For years, diet and exercise were championed as the twin strategies for weight loss. But as the obesity epidemic spreads, a growing body of research has looked to other explanations for why people become obese, Hayley Mick writes in Life on the scale.
Dr. Arya Sharma, chair of obesity research and management at the University of Alberta, along with Chris Dukarich, who has lost 128 pounds in the past year, will be online Wednesday at 1 p.m. ET to take your questions. Ask Dr. Sharma about the latest in research, why doctors think some people gain weight and others don't, and what options are out there for those who are struggling. Mr. Dukarich will take questions on his own experience with weight loss. Want to know how he did it? Just ask.
Your questions and their answers appear at the bottom of this page.
Dr. Arya Sharma is professor of medicine and Chair of Obesity Research and Management at the University of Alberta. He is also the medical director of the Edmonton Regional Weight Wise Program and the scientific director of the federally-funded Canadian Obesity Network. His research focuses on the environmental and biological causes of obesity and an evidence-based approach to managing obese patients. He is also working on the development of novel interventions for treating obese patients and people with a propensity for obesity. Scientific associations of which he is a member include the Canadian, American and International Societies of Hypertension and the Canadian Association of Bariatric Physicians and Surgeons . Dr. Sharma maintains a widely read blog where he regularly posts his ideas and thoughts on obesity prevention and management: http://www.drsharma.ca.
Chris Dukarich, 27, used to live off Slurpees and fast food. Since attending the Wharton Medical Clinic's Weight Management Centre in Hamilton, Mr. Dukarich lost 128 pounds in less than a year, shaving 15 points off of his BMI and 20 inches off his waist.
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Big Canadian from Canada writes: I am a young male, in my mid-20's, struggling to cope with my weight. I have been overweight my entire life and have constantly struggled with trying to maintain my weight as well as deal with the negative social baggage that comes with it. Several years ago I rapidly ballooned and later decided to 'really get serious' about addressing the issue. I dropped 110lbs in approximately 6 months and managed to keep most of it off over the next few years but added back another 25lbs while trying to maintain full-time employment and full-time university work. I have since lost around 30lbs but my efforts have plateaued in the last 2.5 months. Both times I have lost weight purely by switching to a well-balanced diet of smaller proportions (no Atkins or starving myself) and working out at the gym for 1+hours per day, 5-6 days per week. I still consider myself about 30lbs overweight but do not seem to be able to get rid of the last bit all the more frustrating because the social stigma seems to be just as prevalent for a guy that is 30lbs overweight as it was for one who is 130lbs overweight. I am wondering what the effectiveness of a surgical procedure, such as lipo, would be for someone in my situation or if there is a legitimate 'diet pill' or supplement that can aid in my weight loss?
Dr. Arya Sharma: You mention several issues. Firstly you have been able to lose a large amount of weight, but are struggling to keep it off. This is not uncommon. The basic rule here is that to keep the weight off, you have to continue doing whatever it was you did to lose the weight in the first place. If you are struggling to keep it off, this means that your weight loss was indeed too "radical". You need to be more realistic in setting your weight target. Rather than trying to reach an "ideal weight" you need to focus on achieving a weight which you can maintain while still enjoying life. Unfortunately, this weight will probably be higher than where you would like to be - this is something you may simply have to accept.
Regarding surgical options: liposuction is NOT a treatment for obesity. It is a purely cosmetic procedure and does not provide any of the health benefits seen with behavioural, pharmacological or surgical weight loss. before considering surgery, I would make sure that you have made all the behavioural changes that you could possibly have made and have tried the prescription drugs for obesity to see if they can help you manage keep the weight off.
The stigma you mention is unfortunately widespread and there is little you can do about it except to work on your self esteem and learn to ignore the taunts from people who do not know better.
Chris Dukarich: Big Canadian, Unfortunately i can't fully answer your question because i myself haven't fully experienced the "plateau" just yet. My last couple weigh -ins i have only lost 4 pounds in 3 weeks compared to the 8-10 pounds over the past 9 or 10 months. At first i was disappointed but when i looked at the entire picture, i'm still losing weight, feel great inside, so really even a half pound weight loss should be considered a success.
All i can say is keep doing what your doing. Eat small meals. You should eat 6 times a day. (every 2 hours). High Protein , High Fibre and LOTS of water. I'm not looking forward to joining thr gym but its only a matter of time. My only exercise has been walking and swimming but its almost time to hit the weights to tighten things up.
E Vopni from Canada writes: My obstacles for losing weight are more psychological than anything. I go through really healthy phases of eating a well-balanced diet and getting a lot of exercise (and losing weight), but what breaks these good habits are my own mind games. I hide 'bad' foods around the house like an alcoholic. I sneak scoops of ice cream when my husband steps out the door. It's like I get a rush from sneaking and/or indulging in 'bad' foods. Even though, the truth is, my husband couldn't care less.
It's self-sabotage. I recognize that. But I don't get why I do it. It's almost as if I'm afraid of my own weight loss success story. Have you ever heard this before?
Dr. Arya Sharma: You are right that your weight problem is mainly psychological. In fact, what you are describing may very well be a sign of a condition called "Binge Eating Disorder". I am guessing that you are a strong emotional eater, are uncomfortable with increased attention and have a sense of lack of control and despair when you indulge in the foods that you describe. Losing weight generally makes the symptoms worse and leads to "self-sabotage".
Many patients with this disorder have experienced traumatic events in their past (e.g. mental, physical or sexual abuse) that are influencing their eating behaviour.
Fortunately, with appropriate psychological counselling (cognitive behavioural therapy) many patients can learn to control or avoid their "binges". This would be the first step towards gaining control of your weight.
For more on this you may refer to my obesity blog: http://www.drsharma.ca/out-on-a-binge.html
Chris Dukarich: E Vopni, I too was guilty of binge eating on the "bad" foods. Eating the entire bag of chips or a sleeve of cookies instead of just one or two. The only thing i can say is if these "bad" foods are playing mind games then it's simple, don't bring them in the house. Or replace them with items to binge on that are good for you. Bran Bars, low cal bars. There's even a High protein frozen yogurt you can try that is very tasty.
For me once i started my life style change and started noticing results these junk foods and fast foods became less and less important in my life because i started to replace them with better tasting alternatives. Also read the facts. Turn that carton of ice cream around or in my case cookies or chips and read the nutritional values (or lack of). You will be shocked by the fat content, sodium, and carbs in these items. Knowledge is everything. Knowing what you are eating and what effect the foods you are eating plays a large role of a successful lifestyle change..
Chelsea from Canada writes: Hi Chris, I'm just wondering what you do when you're invited to someone's home or go out for dinner? Do you indulge? Or do you always stick to your new lifestyle? THank you.
Chris Dukarich: Hi Chelsea, This is a great question!!!
Part of the Lifestyle change is knowledge. Knowing what foods you can eat ie: high protein choices. Sometimes at family functions there isn't always a healthy choice so sometimes just adding a second helping of veggies is a better choice then a second serving of pasta or pizza. Also, it helps to have something good to eat for lunch or have a snack prior to leaving to a family dinner or outing. Bring along a protein bar to eat or enjoy it while family members are enjoying the "junk" trays and what i like to call "no no's" before dinner.
When i go out, the only take out or fast food I eat is Subway. Trust me, they are NOT paying me to say that. They are one of only a few place who proudly show what exactly is in there food they are serving you. And it tastes good!
When it comes to restaurants i still do eat out here and there. Once again, it just takes a look at the menu and picking out something that is "good" for you. or the little things, taking the skin off a roasted chicken dinner or ordering your fish pan fried instead of deep fried. And watch the sides or add ons. Instead of rice or potatoes, get a sweet potato or double up on the veggies.
I hope this helps a bit.
Carrie Makrigiannis from Toronto Canada writes: Question for Chris...have you completely cut out all 'junk' food from your diet? Do you drink juices or pops? Coffee? Tea? And if so, do you drink diet or low calories versions now? I ask, because I've heard that artificial sweeteners can actually make people hungrier and therefore make it more difficult to lose weight.
Chris Dukarich: Hi Carrie!!! Another great question.
Yes i have cut out all junk food out of my lifestyle because i have come to realize that i am so much better off without them. Aside from the odd popcorn at the movies (with no added butter i might add) the chips and fastfood are long gone.
The only drinks in my lifestyle are WATER, coffee, tea, 1% milk and i have recently enjoyed Fat Free Soya milk. I use to drink a lot of the "zero" pops but what my dr told me was you have to watch the artificial sweeteners in these products. They can also work like sugar and trigger certain things in the brain. There is no such thing as a healthy juice. They are loaded with sugar. My best bet to you...drop the pops and juices and increase the WATER. IT's all the h20!!!
Holly Kramer from Toronto Canada writes: I have always controlled my weight by fasting. Almost a year ago I quit smoking (2 pkgs/day) but didn't gain any weight. Then suddenly 6 months ago, I gained 25 lbs. in 2 weeks for no apparent reason -- all of it in my thighs and abdomen. I am 5'7' and now weigh a whopping 170 lbs for the first time since I was pregnant 30+ years ago! YIKES! Now my naturopath and others say this is because I don't eat enough (about 750 cal./day, NO junk food! and I walk about 5 miles daily) They claim that my body is probably in 'starvation mode' and conserving fat. This makes no sense to me whatsoever. If fasting and a low cal diet and walking a lot kept my weight down for 30+ years while I smoked, and fasting and a low cal diet and walking a lot makes me gain weight now that I don't smoke, eating more can only make me fatter! I don't really want to smoke again, but I have decided that if this extra weight does not come off before my quit date anniversary I'll have no choice but to resume smoking, since there have been no health benefits yet from quitting and I really need to get back to a normal weight. Obesity is at least as dangerous as smoking!! I can't afford a gym (I quit smoking because I couldn't afford it, and don't have time for exercise besides all the walking I do). Is there any hope for this porko?
Dr. Arya Sharma: Weight gain after smoking cessation is a common problem. This is because smoking speeds up your metabolism, suppresses your appetite and also helps you deal with stress.
However, the risks of smoking are far greater than the risks of being overweight. In fact you would have to actually gain around 70 lbs before your health risk matches that of someone who continues smoking. Weight gain should never be an "excuse" to go back to cigarettes!
Frankly, I am very skeptical about your 750 Kcal calculations. You are probably missing calories somewhere - remember there are a lot of "hidden" calories that you may not be aware of, especially in drinks (pop, juice, coffee, alcohol).
If we assume that you are in fact "miraculously" gaining weight on only 750 KCal/day, you may need to be assessed for fluid retention and nutritional deficiencies. In rare cases severe "undernutrition", especially lack of protein, can lead to water retention (you may have seen the pictures of starving kids in Africa with their huge bellies - that is water retention resulting from sever undernutrition).
Hard to say what the real problem is without actually assessing you.
Amanda Totes from Toronto writes: I've lost about 40 pounds but I'm finding that although I'm another 35 or so from my goal, I'm hungry a lot of the time. I'm losing the weight very slowly, so it's not as if I don't eat enough. I do. Yet I'm often starving. How can I control my hunger?
Dr. Arya Sharma: You are obviously hungry because you are not eating enough. Starving yourself is never successful in long-term weight loss - eventually, the hunger will get the better of you and you will eat and gain the weight back.
One way to deal with hunger is to not create too much of an energy deficit, or in other words, you should not eat less than around 500 KCal less than your body actually needs. Also, you can "trick" your stomach into thinking it is full by eating larger amounts of fruits, vegetables, fibre and protein.
Also regular eating is key - at a minimum three square meals a day - pehaps with health snacks in between.
Finally, you need to be realistic about your weight target. A reasonable target is 5-10% less than your weight before you started losing - this may be less than what you would like to see, but going beyond that may just not be sustainable - you may lose more, but you will likely gain it all back or carry on a lifelong struggle to keep it off.
Chris Dukarich: Hi Amanda... I am NEVER hungry. I never thought that day would come when i could say that, but its true.
You should be eating 6 times daily. High Protein and lots of fibre.
Couple helpful hints:
-eat within 30 -60mins of waking up...never any later! Your body will start to go into "starvation mode" trapping and storing anything you give it, into your fat cells.
- after breakfast eat roughly every 2 hours.
-eat slowly. chew your food well. Take 15mins to eat your breakfast, lunch and dinners.
Drink lots of water. if you do feel yourself becoming hungry, have a glass of water.
Finally, you should never eat a meal feeling "starved" or with your stomach growling. Remember "protein first" have a handful of almonds or half of a protein bar, anything with protein in it first, then 15mins after that, eat your meal. Its not healthy to eat your meal feeling so hungry.
i hope this helps, good luck :)
RT from Canada writes: What are some of the foods that you got you through this? things that satisfied cravings, kept you feeling full, etc.
Chris Dukarich: Really the biggest thing was eating the 6 times day, every 2 hours. Giving my body little amounts of food throughout the day instead of only once or twice like "old" Chris use to do.
As far as the foods i eat:
-bran buds, fibre one cereal in the morning
- bran bars
Really anything high in protein or fibre.
Think of the Protein and Fibre as a piece of hard wood on a fire. When your body consumes these products, your internal fire burns much longer and doesn't require another piece of wood until roughly that 2 hour feed time. Carbs = soft wood. When you consume these foods (pasta, rice) your internal fire is going to scream for more wood much sooner then if you had some food which is protein or fibre based.
Finally look into try meal replacements. These played a vital role in my success and are great if your in a rush or on the runs. High protein bars, shakes that are loaded with 15-20 grams of protein and under 200 cals are a great tool for any life style change.
TW from Calgary writes: Had you ever lost weight in the past? I'm wondering if this experience has been different for you than previous attempts.
Chris Dukarich: Hi TW, I have tried other methods in the past, some which i don't care to mention their names but for whatever reason this one has worked for me. I think because its more "medical". Coming into the dr's office every few weeks and the weigh-ins have really helped keep me on track.
Like i tell everyone, this has worked for me. Will it work for everyone? I don't know. You will take from it, what you put in. I eat, sleep and breathe this program and my meal plan. There is no greater goal in my life right now then making me a better person and with that said, maybe with me giving 120% everyday, i have achieved such great success as i have.
Its all about motivation. Get the motivation started. Start small. Lose 5 or 10 pounds and build off that. Next thing you know people start noticing and that motivates you. Then your clothes start to fit a bit better or you start dropping to small sizes and that motivates you.
Do not for one second let your mind tell you that you can't do something. If you think like that, you will never succeed. That's why its key to get your motivation and confidence up, Losing a few pounds early will help in this and next thing you know, you'll be telling yourself "hey i can do this." "I feel great" If you put your mind to it, and give it everything you have, you will succeed. I am living proof.
Take Care, And keep fighting the good fight!!!!
Joanne K from Canada writes: This is a question for Dr. Sharma. I'm female 36 years old and have struggled with my weight since I was 11. I've tried weight watchers, Jenny Craig, Atkins, South Beach, calorie restriction and a number of other diets. Dieting has worked for me in the short-term but not over time, and I always regain more weight than I lost in the first place.
I've tried to lose weight by NOT dieting, but focussing on eating smaller portions and exercising which I do regularly. I have about 50lbs to lose. I have a high bmi, family history of stroke, high blood sugar and pressure. I know I need to lose weight but I've become hopeless. Although I cook healthy meals at home (veggies every day, fish, skinless chicken and fish), bring lunch to work, take exercise classes and work out at the gym I don't get results. I'm really frustrated and wonder if you have any suggestions or advice. Thank you very much.
Dr. Arya Sharma: Dieting does not work, because to keep the weight off you would need to stay on whatever diet you chose forever. The minute you go off ANY diet, the weight will come back - often with a "vengeance".
It sounds like you are already doing the right things - eating several health meals a day and being as physically active as you can.
I am not sure where the number 50 lbs come from? If you are primarily interested in losing weight for health reasons, you can see huge benefits with simply losing 5-10% of your weight and keeping that off.
If 50lbs was 10% of your weight - you'd actually have to weigh 500 lbs, which I am guessing is not the case.
For someone, who is 200 lbs, simply losing 10 (5%) to 20 (10%) lbs is all it takes to improve blood pressure, blood sugar and feel better.
You may need to be more realistic about your weight-loss target.
RAMAN BRAR from Brampton Canada writes: Dr Sharma,
In light of new research, blaming genes for obesity, do I need to be cautious about weight gain for whole of my life, in case I genetically tend to be overweight.
Dr. Arya Sharma: Yes Raman, some people are genetically more likely to become obese than others.
As you know there are many skinny people out there who eat nothing but junk food and never exercise, yet do not gain weight - they are genetically lucky (at least with regard to their weight).
On the other hand, there are also many people out there, who despite eating healthy and exercising regularly have a hard time controlling their weight - they are genetically less "lucky".
If you belong to the many people (in fact the vast majority) who are genetically programmed to gain weight you need to be all the more careful to maintain a healthy diet and be as active as you can.
Prevention is always the best medicine!