult by swimming at noon with a work friend. We later switched to running when the community pool became too crowded to swim laps. Our friendship made it easy for us to get fit together.

Most of my close adult friendships have been formed because we share physical activities as well as sensibilities. For the past two years, I have admired from afar four women who walk together every morning, regardless of weather. They are always happy and animated - clearly getting together is not a chore for them.

4. Go places under your own power. Day to day, most of us feel pressed for time.  Perhaps the most time-efficient way of getting more exercise is combining it with transportation. Try walking or cycling to work, run errands or get together with friends. To cover long distances, find ways to combine self-locomotion with public transportation.

Many baby-boomers who are downsizing houses would also like to downsize their car fleet as well as their clothing size. When moving, look for neighborhoods that are pedestrian and bicycle-friendly. At least one helpful website lets you analyze the walkability of any address in larger US cities.

Similarly, consider vacation spots that allow you to get around under your own power. This is not only economical but will help counteract the weight gain that seems inevitable with most vacations.

5. Get a dog and give it a great life.  A great life for a dog is a healthy, active life for you. A recent study showed people who walk their dogs see more improvement in their fitness than people who walk with humans. Unlike human companions, dogs don't come up with excuses not to walk. Dogs will happily go out in almost any weather and you find out you can, too.

6. Spend less time sitting. Sitting at a desk at work, watching TV, or at a home computer occupies most of the day for a lot of people. Along with sleeping, sitting in a comfortable chair is the least active thing our bodies can do. Most calorie expenditure charts show standing uses roughly twice as many calories as sitting, and calorie expediture goes up from there with more intense activities. Be creative about finding ways to sit less; when you do sit, try using an exercise ball part of the time (even though the TV comedy The Office made huge fun of this).

Wearing a pedometer is an easy way to quantify how much you are moving around during an average day and has been shown to increase sedentary women's activity levels.

7. Increase your activity gradually. Once you've made up your mind to be more active, don't risk injury by overdoing it in the first several weeks. Remember you're in this for the long haul. Give the weakest parts of your body time to catch up to the strongest. 

8. Mix things up. Humans like variety. If you involve yourself in a variety of activities, you are less likely to get tired of what you are doing and to have overuse injuries. Part of the beauty of living in a place with distinct seasons is engaging in different seasonal activities. For instance, here in Minnesota, we never get tired of cross-country skiing because, believe it or not, the winter is too short.

9. Have a mindset that exercise is a priority, not a luxury. To be healthy, we need physical activity just as we need fluids, nourishment, mental stimulation and sleep. Physical activity should be a normal part of virtually every day, not something we'll do if we have time and inclination. Each day, figure out a way to fit some sort of exercise into even the busiest schedule. 

I've gathered these ideas from talking with my friends and patients, and from my own experience of being physically active throughout my adult life. Even if you have never liked to "exercise," you'll do good things for your health (and have fun) if you move more and sit less.

Obesity replaces smoking as top US health burden

The good news is that smoking is no longer the biggest health threat to Americans.  The not-so-good news is that, while fewer people are smoking, many more, including record numbers of children, have become obese.

The medical definition of obesity is a body mass index (BMI) greater than 30. For example, for a woman who is 5'5", any weight above 180 lbs is in the obese range. BMI for normal weight ranges from 18.5-24.9; the overweight range is from 25-29.9. To be in the normal range, a 5'5" woman would weigh between 112 and 150, a fairly generous spread.

While smoking rates in the US have declined in recent years, obesity has been on the rise. Between 1993 and 2008, obesity in the US increased by 85%.

The risks from smoking and obesity are different. Smoking increases risk of premature death whereas obesity increases risks of morbidity, or ill health.  Both can result in fewer years of quality living, with obesity now edging out smoking as a robber of quality years.

If everyone in our country miraculously became a nonsmoker of normal weight, on average Americans would gain 5 quality years of life.

Obesity can limit normal activities through early arthritis, diabetes and heart disease.  And these progressive conditions lead to less and less physical activity. Like smoking, the problem of obesity is best addressed by prevention. Once a woman has become obese, it is a difficult condition to change.

Physicians regularly encourage smokers to quit and discuss approaches to weight loss with our overweight and obese patients. In my practice, I see smokers quitting and overweight women getting back into a normal weight range far more often than I see obese women succeed in losing weight. Their lack of success seems in large part due to the obesity-related physical ills that do not allow them to be physically active. 

Much has been written about the causes of obesity in the US. At or near the top of everyone's list is a sedentary life style that is so much more common now than even a few decades ago. In my next post, I'll discuss practical approaches to being more physically active.

A conspiracy to make us fatter?

For the fourth year in a row, the general health of Americans has not improved. A nationwide report, America's Health Rankings, says continued tobacco use and increasing obesity are the main reasons our health improvement has flat-lined.

This report began in 1990 and for many years showed steady gains in Americans' health. The trend stopped in 2005. Now, among world nations, the US ranks 28th in life expectancy, 20th in child well-being and 19th in mortality from treatable conditions.

Depending on how we respond to our current economic woes, our national health could get worse. Smoking and over-eating are time-honored ways of dealing with stress. But if we can find other ways of managing stress, some of which also save money, we could actually get healthier.

One change we can make is to eat more home-cooked meals, which are almost always cheaper and  healthier than fast food or restaurant fare. But even recipes from scratch have become more calorie-laden over time.

A recent analysis of recipes in Joy of Cooking looked at 18 recipes that have been published in every edition since 1936. In that time span, average calories per recipe increased 47%, and average calories per serving increased 63%.

Over the same time, our plates, bowls and silverware are growing ever larger, along with portion sizes  in restaurants.  Women's clothing manufacturers have adjusted sizes, so today's size 10 is a 1990 size 14. This could be a brilliant conspiracy to make us all fatter.

I have an Asian food cookbook that assigns Asian and American portions for each recipe. A typical example is "4 American portions — 8 Asian portions". So an American is expected to eat twice as much as an Asian. The problem is, a lot of us do.

Cooking at home will benefit us most if we pay attention to our portions and then downsize them. At home, we often serve up food casually, giving men a bit more than women, then going back for seconds as our tastebuds dictate, before we even know if we're still hungry.

A new lifestyle phrase I like a lot is "eating mindfully." We can get satisfaction from less food if we use smaller plates and bowls, arrange our food artfully, then eat slowly and appreciatively. That way, even an Asian portion might seem like enough.

Eat less, move more

The New England Journal of Medicine recently reported on long-term success of weight-loss diets. 811 overweight adults were randomized to one of four diets with differing amounts of of fat, protein and carbohydrates.

Each diet allowed participants to eat approximately 1500-1600 calories per day. 90 minutes of self-monitored exercise per week was also part of the program. The goal for each individual was a 750 calorie daily deficit, obtained by eating less and exercising more.

80% of participants completed the study. At 6 months, 1 year and 2 years of followup, there were no significant differences among the four groups in amount of weight lost or satisfaction with the diet.

After 2 years, participants had maintained an average weight loss of 4 kg (10 lbs). Measurements of blood pressure, waist circumference and cholesterol and glucose metabolism were all improved even though the amount of weight lost was modest.  

Obviously, participants were not able to achieve a 750 calorie daily deficit long-term or they would have lost more weight. Those who attended group sessions and stuck closer to study guidelines did have better individual results.

Diets claiming success through special food combinations should be recognized as gimmicks. These approaches sell books and fill hours of daytime TV, but ultimately mislead people into thinking they can lose weight without cutting calories.

What every overweight person needs is a long-term personal strategy for moving more and eating less.

I've seen the best results in my clinic when people honestly evaluate their habits and make changes they can live with over time. For starters, find a way to exercise that you actually enjoy and limit your access to foods that are your downfall.

Follow a diet that allows you to eat foods you like but accept you will be eating them less frequently and in smaller amounts. Stick with your plan and be patient.

Shortcuts — whether to lose weight, avoid traffic or fix a relationship — hardly ever work. Perhaps that's why the shortcut isn't the way we'd usually go.

Losing weight helps with urinary incontinence

Urinary incontinence is a common problem that decreases quality of life for millions of American women.

If you are significantly overweight and have urinary incontinence, a new study has some good news for you. Losing a relatively modest amount of weight can significantly decrease urinary incontinence, particularly stress incontinence when urine escapes with a cough, sneeze or other physical activity.

The study randomly divided 338 overweight women with incontinence into two groups. Both groups got instruction on healthy lifestyles and information on incontinence, including how to effectively strengthen pelvic-floor muscles. The weight-loss group also began a supervised six month weight loss program.   

After six months, the weight-loss group had dropped an average of 8% of their initial weight. 75% of the women in this group reported their incontinence was less of a problem. They said incontinence episodes were less frequent, and more than half the women reported losing less urine per episode.

The control group also lost a little weight, an average 1.6% of their baseline weight, and over half had some decrease in their incontinence. However, a significantly greater number of women in the weight-loss group said they were satisfied with the change in their incontinence.

The improvement in the control group does suggest that basic incontinence information and pelvic-floor exercises can be of some help. This is encouraging for women with incontinence who are not overweight or have not been able to lose weight.

For the significantly overweight woman with urinary incontinence, weight loss can greatly improve this condition as well as other medical problems.

Why controlling food cravings may be harder for women

As an increasing percentage of people in the US are significantly overweight, scientists are working to understand how hunger and food cravings work in the human brain.  Sad but true, compared to men, more women are overweight, have trouble losing weight and are more likely to regain weight. 

A recent study from Brookhaven National Laboratory in Upton, New York, looked at gender differences in the brain's ability to control responses to favorite foods.  Positron emission tomography (PET) scanning was used to monitor brain response in a small number of male and female volunteers. 

There were three different scan scenarios.  During one scan, the volunteers were enticed by their favorite foods and were encouraged to smell, taste and interact with the food without eating it.  In a second scan, they were tempted by the same food but instructed to inhibit their cravings.  For the third scan no food was presented.

When men inhibited their cravings during the second scan, activity in food-oriented areas of the brain was less than in the first scan.  For women, there was no drop in food-oriented brain activity when they inhibited cravings, even though the female volunteers said this helped them feel less hungry.

My patients often say they have a hard time staying away from snacks and treats in the house even thought they are intended for other family members. This small study may explain why.  Our brain enthusiastically responds to favorite foods, even though we are telling it no.  The easiest approach really is to keep problem foods out of the house — that way we don't keeping hearing their siren song.