Waist Management

Staying slim in Pittsburgh may be more challenging than in other cities. But it’s no excuse. Here are 13 hidden causes of weight gain and advice to get you on a winning path to a healthy weight.

What’s the No. 1 health issue facing Pittsburghers?

It’s an easy one to identify but a tough one to solve: our weight. Two-thirds of us are overweight or obese. One survey ranks us in the top 15 cities of greatest inactivity.

It’s easy to cringe when we face the “battle of the bulge” because so many of us feel we’re losing the fight. So, what to do about this issue? If you think slimming down is all about diet shakes and foot races in mini-shorts, read on. No matter what size package you’re in right now, it is possible to manage your weight and promote your health with some easy-to-make changes you can use every day.

While we have some unique challenges in Pittsburgh when it comes to weight loss, there is a whole host of positive things we can do to get energized, feel better and improve not only our waistlines but also our general health.

Why It’s Hard to Stay Slim In Pittsburgh

We face some special challenges in our region when it comes to managing our weight. These are not excuses but part of who we are. Once these issues are recognized, it’s easier to work around them.

  • Weather: We love our seasons, but the weather can be a big deterrent to getting outside. We don’t have a year-round sunny and warm climate as in Florida or California, where it’s easy to be outdoors most of the time.
     
  • Terrain: We have a beautiful, hilly terrain, but it can be tough to navigate those hills on foot or on a bike. We don’t have a flat grid like New York or Washington, D.C., where people pride themselves on walking long distances.
     
  • Family Affairs: Pittsburghers are family-oriented in so many great ways, and food is an important part of this mix. Family gatherings often focus on a variety of favorite foods—but not on all the calories.
     
  • “Pittsburgh Portions”: Not only here but all across America there is the problem of “portion distortion.” Often, a “single” serving in a favorite restaurant is enough for two or three people.

Taken together, these are all parts of a lifestyle that can be better managed. While it’s sometimes tough to know where to begin in addressing weight management, some basic knowledge will empower you to make some changes. 

Weighing in on a Healthy Body

There’s a lot of confusion about what your “ideal weight” should be. The term “ideal” doesn’t have a lot of meaning until you put the pieces of the puzzle together. An easy way to start is to find out your Body Mass Index. This number accounts for both height and weight, gender, frame size and muscle mass (unless you are a super-hero!). It’s the best all-around number to know in identifying where you are in the healthy weight-range continuum.

You may wonder how much weight you need to lose for better health. There’s no perfect answer, but consider common sense. Whether you are overweight by medical guidelines or even moderately to severely obese, there are effective strategies you can take to trim down, particularly if you have an illness, such as high blood pressure or diabetes, affected by your weight.

If you’re at a stable weight and have no health-related problems, consider staying at that weight. You may want to lose a few pounds simply for aesthetic reasons; keep in mind that the BMI chart is composed from information based on thousands of people, and you cannot always use population data to make the best choice for you.

Once you’ve sized yourself up, it’s time to take a closer look at what you are both willing and able to do for a trimmer waistline. At first glance, many people say, “I’ll do anything to lose weight,” but often, that’s not true. What you need is a combination of realistic goals, efforts and expectations.


Beware the 13 Hidden Causes of Weight Gain

If you’re thinking, I’ve been there, done that, and I’m not losing weight, look at some of these hidden causes of weight gain that could be obstacles in your quest for a healthier you:

1. Confusing “Heart-Healthy Fat” or “Fat Free” With “Low Calorie”: Label-reading these days is like reading an encyclopedia—so much information, but what really counts? There is a lot of confusion about “healthy” versus “lower-calorie” eating. While the first step in any healthy-eating plan is to seek out heart-healthy fat, don’t be fooled by product marketing. Olive oil is great for your heart but not for your waistline; both olive oil and butter have the same calories. Nuts are heart-healthy and protein-rich—but just a small handful has 100 calories! Trans-fat-free doesn’t mean fat-free. Nowadays, you need to read labels for the calorie count.

2. Portion Distortion: Few of us are good at “eyeballing” portion sizes or estimating calories in foods. Studies show we’re at least 50 percent too low in our “guesstimates.” (Even professionals in the field miscalculate!) Our measuring cues—including plate size, utensil size and hidden fats—are deceiving us. In fact, the average dinner plate in Europe is close to the size of our salad plate, and our dinner plates are like their platters. No wonder standard portions look skimpy!

3. Skipping Meals: Whether it’s to save time or calories, most meal- skippers think, “I skip meals, but it’s not a problem until I get home for dinner. Then I’m eating all night.” Here’s the bottom line: If we skip a meal, biology kicks in and makes us even hungrier for the next meal. This is a strategy doomed to fail.

4. Getting Too Much Exercise: This may sound contradictory, but rigorous exercise actually stimulates hunger. It’s the body’s response to “refuel” for metabolic balance. In caveman times, this was helpful for survival, but not now, when food is easily available 24/7.

5. Overestimating Exercise Calories: We often don’t correctly estimate the calories we lose in exercise. We might feel sweaty and think we’ve burned thousands of calories, but the truth is it takes about five minutes to consume 500 calories and nearly two hours for most people to burn them off!

6. Not Exercising Enough: Those claiming they are simply too busy for any activity can have a real problem. Even a small drop in the activity of daily living—cutting out a 20-minute walk—can add 100 calories a day, which would be 10 pounds in a year. Here’s a typical comment: “I used to park blocks away in a cheaper lot. I got promoted and now use the corporate lot. I’ve gained 5 pounds in three months.”

7. Lack of Sleep. Not getting enough sleep is among the top hidden reasons for weight struggles. As a result, people become fatigued and eat for energy. Being tired can lead to apathy and a lack of focus when it comes to a healthy lifestyle plan. Many of us eat between meals to “wake up” when what we really need is a power nap.

8. Poor Stress Management: Mindless eating can come from poor coping skills with stressors in life. We eat to soothe and reward ourselves, which does work—temporarily—to make us feel better. It’s important to learn to self-soothe and manage stress without food.

9. Weight Creep: Some general awareness every day is needed to avoid what I call “weight creep.” It takes only a few extra calories a day to gain extra pounds a year. Most often, people “relax” their healthy lifestyle on the weekend, or they stay on their eating plan four or five days a week. That’s enough to promote a pound or two a month of hidden weight gain.

10. Medication Side Effects: Some medications can lower your metabolic rate and stimulate hunger as a side effect. These include some antidepressants, antipsychotics, antihistamines, insulin and other blood-sugar regulators, and anti-inflammatory medications. If you’ve started a new medicine and gained 4 pounds or more in a month, check with your doctor.

11. Undiagnosed Mood Disorders: Depression and anxiety have both biological and behavioral causes. While some people experience loss of appetite, insomnia and weight loss, a large subgroup sleeps and eats more. Also, thyroid problems, which alter weight, are often tied to depression.

12. Thyroid Function: The thyroid gland is your body’s “thermostat,” which sets the “furnace.” Alterations in the thyroid gland, which is regulated by a signal from the brain to release thyroid hormone into the system, can wreak havoc on a weight-management plan. Thyroid problems can be easily tested and treated with a visit to your doctor.

13. Elevated Blood Insulin: Also known as metabolic syndrome, elevated blood insulin levels are invisible unless you get a blood measurement. Symptoms include not only high insulin levels but also central weight gain (a bulging belly, for example), elevated blood pressure and higher blood fats. Those with an “apple” shape can be at particular risk. Only your doctor can evaluate this measure.


Getting Started: Take These Four Simple Steps

In reading along so far, you might think what you’ve just learned is too hard to tackle, so you decide, as many people do, just to give up. Hold on! Hang in there. One size does not fit all when it comes to weight management. Fortunately for us in the Pittsburgh region, we have so many choices—from free weight-management support groups and self-pay treatment groups to insurance-covered medical programs.

But how do you get started? As the Nike commercial says, “Just do it.”

Here are my four steps to weight loss that can get you on the winning path to a healthy weight:

1. Find a Plan That Works for You: I’m always asked about the “best” diet plan or diet book. My answer is always the same: The best plan is one that is compatible with what you’re both willing and able to commit to. Beware of any plan that talks about “good” and “bad” foods and eliminates whole food categories, such as carbohydrates or fats. Balance is the key. While most plans vary a bit, choose one containing about 40 percent carbohydrates, 30 percent proteins and 30 percent fats. (See the sidebar above for some basics about effective weight-management eating.)

Don’t forget to count your calories. Weight loss is based on calories in and calories out. But don’t confuse terms such as heart-healthy, trans-fat free, reduced fat, 100 percent whole grain and naturally fat-free with low calorie. They often don’t go together. In addition, keep a food log. Nothing fancy, but if you bite it, write it. That way, you become more accountable for what you’ve eaten each day.

2. Identify What Physical Activities You Are Willing and Able to Do: You don’t have to run a marathon to exercise, and you don’t even have to “exercise” to get some exercise. What you do need is to be more physically active. The first step in this process is to increase what I call “activity of daily living.” This means to get more steps in your day: parking farther away in a parking lot from your destination, taking the stairs for a flight or two, getting up off the couch, walking around while on the phone—there are dozens of easy ways to incorporate healthy activities in your daily living.

The bottom line is to have at least 20 to 30 minutes a day of moderate walking. This strategy alone—without any other changes—will help you drop about 10 pounds in a year. Consistency is key here, and purchasing a pedometer to monitor your steps can be a big help. While the “gold standard” is 10,000 steps a day for weight loss, don’t aim for that at the start. Work up to 5,000 steps a day, and within a month, get to 10,000. It’s a habit you can form.

3. Set Realistic Goals and Keep Motivated: I often think weight loss is more about our ”heads” than our “stomachs.” We eat for so many reasons that are unrelated to physical hunger, including happiness, sadness, stress, anxiety, boredom and habit. (Anyone for Raisinettes and popcorn at the movies after a big dinner?) Behaviors relating to lifestyle are very tough to change, but with so many ways to do it, change is quite manageable—if you start with a plan. The first word here is “realistic,” and I encourage you to set some realistic and specific goals for yourself. A slow and steady set of changes becomes a habit for a lifetime after about two to three weeks. Here’s one example: Instead of saying, “My goal is to lose 30 pounds,” say, “I’m aiming to lose a pound a week for the next three months, with a goal of at least 10 pounds.”
It’s also important to address how well you’re able to cope with daily stress. If it’s a struggle to manage stress on your own, seek the advice of a friend, support group or private therapist.

4. Talk to Your Doctor and Identify Options: Have trouble talking to your doctor about your weight? You are not alone. Many people do, feeling embarrassed or judged. However, your doctor is not a mind-reader, and he or she needs to know that you want to have a dialogue about weight loss. Where your doctor can help is not as a sole source of support for all of the diets you’ve tried but as a professional who can help you evaluate possible medical causes for weight gain. A doctor also can open a realistic discussion about where to locate the right kind of support for your weight-loss needs. Your doctor can be your partner in figuring out the biological issues relating to weight gain but cannot always be the right contact for behavioral issues, which might need further referrals.

If you’ve made a consistent lifestyle change and find that you’re not making progress (review the 13 Hidden Causes of Weight Gain) or your point of intervention is beyond what lifestyle alone can do, talk with your doctor about prescription medications or obesity surgery. These can support, but not replace, the lifestyle effort.

Although prescription medications are limited in utility (it’s hard to turn off appetite without many side effects) and often are an out-of-pocket charge, talk to your doctor about this option. If you are considered severely obese (termed Class 3, meaning a BMI of 40 or more) or moderately obese (termed Class 2 with significant medical illness), you might consider a surgical option. Try to set up a separate consultation with your doctor, not when you’re visiting for a specific ailment, which often could be related to your weight.


Keeping the Weight Off: How to Stay Weight-Stable

What is successful weight management? It’s identifying a healthy weight that you can maintain with moderate—not heroic—effort. Your empowerment comes with acceptance that keeping weight off (not weight loss!) over the long term is success, and that requires choosing a realistic, not ideal, weight. Pittsburghers, like all Americans, are great at losing weight but not so great at keeping it off. The difference in weight loss and weight maintenance is quite small and sometimes is just a matter of cutting out 100 calories or adding a 20-minute walk.

So, what are we to do? For long-term success, consider these final tips:

  • Consider a Diet Buddy: Seek out a friend or relative, join a support group or connect online. “Going it alone” is tough when it comes to staying on track. Some people like group support, while others prefer the personal touch of a one-on-one connection. Be realistic and search out what works best for you.
     
  • Maintain Structure: When you have a daily structure to support your effort, you’re automatically in control. Weigh yourself weekly or even daily, keep a food journal and take a walk every day.
     
  • Stay Consistent: Lifestyle changes are difficult and must be learned over time or relearned when necessary. Focused effort is important to stay on track, and daily accountability to your eating and activity plan is a must. It’s the small changes done daily that add up to consistent calorie savings. You can turn some small changes into a lifelong habit—in a matter of two or three weeks.
     
  • Learn From Your Mistakes: A lapse is normal, but avoid a total collapse. We’re all human, and we can only put forth our best effort, not a perfect effort. There will be times we get off track. It’s important to recognize these small lapses as a learning experience and then change behaviors to avoid them in the future. Don’t despair and figure, “What’s the use?” Keep going. Practice. Eventually you’ll find your effort really works!

Pittsburgh magazine health editor Dr. Madelyn H. Fernstrom, Ph.D., C.N.S., is the founder and director of UPMC’s Weight Management Center. She is the diet and nutrition editor for NBC’s “Today Show” and is the author of The Runner’s Diet. Also, visit “Health Journal with Dr. Madelyn Fernstrom,” a health and wellness blog at iVillage.com.

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