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Tuesday, January 31, 2012

Intuitive Eating and More

Recently Personalized Primary Care Atlanta hosted an evening workshop reviewing some of today’s popular diets.  Nutritionist, David Orozco, RD  presented an overview of popular diets including: Atkins, South Beach, Paleo, Sugar Busters, DASH, Mediterranean, Zone, Weight Watcher’s, and the HCG diet, among others. 

In his talk Mr. Orozco briefly described some key elements of “fad” diets to beware of: 
  • A magic bullet (i.e. the hormone HCG, which, when given with a 500 kcal per day diet, results in weight loss)
  • Diet phases or stages, such as “Rapid Detox” and “Maintenance” phases
  • Celebrity testimonials and endorsements
Medical professionals agree that the DASH diet and the Mediterranean diet have the most scientific evidence to back up their potential benefit in terms of health related outcomes such as hypertension and metabolic syndrome. These two diets are also ranked #1 and #2 respectively by a US News ranking of "Best Diets." WebMD’s diet comparison tool comes very highly recommended if you are sorting through diet options.

However, Mr. Orozco advocates a different approach to dieting: “Intuitive Eating,” or “Mindful Eating.” These concepts involve gaining an understanding of one’s relationship with food and then healing it, such that an individual gains a heightened responsiveness to his or her own body signals.  The premise, a kind of psychotherapeutic approach, is that intuitive eating will result in better food equilibrium and eventual healthy weight maintenance.  I’ll admit that I have not yet read the book, but am eager to do so.

As I listened to the talk, I brought to the table my own perspective—I have never struggled with my weight, I am a relatively compulsive exerciser, and I enjoy cooking and eating out.  Exercise alone has been shown to be an effective technique to help with weight maintenance.  My personal experience (I’ve been about the same weight since age 18) is testimony to this. However, the one time that I did lose 15 pounds, I did it through calorie counting.  Since then (twenty years ago), I’ll admit that I do have a conscious awareness of the caloric value of most food that I ingest.  Do I eat chips, chocolate, an occasional Quarter Pounder and fries? Absolutely; but when the scale tips up five pounds I am quick to take action and cut back.  For dinner tonight—homemade lentil soup with kielbasa, bacon, and carrots, brown rice, green salad with blue cheese, and a glass of Argentine Malbec; for dessert: a sliver of lemon pound cake topped with coconut gelato.

I have found that with my patients who want to achieve more than ten pounds of weight loss, a structured approach is essential—a specific action plan.  Vague plans to cut back and “eat healthier” tend not to be effective. Over the years I have asked my patients who have successfully lost weight what their strategy was.  Though the strategies that my patients describe are as diverse as are the array of diets on the market,  a common thread seems that those who have been successful are able to articulate a clear plan of action that led to the weight loss.

I am an advocated of calorie counting and Weight Watchers (whose point system is essentially like calorie counting).  My viewpoint is that for weight loss, it’s not so much the content of the food that matters, but rather the quantity and caloric value.  However, there is some evidence that low carbohydrate diets may produce more weight loss than very low fat diets (i.e. the Ornish Diet) though this finding has not yet been definitively proven. A pound of fat is equal to 3500 kcal. It’s hard to lose more than a pound of fat every 7 to 10 days, and I don’t recommend it.  I personally consume about 2000-2500 kcal per day (with 30-60 minutes of exercise on most days).
Here are some of my own weight loss tips: 
  • Eat smaller portions, but don’t skip meals
  • Count and record your calories for at least 1-2 weeks when you begin to diet
  • Don’t reduce your caloric intake by more than 500 kcal per day below baseline intake (it’s too hard to maintain)
  • Don’t drink diet drinks and don’t drink any beverage all day long (including water)
  • Do have coffee or tea following a meal if you are not quite satisfied
  • Do enjoy a mealtime ritual at least once a day-- set the table and play some music while you dine, enjoy your oatmeal and coffee while reading the paper
  • Don’t snack more than once per day
  • Do allow yourself to feel hunger for a couple of hours before you eat
  • Limit refined carbohydrates and add healthy fats, but forget margarine, it’s no substitute for butter
  • Don’t eliminate your favorite food, save it as a treat a day or two per week
  • Treat yourself to meals out, but split your portion with a companion or eat an appetizer instead of an entree
  • Exercise 3-4 times per week, but keep in mind that adding exercise alone rarely works to achieve more than 5 to 10 pounds of weight loss 
  • Don’t chastise yourself if you are unable to exercise, most of weight loss comes through alterations in one’s diet not through exercise
  • Cook at least three times per week using whole food ingredients and cook enough for two meals so that you can have leftovers
  • Pack your lunch and bring it to work
Once your desired weight loss is reached, this is where intuitive or mindful eating becomes important—retraining oneself toward a healthier relationship with food.  Weight maintenance is the hard part. Some of you may have read a recent New York Times Magazine cover article entitled “The Fat Trap” by weekly health columnist and author of the NYT "Well" blog Tara Parker-Pope.  Ms. Parker-Pope makes the case that powerful metabolic and hormonal factors make it very difficult to maintain weight loss.  I personally find Ms. Parker-Pope’s viewpoint overly nihilistic, though she brings to light interesting information.  A petitioned response to Ms. Parker-Pope’s piece, authored Gary Taubes and Peter Attia, MD, argues that Ms. Parker-Pope’s article neglected the important effect of insulin resistance on obesity.  The authors maintain that restriction of refined carbohydrates, as opposed to overall caloric restriction, can allow overweight patients to successfully bypass some of the metabolic impediments to weight loss by reducing insulin resistance, while all the while suppressing hunger through increased protein and fat consumption.  Indeed there is some medical evidence to support low carbohydrate diets.

In my own practice I have seen numerous patients lose weight successfully.  The metabolic effects on cholesterol, blood sugar and blood pressure are typically profound.  Remember, if you are overweight or obese, weight loss in itself is as important of a goal as is healthy eating.

How did you lose weight? Were you able to maintain it? What do you think of the intuitive eating concept? I welcome you to share your own lessons and help others. 

*To learn more about intuitive eating contact David Orozco RD of T+D Wellness in Atlanta at 404-228-9704.


  1. Does this mean I can't trust Marie Osmond about Nutrisystem or Jennifer Hudson about Weight Watchers?

  2. I believe that avoiding ready-made foods may be the first step to lose weight. They can taste great, but highly processed foods include very little nutritional value, making you feed on more just to have enough electricity to get over the day. If you are constantly eating these foods, transferring to whole grains and other complex carbohydrates will help you have more vitality while consuming less. Great blog post.

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