By Mary Hartley, RD, with Dana Shultz
All of the diet and health advice we’re fed today can be confusing. But some have suggested that what it really all comes down to is eating the right amount of calories and staying active most days of the week. While this may sound like a simple solution, ‘how many calories we really need’ can be rather elusive.
There’s a whole slough of online tools that promise to accurately calculate the amount of calories we require. But how many of us really know if we’re ‘moderately active’ or ‘vigorously active?’ What’s the difference between the two. And are we also to assume that all women 5’5” tall and 130 pounds have the same resting metabolic rate?
To answer these sometimes baffling questions, DietsInReview.com’s Registered Dietitian, Mary Hartley, RD, weighs in to help us find the truth about what we really need to know when it comes to calorie requirements.
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Call it a tax, but there is no such thing as a free lunch.
ObamaCare (a.k.a. The Affordable Care Act or ACA) is a huge law with sections and subsections. It was introduced because 30 million Americans do not have health insurance, which is considered by many to be a basic right, and to mandate incentives to make the health care system more efficient, effective and safe. The law would force every American to carry health insurance and obligate insurance companies to cover everyone, even those with pre-existing medical conditions. But a few key provisions were challenged by states and parts of the federal government on the basis of constitutionality. The Supreme Court was brought in to decide the argument.
Two key provisions caused the most concern:
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This week, we’re helping to raise understanding about infertility by recognizing National Infertility Awareness Week. One in eight couples of childbearing age is diagnosed with infertility, and for women, polycystic ovary syndrome (PCOS) is a leading cause. It is a hormonal imbalance accompanied by two of three characteristics: overproduction of androgens (male hormones); irregular menstrual cycles; and an ultrasound that shows ovaries with tiny follicles that look like cysts but are not. PCOS affects six to eight percent of women of childbearing age.
The signs of PCOS vary greatly among women. Some have excessive hair growth in a male pattern, as well as weight gain, acne, and scalp hair loss. Others have insulin resistance that may lead to diabetes, with lipid disorders and high blood pressure. The good news is that women with PCOS can and do get pregnant, but conception often means an unpleasant ordeal of tests, procedures, cycle tracking, and medications, not to mention cost.
Lifestyle interventions (i.e. healthy eating and activity) that help control weight are a cornerstone of PCOS treatment. Having too much body fat and eating too many carbohydrates aggravates insulin resistance and hormonal imbalance. The diet for PCOS should have only the number of calories that it takes to maintain a healthy weight and carbohydrates should not contribute more than 40 to 50 percent of total calories.
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UPDATE 7/17/12: Qnexa was approved by the FDA on July 17, 2012. This marks the second weight loss drug approval in 2012; the first weight loss drugs approved since Alli in 1999. The prescription drug will be sold as Qsymia.
The inmates are running the asylum. Reversing an earlier decision, the medical experts on FDA’s Endocrinologic and Metabolic Drugs Panel cleared the way for approval of the new diet drug Qnexa. Qnexa (PHEN/TPM) is a combination of phentermine and topiramate (PHEN/TPM). Topiramate is used to treat seizures and prevent migraine headaches and phentermine is approved for the short-term treatment (i.e. a few weeks) of obesity. PHEN was half of PHEN/FEN, the discontinued diet drug that led to valvular heart disease and potentially fatal pulmonary hypertension, primarily in women. Qnexa is indicated for “BMI greater-than or equal to 27 kg/m2) with weight-related co-morbidities such as hypertension, type 2 diabetes, dyslipidemia, or central adiposity (abdominal obesity),” the group with the highest heart disease risk.
The panel decided that the complications of obesity outweighed the risk of heart problems. It’s hard to believe they were swayed by the research. The 2010 study published in the Lancet reported that people who took the highest dose of Qnexa (not the lower approved dose) lost at least 10% of their body weight and showed improvements in their risk cardiac factors. Clinical trials by the manufacturer showed 45% of subjects treated at the low dose lost > 5% of baseline body weight following one year of treatment. No one seems to care that we’re talking about a 10 to 15 pound weight loss on a 200 pound person. Do we need a drug for that, especially one that comes with heart disease risk? No matter because the results showed statistical significance in a placebo control study.
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At any point in time, one in three women and one in five men in the United States are on some kind of diet. Most dieters opt for traditional programs that count nutrients or servings of food or actually specify which foods to eat. Those diets produce short-term weight loss, but two or three years later, 95 percent of traditional dieters regain the weight. But the diet industry manages to hold on because hope springs eternal in the human breast.
Research shows that starvation, whether from natural causes or intentional dieting, increases the risk of overeating and binge eating disorder (binge eating disorder is a distinct entity and not the same as overeating.) On-again, off-again dieters regain lost weight by over-eating in-between periods of restrictive dieting. The human body is simply programmed to respond to starvation by hoarding food when it becomes available.
On-again, off-again dieters develop a “dieting mindset.” They lose touch with their thresholds for taste and fullness. For example, when normal eaters eat sweets or a meal, they cross over a threshold and lose their desire for more sweets or food. Chronic dieters, on the other hand, learn to ignore those signals. They decide when, what, and how much to eat based on whether they are on or off a diet. That leaves them susceptible to eating in response to external cues, like TV commercials and food pushers, and to non-food cues such as boredom and unpleasant feelings.
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