Everyday Fitness

By Pamela Peeke, MD

Happy New Year to every WebMD member! Take a breath and hit the pause button. Let’s talk about how you want to live from here on out. If you believe you’re doing well— eating nutritiously, staying mentally and physically active— then keep it going, and try to continuously challenge yourself to stay engaged and on track. And share your thoughts on this blog and exchanges to help others. However, if you feel like making some improvements to boost your health and wellbeing, I’m going to roll out a simple, practical strategy to teach you healthy lifestyle basics while showing you how to coach yourself to sustain your success for a lifetime. You see, you have what it takes to help yourself. You just need to discover how powerful you really are.

I prefer to approach lifestyle as an ongoing, dynamic, holistic and integrative process. You’re not a robot that can be commanded to get up and exercise and eat well right away. You’re a human being who’s come to the table with a lifetime of triumphs and difficulties and you need to be honored for your uniqueness. As you look ahead at this new year, let’s think way outside any box, and instead be mavericks in how to craft a better way to live. You’ll notice I’m not emphasizing a 12 month weight loss campaign. This is much bigger. This is about a mind and body transformation that is sustainable for life— your life. Transformation is the goal.

For the next twelve months, you’ll be provided with a multilevel blueprint to help you navigate your mental and physical challenges. This will include:

Twice weekly blogs: You’ll be hearing wit and wisdom from the “Masters”, men and women who have achieved mental and physical transformations and are eager to share secrets of their ongoing journeys and success. In this blog you’ll hear from Tara Costa, well known from her Biggest Loser story and author of the foreword to my book The Hunger Fix. We welcome your comments on the blog and plan to reply to as many of one of you as we can.

Diet Community Exchange: Join the WebMD Diet Community Exchange and reach out to get support from other WebMD members who are at various stages of their transformation journeys. I’ll be there as well to answer questions, post tips and resources and participate in the discussion groups. Research now shows that when you can get ongoing support and coaching like this, you’ll be more successful in the long run.

Weight Loss Wisdom Newsletter: Sign up for the WebMD Weight Loss Wisdom Newsletter. You’ll see snippets from my blogs and the diet exchange interwoven into helpful new news to guide you on your journey. The wonderful editors do a terrific job of filtering through all of the new information coming in to drill down to the most helpful facts, tips and tools to arm you for your daily lifestyle challenges.

OK, are you ready to get started? Great. First, take my Are You Ready for Change quiz. It’ll help you get the reality check you need prior to embarking on your journey. This is meant primarily to help you start to think about the things you’ll need to change as you push forward. You’ll be addressing each of these on an ongoing basis so don’t worry about anything other than being aware that these are important issues.

1. Are you motivated to make long-term lifestyle changes that require eating healthy foods and becoming more physically active?

2. Have you fully identified the main stresses
in your life now and during the next several months?

3. Do you truly believe that there is no magic bullet, but instead patient work on your part?

4. Do you believe that you can change your eating habits?

5. Do you have family, friends, or both who will support your weight-loss efforts?

6. Are you willing to find ways to be more physically active?

7. Are you realistic about your mental and physical transformation goal?

8. Are you willing to record your food intake, physical activity, and mental focus, and will you make time to do so?

9. Are you willing to look at past experiences in starting a healthier lifestyle and other areas of your life to see what has motivated you and kept you working on obstacles to success?

10. Do you view changing your eating and physical activity habits as a positive experience?

11. Have you resolved, or are you in the process of resolving, any eating disorders or other emotional issues that make it difficult for you to achieve a healthy weight?

12. Do you believe that achieving your mental
 and physical transformation is a lifelong process that requires you to change your behavior, eating habits, and level of physical activity?

13. Are you ready to make that commitment?

There’s no right or wrong answer to this quiz. It’s an opportunity for you to review where you stand in your determination and ability to make changes in your life. Carefully examine the people, places and things in your life that may stand in your way to successful transformation. We’ll help coach you to how to adapt and adjust as you go along.

As many of you know, my baseline blueprint for change is using my infamous MIND MOUTH MUSCLE template. Let’s dig in with small steps in each element.

MIND: We’re not doing any resolutions. We’re taking small steps to build a powerful foundation for lifelong health and wellbeing. Don’t stress yourself with lofty goals. Instead, practice staying mindful and vigilant for only TWENTY FOUR HOURS. That’s correct. Get through each day using my “Just for Today I Can_____”. Break up the day into segments highlighting the trouble hours (nightly eating, overeating in the afternoon, skipping lunch) and concentrate on your significant changes occurring during those blocks.

MOUTH: I highly encourage you to log onto the WebMD Food and Fitness Planner. You need to have a basic plan to use and customize for your own needs. In future blogs, I’ll be talking about many of the new apps available and many resources to help you individualize your nutrition as you go along. For now, go to your kitchen and ditch any processed or refined food products lurking in your pantry and fridge. Give’em away or pitch them. Now, get to the grocery store and, using the Food and Fitness Planner’s guidelines, as well as my basic “how to prepare your kitchen for healthy eating” in The Hunger Fix, gradually stock up on whole foods. Vow “no more science fair projects in my kitchen!”

MUSCLE: Assume the vertical more often each day. Just get up and move more. Walk for 30 minutes accrued at least 5 days every week. Add a little intensity by varying the speed or incline as you go along. Just take it gradually if you’ve been pretty sedentary. Grab a pedometer. Your eventual goal is 10,000 steps every day that you can. For now, just see what your start number is and plan on adding 500 or more steps per day every week until you hit your goal.

Finally, let’s end with the Voice of a Master.

“I didn’t become 316 pounds overnight. Packing on the pounds was a process, one that, at times, I don’t want to remember. But finally facing what got me there is what has helped me realize that I never want to be like that again—lost, dissociated from myself, and hungering for the lies and the quick fix of my food addiction. I’m an emotional eater. Whether I was sad or extremely happy, it didn’t matter—every emotion was registered as “hunger” and filled with food. And the fact that most of my family has weight issues, and the majority of them are still obese, certainly didn’t help. Sunday dinners at Grandma’s house had four courses! There was no getting up in the morning to take a walk. We were clued out. Most of us do not understand that once we identify our true hunger, we can set the scope of our dreams—that no matter how powerful the influences are, we do not have to be trapped by our environments.” Tara Costa

Good luck and I look forward to hearing from you

By Pamela Peeke, MD

For most of her 67 years, Kris has waged war with her body weight. From early childhood, she carried much more weight than the other kids. As the years went on, she became hooked on the daily routine of overeating her favorite sugary, fatty, salty food combinations. Topping out at 325 pounds ten years ago, she’d had enough, detoxed off the junk, and managed to battle her way down to 220 pounds. She was going strong when her husband, the love of her life, passed away. Distraught, lonely, and grieving, she sought relief from her old “friends”– her food fixes — and packed on fifty pounds. Her expanded girth led to aching knees and back pain. Instead of retirement years filled with social activities and new challenges, Kris found herself hiding at home, filled with blame, shame, and guilt. Lost and feeling helpless, hopeless, and defeated, she finally realized she was addicted to these foods as well as her whole way of life. She’d had enough. That’s when she came knocking on my door.

Eager to start, Kris declared, “I’m ready to take on my munching monster”. As we began the journey together, she constantly amazed me with her ingenuity, always finding creative ways to switch out food fixes for healthier fare. Popping into my office shortly after our first session, Kris shared a little secret that I now want to gift you with. It’s called Kris’s Cookie Jar of Love and Inspiration.

Cookies were one of Kris’s go-to fixes, whether she was stressed, happy, or bored. Growing up, her mom would keep a constant supply of freshly baked cookies in a colorful jar. Sneaking into the kitchen day and night, Kris would dive into the jar, load up, and run with her precious stash back to her room. The cookies kept coming well into adulthood. When she hit 325 pounds, she knew the cookie binges had to stop. Staring at the cookie jar, she had mixed feelings. It had always conveyed a sense of comfort and safe harbor from life’s usual pains and angst. Yet, it also represented loss of control, a canister of cravings, and a mountain of anesthetics to numb her from the frustrations and anxieties in her life. Conflicted, she sat with it for a while and then had what I love to call an EpiphaME.

She loved that jar sitting in her kitchen and didn’t want to give it up. So she created a win-win solution. She’d keep the jar but redefined its role in her life. Grabbing a pen, scissors, and colorful paper, Kris set about cutting small circles and squares, the shapes of her familiar cookies. Then she inscribed on each piece of paper one of her favorite inspirational sayings. The collection included affirmations lovingly handwritten by her husband, who wanted to help cheerlead Kris through challenging times. Whenever Kris read or heard another great quote, she’d quickly make another “cookie” and toss it into the jar.

So, whenever she felt like caving to the craving, instead of diving into the jar to run from and numb herself with cookies, she now reached into the cookie jar and grabbed an inspiration or two. Reading “You go girl, you can do this to live the life you so deserve!” killed the craving on the spot. It also broke her addictive food trance and snapped her back into reality. Her mindfulness and vigilance was heightened. A deeply spiritual woman, she also prayed a little prayer of gratitude for her quick regrouping with the help of her cookie jar of love and inspiration.

The jar was her pal until her husband passed. Her grief was overwhelming and she sank into years of self-neglect, depression, and social withdrawal. The jar got pushed to the back of a kitchen shelf. When Kris awakened from this painful period seeking help, that’s when Kris and I began our journey together.

As we began her detox from her food fixes, we also began to reorganize her lifestyle habits to support the new program. And as we begun, she’d all but forgotten the jar. Until one day, she accidentally bumped the kitchen shelf and the jar landed in her lap. Smiling, she couldn’t help but think, “Coincidences are God’s way of acting anonymously”. Quickly, she reached into the jar, pulled out an inspiration and laughed out loud as she read “No, this isn’t a cookie — this is the rich and fulfilling life you deserve. That’s what you’re really hungry for.” Inspired once again, each week she now adds fresh new material to her cookie jar, which she now proudly displays front and center on her kitchen counter.

As we have worked together, Kris has been having countless EpiphaME’s. Perhaps many of you can identify with some of these as well. Each one has led to more inspirational “cookie” deposits in the jar.

1)     Practice Self-Compassion: Kris had never realized that she’d devoted her entire life to care giving others, mostly in deference to her own needs. This became apparent when her husband died. Suddenly she was left with a void. Who was she to care for now? It never occurred to her that she needed love and support and care giving as well. That’s when she realized she’d always believed she didn’t deserve that kind of attention. It was always about someone else. A milestone in her detox and recovery program occurred when she discovered that she not only deserved love and compassion, but without giving herself those two gifts, she could never be the best care giver to others. At the age of 67, she finally figured this out and realized it’s never too late.

2)     Pitch the Unhealthy Voices: “You’ll never make it,” “You’re too far gone,” “Give it up. It’s too late.” For most of her life, Kris listened and believed these Unhealthy Voices. In addition to feeling like she didn’t deserve happiness and love, she realized she was incorporating these voices into her sense of self-worth and self-esteem. When she did, she’d feel low and cave to the crave. Grabbing those cookie jar inspirations reminded her time and time again that she was strong and powerful and deserved every lick of love and support coming her way. This time she was angry and firm as she said “No more! I don’t believe those voices. I believe my own!” and set about writing more self-created messages of support.

3)     There’s Science Behind the Munching Monster: Like so many people, Kris was relieved and thrilled to realize that there was excellent new science to help her understand the biology of her relationship with food, specifically her food addiction. Armed with the new science (see The Hunger Fix book) and a plan of action, she was finally hopeful for lifelong recovery from being hooked on the hyperpalatables. She created more “cookies” that now said “Reclaim your brain. You can do this!”

As I write this blog, Kris has just emailed me another update. You can see she’s bound and determined to make this work:

“Things are going great as I go through some challenging times. I was invited to five holiday/retirement gatherings last week. I declined the buffet parties and chose the open house luncheon/tea and did very well sipping a cup of tea (trying different flavors) w/steamed shrimp & vegetables and staying away from the food on the Munching Monster’s tray and remembering that the party was about mingling, not munching!”

I have a suggestion for everyone. How about creating your own cookie jar experience? It could simply be a lovely box of affirmations, inspirations, and self-coaching thoughts that can help you when you feel the urge to cave and self-destruct. Hey, the jar’s contents are zero calories but heavy on the self-compassion, love and support. Give it a whirl!

For most of her 67 years, Kris has waged war with her body weight. From early childhood, she carried much more weight than the other kids. As the years went on, she became hooked on the daily routine of overeating her favorite sugary, fatty, salty food combinations. Topping out at 325 pounds ten years ago, she’d had enough, detoxed off the junk, and managed to battle her way down to 220 pounds. She was going strong when her husband, the love of her life, passed away. Distraught, lonely, and grieving, she sought relief from her old “friends”– her food fixes — and packed on fifty pounds. Her expanded girth led to aching knees and back pain. Instead of retirement years filled with social activities and new challenges, Kris found herself hiding at home, filled with blame, shame, and guilt. Lost and feeling helpless, hopeless, and defeated, she finally realized she was addicted to these foods as well as her whole way of life. She’d had enough. That’s when she came knocking on my door.

Eager to start, Kris declared, “I’m ready to take on my munching monster”. As we began the journey together, she constantly amazed me with her ingenuity, always finding creative ways to switch out food fixes for healthier fare. Popping into my office shortly after our first session, Kris shared a little secret that I now want to gift you with. It’s called Kris’s Cookie Jar of Love and Inspiration.

Cookies were one of Kris’s go-to fixes, whether she was stressed, happy, or bored. Growing up, her mom would keep a constant supply of freshly baked cookies in a colorful jar. Sneaking into the kitchen day and night, Kris would dive into the jar, load up, and run with her precious stash back to her room. The cookies kept coming well into adulthood. When she hit 325 pounds, she knew the cookie binges had to stop. Staring at the cookie jar, she had mixed feelings. It had always conveyed a sense of comfort and safe harbor from life’s usual pains and angst. Yet, it also represented loss of control, a canister of cravings, and a mountain of anesthetics to numb her from the frustrations and anxieties in her life. Conflicted, she sat with it for a while and then had what I love to call an EpiphaME.

She loved that jar sitting in her kitchen and didn’t want to give it up. So she created a win-win solution. She’d keep the jar but redefined its role in her life. Grabbing a pen, scissors, and colorful paper, Kris set about cutting small circles and squares, the shapes of her familiar cookies. Then she inscribed on each piece of paper one of her favorite inspirational sayings. The collection included affirmations lovingly handwritten by her husband, who wanted to help cheerlead Kris through challenging times. Whenever Kris read or heard another great quote, she’d quickly make another “cookie” and toss it into the jar.

So, whenever she felt like caving to the craving, instead of diving into the jar to run from and numb herself with cookies, she now reached into the cookie jar and grabbed an inspiration or two. Reading “You go girl, you can do this to live the life you so deserve!” killed the craving on the spot. It also broke her addictive food trance and snapped her back into reality. Her mindfulness and vigilance was heightened. A deeply spiritual woman, she also prayed a little prayer of gratitude for her quick regrouping with the help of her cookie jar of love and inspiration.

The jar was her pal until her husband passed. Her grief was overwhelming and she sank into years of self-neglect, depression, and social withdrawal. The jar got pushed to the back of a kitchen shelf. When Kris awakened from this painful period seeking help, that’s when Kris and I began our journey together.

As we began her detox from her food fixes, we also began to reorganize her lifestyle habits to support the new program. And as we begun, she’d all but forgotten the jar. Until one day, she accidentally bumped the kitchen shelf and the jar landed in her lap. Smiling, she couldn’t help but think, “Coincidences are God’s way of acting anonymously”. Quickly, she reached into the jar, pulled out an inspiration and laughed out loud as she read “No, this isn’t a cookie — this is the rich and fulfilling life you deserve. That’s what you’re really hungry for.” Inspired once again, each week she now adds fresh new material to her cookie jar, which she now proudly displays front and center on her kitchen counter.

As we have worked together, Kris has been having countless EpiphaME’s. Perhaps many of you can identify with some of these as well. Each one has led to more inspirational “cookie” deposits in the jar.

1)     Practice Self-Compassion: Kris had never realized that she’d devoted her entire life to care giving others, mostly in deference to her own needs. This became apparent when her husband died. Suddenly she was left with a void. Who was she to care for now? It never occurred to her that she needed love and support and care giving as well. That’s when she realized she’d always believed she didn’t deserve that kind of attention. It was always about someone else. A milestone in her detox and recovery program occurred when she discovered that she not only deserved love and compassion, but without giving herself those two gifts, she could never be the best care giver to others. At the age of 67, she finally figured this out and realized it’s never too late.

2)     Pitch the Unhealthy Voices: “You’ll never make it,” “You’re too far gone,” “Give it up. It’s too late.” For most of her life, Kris listened and believed these Unhealthy Voices. In addition to feeling like she didn’t deserve happiness and love, she realized she was incorporating these voices into her sense of self-worth and self-esteem. When she did, she’d feel low and cave to the crave. Grabbing those cookie jar inspirations reminded her time and time again that she was strong and powerful and deserved every lick of love and support coming her way. This time she was angry and firm as she said “No more! I don’t believe those voices. I believe my own!” and set about writing more self-created messages of support.

3)     There’s Science Behind the Munching Monster: Like so many people, Kris was relieved and thrilled to realize that there was excellent new science to help her understand the biology of her relationship with food, specifically her food addiction. Armed with the new science (see The Hunger Fix book) and a plan of action, she was finally hopeful for lifelong recovery from being hooked on the hyperpalatables. She created more “cookies” that now said “Reclaim your brain. You can do this!”

As I write this blog, Kris has just emailed me another update. You can see she’s bound and determined to make this work:

“Things are going great as I go through some challenging times. I was invited to five holiday/retirement gatherings last week. I declined the buffet parties and chose the open house luncheon/tea and did very well sipping a cup of tea (trying different flavors) w/steamed shrimp & vegetables and staying away from the food on the Munching Monster’s tray and remembering that the party was about mingling, not munching!”

I have a suggestion for everyone. How about creating your own cookie jar experience? It could simply be a lovely box of affirmations, inspirations, and self-coaching thoughts that can help you when you feel the urge to cave and self-destruct. Hey, the jar’s contents are zero calories but heavy on the self-compassion, love and support. Give it a whirl!

By Pamela Peeke, MD

For years I have listened to my patients referring to their eating problems using a drug vernacular. “I need another hit,” they would say, “Withdrawal is killing me,” or “I need to score some more.” In the back of my mind and those of my colleagues, we collectively wondered if there was an addiction going on here.

At that time in history, there were some compelling research studies that suggested a food and addiction link. But all of us needed more. I waited somewhat impatiently until there was finally a critical mass of data from neuroscientists. When there was finally enough excellent, credible published information, I did what I’d planned for so long — write a book, translating this groundbreaking new science into practical tips and tools to help people who were hooked on certain foods and felt helpless, hopeless, and defeated about it. When I launched The Hunger Fix: The Three-Stage Detox and Recovery Plan for Overeating and Food Addiction I must have hit a nerve. Within five days of launch, the book became a bestseller. All I cared about was that people could benefit from knowing that, as many have shared, “I’m not crazy — there’s something real going on in my brain”. For that matter, at the Weight of the Nation conference in Washington, D.C., last May, Kathleen Sebelius, Secretary of Health and Human Services, stated in her keynote address, “Obesity can be caused by any combination of factors. For some it’s an addiction like smoking.” That was a first from such a high-ranking government official.

Food addiction is real.

Capsule Summary of the Science: The first chunk of new science presented in the book—based on NIH research by Dr. Nora Volkow, Director of the National Institute of Drug Abuse — was possible through the use of unique brain scans (PET and functional MRI’s) enabling scientists to  peer into the brain and identify changes that occur when someone is actively addicted to anything—from alcohol to drugs to food. Scans show damage and impairment in both the reward center as well as what I call the “smarty pants” part of the brain, or the prefrontal cortex (PFC). Tap your forehead. Right behind it lies the PFC. It provides you with executive function—planning, organizing, creating, and reining in impulses. It helps power up your willpower as well as your won’t power. If it is dysfunctional, moderation becomes a moot point.

Food is meant to be palatable, rewarding, and pleasurable. Our reward system secretes rivers of the pleasure brain chemical dopamine when we are cued up to find our favorite foods as well as when we’re consuming them. Dopamine drives us to love the smoothness of fat, and consuming it helps us survive in times of famine. That primal reward and survival system has been working beautifully for thousands of years.

Then something happened: we changed up the food supply. To feed a large population, food had to be manufactured, frequently with added sugar, fat, and salt to enhance taste. Your primal brain was overexposed to the 24/7 availability of the sugary/fatty/salty food combos—the “hyperpalatables”. Most brains were overwhelmed with this daily tsunami of reward and pleasure. Consuming these kinds of foods left people feeling out of control leading to overeating. As a result, the brain’s primal survival mechanism kicked in. It drove down the number of dopamine receptors so that you didn’t feel this overload of reward and were no longer over-stimulated. That’s the good news. The bad news is that now you can’t feel the usual pleasure with one serving of a certain food, and suddenly you need more and more. Before you knew it, your buttons were popping and fitting into your jeans became mission impossible.

The bottom line is that the sugary/fatty/salty combos hijack your reward center and impair the part of your brain that is supposed to help you be focused, stay vigilant, and rein in the urge to splurge. The end result is that you cave to the crave every time. That’s the vicious cycle of addictive eating.

Physical-Mental Changes: In the study of food addiction, biology meets psychology. They are inextricably intertwined. In all addictions, there are organic brain changes as well as conditioned behavioral responses that both have to be addressed in prevention and treatment. We’re saying goodbye to the days when we assume this is only about willpower. That’s one component, but based upon the new scientific findings, healing the organic damage must be integrated into any intervention.

Who’s affected? Yale University researchers created a validated science-based quiz to see if you have an issue with food and addiction. Take a moment to check it out here. People of all sizes and ages can be affected. Experts predict that after rigorous population sampling is conducted, the majority of overweight and obese people will be found to be food addicted to some degree. Folks who are cross addicted (have more than one addictive habit such as food and smoking) tend to have a more pronounced experience and during treatment, need to really hone their vigilance and focus to stay on track through recovery.

What This Means to You: This new research is a game-changer. No longer will people be foisted into a one-size-fits-all approach to weight management and wellbeing. Instead, we have now discovered a new category of folks, those with an issue with food and addiction, who need a more customized and individualized approach to their problem. What’s that going to entail?

You have to do direct battle with the hyperpalatables. Identify which foods and beverages lead you to lose control. As with any addiction, you have to go through a withdrawal, and then enter a lifelong recovery. I use my trademark three pillars: Mind, Mouth, Muscle to power you through the process. You’ll be changing up entrenched lifestyle habits as well as healing your brain’s reward and PFC centers.

Join Shayla on Her Journey: I was thinking about the best way to share this science with WebMD readers. The answer is to make it real. When I appeared on one talk show, I was asked to work with an extraordinary young woman, Shayla, who has a profound food addiction, especially to sugar. Watch the show and pay particular attention to her segment and the video of Shayla at home surrounded by her chosen hyperpalatables. It has been an honor to work with her as she has courageously taken herself on, detoxing while living her rich and full life as a mother, spouse, mental health professional, and part-time college student. Beginning this week, follow her experiences as she strives for progress, not perfection, and tackles the daily challenges of coming clean and staying that way. I’ll also be introducing other wonderful men and women who are looking for support in their journeys. Check out our Diet Community Discussion Group and help support your fellow WebMD members. Whether you have already achieved your health and wellness goals or are beginning or somewhere on the journey, everyone wins. It’s through sharing that the lessons come alive and become meaningful and relevant to your life.

We look forward to vibrant and terrific communication on the blog and the exchange.

By Pamela Peeke, MD

Tired of someone else telling you what fit, beautiful/handsome, or healthy looks like? Every day, the media bombards us with images of their biased take on buffed and chisel-fit bodies. When WebMD members begin their journey from an unhealthy/unfit starting point to one much healthier, I’ll bet some of those Photoshopped pics float through their minds. My recommendation? Reject the pretty pics and concentrate on creating your own definition of what it looks like to be at your best, mind and body. Want some help with this? Log onto fitnessrebellion.com, read the manifesto carefully, make that commitment to self, and become a health and fitness rebel.

I love this approach. Look at the opening words:

‘I reject the notion that beauty, desirability, and worthiness are one size fits all. I think happy people are the healthiest people. It’s not enough to just look good on the outside. I want to feel good on the inside, too.

‘I will give my one, precious body the respect it deserves. We’ve been together a long time, and we’ve got miles to go. When my body is strong, I am strong. When my body feels good, I feel good. Wherever I go, my body goes, too. When I take care of my body, it takes care of me.’

Who created this? My good friends and founders of Anytime Fitness, Chuck Runyon and Dave Mortensen. You might have also just seen them on the Secret Millionaire living in a struggling Omaha neighborhood and giving back to that community. They have a wily sense of humor too. Chuck and team recently authored the terrific book with the provocative title Working Out Sucks, accompanied by the subtitle And Why It Doesn’t Have To. It’s an easy and fun read and segues smoothly into their Fitness Rebellion website. Runyon’s voice is authentic, as he can relate to every man or woman who’s ever broken into hives just thinking about exercise. He gets it. As well, he asks you to do this as a personal journey and to dance to the beat of your own drums.

So many people look at themselves in the mirror and feel frustrated and hopeless. Why? They’re comparing themselves to others, whether from real life or from the media. That’s why you have to become a rebel and reject the hype, unrealistic expectations, and false promises of overnight miracles.

Now, take another look at yourself in the mirror and smile with compassion, kindness, and love. Here are next steps:

1)   Start every day with the following commitment: “Just for today, for the next 24 hours, I will commit to_________,” and then fill in the blank with one small step you’re going to stick to. It could be getting to bed by 10 p.m. or having a healthy breakfast. Frustration is born when you live in the future, fretting that you’ll never get to the finish line. Bag that, and stay mindful and in the present moment. Embrace it, live it, and stay focused and on track. You can do this for 24 hours. Take every day this way. Wake up with that daily commitment to self.

2)   Practice self-pride and love. Celebrate every victory (“Hey I ate a healthy breakfast three days in a row so far!”) no matter what size. Be proud of your efforts. Give yourself countless “atta girl/boys throughout the day”. Stop the negative speak to self. No, you’re probably never going to grace the cover of Sports Illustrated. So what? You’re powerful and wonderful and getting healthier all of the time. That’s what you want to concentrate on. Stay present!

3)   Take care of your body. Recall the words of the manifesto “When I take care of my body, it takes care of me”. It’s true! If you want to enjoy your vacation, or that next hike or swim or bike ride with the family, you need a fit and healthy body. You brush your teeth, so care for your body as well. And reap the rewards.

4)   Turn mistakes into lessons. You’re human. Everyone’s going to slip and slide. No problem. Just convert that digression into a lesson. What did you learn? How can you prevent future problems? Think it through. Spend zero time thrashing yourself for a mistake. Spend lots of time coming up with creative solutions so it doesn’t happen again. This learning process is lifelong, so get used to regrouping and moving on.

5)   Be a rebel. You define your best mind and body. You compete with you when you’re taking that morning walk. Today you’re faster, lighter on your feet than yesterday. Terrific! You’re down a pant or dress size. Well done! Just keep it movin’ as you continue to practice your healthy lifestyle habits every single day.

Bottom line: Own this journey you call life. It starts with taking a stand, defining your own success, and, of course, starting your own fitness rebellion.

By Pamela Peeke, MD

You hear it all the time: “Eat mindfully and you’ll not only enjoy your meal, but it’ll be easier to shed weight.” Sounds like a win-win. But most of us hop out of bed at O’Dark Hundred and hit the ground running. We race out the front door either skipping a meal, doing a grab-and-go, or engaging in a bit of dashboard dining. Regardless, we’re usually stuffing food into our mouths…mindlessly. It’s hard to taste and savor when within seconds a meal or snack is gulped and out of sight. It’s also hard to drop that excess weight when our frenzied feasting doesn’t allow enough time — 20 minutes — for the mind to register you’ve eaten enough to satisfy your body’s needs.

Mindless eating like this messes with four key “friends” in our own body chemistry that work together to help us sense fullness and rein in over eating:

1) Cholecystokinin (CCK) is an intestinal hormone that tells the brain you’re in the process of consuming food.

2) Leptin is a fat cell hormone that monitors your fat storage and directs the brain to stimulate more or less eating based upon your energy needs. CCK and leptin work together to produce a sense of fullness.

3) Grehlin is a stomach hormone that stimulates appetite for more food, based upon the brain’s communication with CCK and leptin.

4) Dopamine is a brain neurotransmitter that works in concert with CCK to enhance your sense of pleasure and reward from eating.

By slowing down your eating pace, you allow your own body/brain chemicals to work optimally. Your reward is better enjoyment of your food and, studies have shown, far fewer calories consumed.

You can practice mindful eating anywhere. Always make certain you’re not overly hungry before eating by keeping up with your every 3-4 hour snacks and meals throughout the day. Next up, put that fork/spoon down after every bite. Take a breath and savor the moment.

The best way to practice mindful eating is at home. And here’s the catch: If you want to do this well, do some cooking. Yes, that means spending a little time in the kitchen preparing and then enjoying the fruits of your labors. Science shows that people who cook more drop more weight.

To help guide us on this mindful journey, I turned to my good friend Chef Chad Luethje, executive chef at the Miraval destination spa resort, famous for its mission to encourage people to be mindful and present as they live their lives. I’ve known Chef Chad for many years and have discovered countless handy tips, tools, and techniques while attending his demonstrations. I’ve also waited patiently for him to finally put it all together in a book. At long last “Mindful Eating” (Hay House 2012) landed on my doorstep and I dived in to find nuggets I can now share with all of you. Here are some highlights to help get you started.

1) Cooking is not rocket science. Don’t break out in nervous hives at the thought of cracking open a cookbook and trying some of the recipes. Perhaps the last time you boiled water or cooked an omelet dinosaurs ruled the earth. No worries. Establish a new attitude and look forward to having fun. Start with a few simple recipes that entice you. Build your own repertoire of snacks and meals from there. Don’t be afraid. You can do this.

2) De-Clutter your kitchen. Cobwebs in the pantry? Dust balls rolling around your pots and pans? Microwave functioning on overdrive? You’re not alone. Welcome to the new American kitchen. First things first.

a) Get rid of the processed and refined foods. Purge your cabinets, fridge and freezer of these unnatural science fair projects.

b) Pitch your ancient foods. Look at the expiration dates on any foods you’re keeping. I’ll bet you’ve got some scary museum-grade goodies for the garbage can.

c) Open up your working space. To cook, you need open spaces to work. De-clutter your counter tops. Seeing lots of wide open surfaces helps you feel less stressed, more creative, and organized.

3) Get the right tools. Most people are clueless about what equipment they actually need to cook with. Chef Chad to the rescue with some helpful hints.

a) Bag the knife block. Instead of laying down a lot of cash for that usual block of knives, Chef Chad says all you really need are a quality 8- or 10-inch chef’s knife, thin cleaver, long serrated knife, a 3-inch paring knife, and a carving knife.

b) Pots ‘n pans. The Miraval team recommends stainless-steel-lined pans with an aluminum core. They heat quickly and evenly. Nonstick pans are OK only if you hand wash them and keep an eye out for scratches, which can expose you to the toxic chemicals used to make the coating.

c) Mixing bowls. You’ve got options here — stainless steel, ceramic, and glass. Stainless steel may not go into the microwave like glass, but it tends to be more durable.

d) Heavy Lifting. You need a good perforated metal spoon for stirring stocks and soups. Silicone spatulas that can handle high heat are essential. Lift and turn hot foods with scalloped-edged tongs.

e) More. From food processors to vegetable peelers, there are many more suggestions in the book.

4) Let’s cook! The following is a sampling of cool cooking tips to spice up your mindful journey.

a) Kosher salt’s larger granules take longer to shake out than iodized, so you consume less salt. Plus Kosher salt tastes better and contains 30% less sodium than iodized.

b) Don’t pour oil straight from the bottle. Use less oil by reaching for a plastic spray bottle instead.

c) Herb it up to enhance taste. Dried herbs have more concentrated flavors so use them first. Fresh herbs are added last as their flavors dissipate faster.

d) You don’t need regular high-fat mayo when you can combine three parts plain nonfat yogurt to 1 part reduced fat mayo. No one will ever know!

Here are some general secrets for success for those of you embarking on your mindful eating journey:

1) Sit down and turn off the TV, don’t answer the phone, and get away from the computer while you’re eating. Distractions of any kind foster mindlessness.

2) To become aware of slowing down your racecar pace of eating, use your non-dominant hand and/or use a smaller fork or spoon on a smaller plate. For grins, use a timer to see how long you can go between bites.

3) Watch your portion size by using measuring cups. Almost everyone underestimates how much they really dole out on a plate. Keep a set of measuring cups around — ¼ and ½ cups are great to start with.

Finally, try to integrate mindfulness into all of your daily activities. When you walk, be mindful of your surroundings, inhaling floral aromas and the green spring and summer vistas. Listen carefully to people as they speak to you, being mindful of their body language and verbal cues. It’s amazing how much we miss when we’re not living in the moment. Start this mindful journey with small, gradual steps. I guarantee you’ll be rewarded with a life — and meals — you’ll savor for a lifetime.

By Pamela Peeke, MD, MPH

I wonder how many of you have a bucket list of items you want to do during your lifetime. I have mine. There are jewels of adventure and experiences I want to have while I’m still able to rock and roll physically and mentally. One of those was running the Boston marathon. Truth be told, I have no business running marathons, as I’m built for the sprint. But there’s something cool about that medal at the end of the long road.

When my colleagues at the American Medical Athlete Association (AMAA) invited me to speak at their 2012 annual meeting, which takes place the weekend of the Boston marathon, they also offered me an opportunity to run with them in the race. And of course I accepted. You see, this was going to be my last marathon, the end of long distance running in my life. So this marathon was very special. It was my swan song to the 26.2-mile challenge.
With outdoor athletics, the one potentially troublesome variable is the weather. As all of us Boston runners eagerly logged onto the predicted temperature for race day, to our amazement, the weather was becoming unseasonably warm. To make matters worse, the only day predicted to have a major temperature surge was race day. Worried race administrators began to send a series of emails to all runners inviting anyone with medical conditions to defer until next year. Four thousand of the almost 29,000 qualified runners took them up on their offer. About 25,000 of us decided to give it a go on April 16^th. For me, there was no option. My mind was set on completing this bucket list item and having fun, somehow, out on the hot and hilly course.

On race day, as the bus filled with my fellow AMAA runners pulled up into Hopkington, I reflected on the fact that I would be running this race by myself, for myself. So often, I have brought my patients and other people along with me. But this last marathon was different. It was a personal journey, taking myself on mentally and physically. I’d done my calculations. For every 5-degree increase over 60 degree weather, I had to slow my pace by 30 seconds. This is frustrating but necessary to avoid heat injury. I looked ahead at a good 5 hours, took a deep breath, and when my wave was up, I was running, following trainer Jeff Galloway’s recipe for safety and success.

Soon enough it was over 90 degrees. As I reached mile 6, I spotted a woman I had noticed in my audience at the AMAA meeting the day before. She was remarkable because she was in terrific shape and she appeared to be older than the average audience member. I also noted that she seemed to be straining to the left, but was trying to keep a steady pace. I headed over and we greeted one another. Beth is a 75-year-old retired nurse practitioner from Wisconsin. This was her 8^th and last Boston marathon and she was determined to finish it. As a physician, I was worried. Despite her wonderful health, 75 years old in 90-degree heat and running was of concern to me. She also noted some back pain, and thus her twisting to the left. OK, do I high five her and continue on my own journey, or do I hang out with Beth and make certain she makes it to the finish line and snags the medal? It didn’t even take a nanosecond to make the decision. Laughing at each other’s bad jokes, Beth and I passed mile 7 together and we were like two peas in a pod from that moment on. It was a win-win. I cherished her wit and humor and companionship and she had me to light a fire under her when things got tough.

Beth and I were keeping it safe with a slow and steady pace. As we hit half marathon and were being cheered on by hundreds of young Wellesley women, I noticed Beth was slowing up on the hill, her back bothering her a bit. The heat was punishing and after 13.1 miles, the medical tents were filled to capacity with people of all ages. I decided to generate a renewed spark of energy in Beth by shouting at the crowds –  “Hey, let’s give it up for Beth. She’s 75!” This was met with deafening cheers and young women screaming: “You’re my inspiration!” Beth jabbed me in the ribs and shouted: “I can’t believe you told them my age!” Laughing, I noted her pace had quickened and she was proudly thrusting her chest out, assuming the posture of a winning running warrior princess. I resorted to this three more times, each time as successful as the last in prompting a second wind. As we passed Boston College, Cameron, a handsome 19-year-old student, popped out of the spectators and ran out beside Beth shouting “I’m going to get you through the next mile!” Smiling, with a twinkle in her eye, she looked at me and said, “He’s definitely my type, so hands off!” He kept her occupied with adolescent banter for the next mile, then graciously bowed out, waving and wishing us good luck. Beth jabbed me again and said, “Do that shout out thing again and let’s get another one!”

When we reached mile 16, the famous four hills loomed ahead of us. Funny thing, neither of us cared. We actually love hills, preferably in cooler weather, of course. What we didn’t know was that earlier in the race at mile 18, last year’s world record breaker in the men’s Boston division, Geoffrey Mutai (2:03:05), had bailed out of the race due to cramps. Other elites were dropping out as well. Neon signs warned runners to take walk breaks, unheard of at this marathon. As it turns out, our marathon was making history as one of the hottest.

Meanwhile, Beth and I were gradually making our way up the hills. What helped us survive was not only the welcome sport drinks and water provided by the Boston Athletic Association, but the thousands of spectators. God bless every one of them for these four gifts:

1) A boisterous and heartfelt chorus of “you can do it” cheers;

2) Ice from their freezers as well as store-bought, which Beth and I happily dumped into our hats and down our fronts;

3) A run for the hoses, as the 26.2 miles was strewn with tall ladders and atop each one was some kind and wonderful person with a garden hose spraying us as we ran by;

4) Every flavor of popsicle, which began about mile 16 and was so wonderful that, to this day, and probably for the rest of my life, I can still taste the strawberry and mango melting in my 100-degree mouth.
By mile 22, we’d reached the top of Heartbreak Hill. Four point two miles of running on the flat to go. I looked at my watch and realized we were doing fine for time. Two more miles and then we finally entered downtown Boston, where the crowd’s clapping and cheering magically buoyed us through more pavement pounding. Viewing the large CITCO sign, I knew we had one mile to go. I felt terrific and sprinted ahead to fulfill my dream of running down Boylston Street Rocky style, pumping the air, mile-wide smile, a few tears of joy, and a dash across the finish line. Beth and I were greeted by gleeful friends and a welcome seat to finally rest after finishing our quest. Twenty-one thousand men and women completed this 116^th running of the Boston marathon that sweaty day.

So, why is the marathon a metaphor for life? Because it’s an exercise in life mastery. Here are some tools to help guide you:

1) Set and Achieve Goals: It’s so important to have a goal you can visualize and can help give you a context within which your other life decisions can be made. Set your mind on a goal, work hard to prepare, learn to stay focused, and push through to achieve.

2) Practice Mindfulness: By being present and concentrating on every step taken in any journey in your life, you’ll realize that life is lived while you’re striving to achieve your goals, not just by achieving them. Live and breathe in the moment, embracing the sights and smells and beauty of your life.

3) Learn to Adapt and Adjust: You never know what life throws you on your quest to achieve any goal in your life. Instead of quitting and running away when things get rough, stay focused and determined and learn how to adapt and adjust.

4) Expand Your Tribe: When you get out there and participate in anything from a book club to a hiking group, you’ll meet amazing people along the way. Some may become lifelong friends. You can’t make new friends unless you show up. Create your own support system and cheerleading squads. We all need them.

5) When You’re Giving to Others, the Journey Gets Easier: Buddying up with Beth most definitely added the spice and fun I needed to have the best experience ever. When you’re sharing with someone else, the miles go by pretty quickly.

6)No Regrets: Throughout your life, make certain to live it richly and fully. Take risks and don’t be afraid to experiment and do new things. Be courageous and adventurous. As Helen Keller once said, “Life is either a daring adventure, or nothing at all.” Err on the side of the adventure!

Speaking of which, I’m already exploring fun new exploits. What about you? Stop deferring and start living. Your adventure awaits you.

By Pamela Peeke, MD, MPH

I had the pleasure of speaking this week at the CDC’s Weight of the Nation conference in Washington, D.C., a meeting that brought together national experts on virtually every aspect of America’s obesity epidemic. This conference was a great reminder of the value of cooperation rather than confrontation in addressing such an urgent public health challenge. It was a forum for everyone in the field to share insights, find opportunities to collaborate and seek answers together. I was able to meet with other physicians, politicians, nutritionists, nurses, mental health experts, educators, insurers, and others from the public and private sectors. The bigger the tent, I say, the better.

My talk focused on the need for health care providers (doctors, nurses, and allied workers) to actively engage their patients and consumers in discussions about the importance of physical activity. We’re literally writing prescriptions for walks rather than pills and potions. The panel, “Systems Change: Enhancing the Obesity Chronic Care Model” had me sitting next to Dr. Keith Bachman from Kaiser Permanente and Dr. Madelyn Fernstrom from the University of Pittsburgh, both of whom have incorporated physical activity as a vital sign in patient charting and monitoring.

What I heard from my fellow panelists reminded me of something I once heard my good friend Dr. Robert Sallis say that summarized my own thinking. Dr. Sallis, a family practitioner at Kaiser Permanente Los Angeles and founder of the American College of Sports Medicine’s Exercise is Medicine campaign, asked: “What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients?”

Heck yes! The prescription is simple: regular physical activity.

All too often, conversations about obesity are driven by the latest theory, whether it’s the best new fad diet, the worst ingredient of the month, or the newest pill. While we can debate all day long about these provocative theories, I am guided by the science. And there is plenty of evidence-based science supporting the benefits of regular physical activity.

Getting up and assuming the vertical more often reduces mortality and the risk of recurrent breast cancer by about 50% and colon cancer by more than 60%. It reduces the risk of developing Alzheimer’s disease by about 40%, lowers the incidence of heart disease and high blood pressure by 40% and reduces the risk of stroke by 27%. And type 2 diabetes? Physical activity lowers the risk of developing it by 58%. Plus you drop weight and feel great. A royal win-win-win.

But the key question is how to get physicians, nurses, and other providers to prescribe physical activity just as they now prescribe medical drugs.

Part of the answer, at least, has been the creation of Exercise is Medicine, a global initiative by the American College of Sports Medicine and the American Medical Association. The goal of Exercise is Medicine is to make physical activity a standard part of disease prevention.

We’ve made a lot of progress in shifting America’s medical treatment paradigm, but much more needs to be done. We’ve conducted research showing 65% of patients would be more interested in exercising to stay healthy if their doctor told them to. This is especially true if the medical care provider is walking the talk and sharing what a great experience it is. We’ve educated policymakers and advocated with the White House, congressional leaders and others to encourage healthcare providers to offer exercise prescriptions to all their patients.

Meanwhile, Kaiser Permanente is demonstrating what all this looks like in practice. In Los Angeles, Kaiser is pioneering an effort to integrate exercise as a vital sign in patients’ electronic medical record, measured alongside blood pressure, weight, pulse and BMI. Preliminary results show that by doing so, the provider has to open the discussion about activity and this discourse can lead to change on the part of the patient.

None of this work would be possible without powerful public and private sector partnerships because obesity is too big a problem for any one organization to solve alone. Many have joined this important effort including the U.S. Surgeon General, the President’s Council on Physical Fitness and Sports, the American College of Preventive Medicine, to name just a few. Private industry sector partners who provide funding and services include The Coca-Cola Company, NBA FIT, the YMCA, and many others.

So what’s next? As I told those attending Weight of the Nation, the next step is to get Medicare, Medicaid, and private insurers to reimburse health care professionals for counseling patients on physical activity. Public debate has focused a lot over the last few years on investing in preventive care. Physical activity and nutrition counseling are low-hanging fruit, a relatively small investment in reducing the $150 billion annual cost attributed to sedentary living, about 12% of the U.S. healthcare budget.

The Weight of the Nation conference, along with an upcoming HBO documentary series set to air May 14 and 15, will go a long way toward calling attention to obesity. And the timing couldn’t be better with the recent publication of a report in the American Journal of Preventive Medicine predicting that by the year 2030, 42% of Americans will be obese and 11% will be severely obese. This is a call to arms for all sectors — public and private — to actively team together to create solutions for this complex problem.

By Pamela M. Peeke, MD, MPH, FACP

My sister emailed me a Youtube video that, quite frankly, blew me away on many fronts. It’s a clip of the first appearance of Jonathan Antoine, a 17-year-old teen, on Britain’s Got Talent. As Jonathan walks onto the stage along with his duet partner, watch Simon’s facial expressions as he rolls his eyes and murmurs to judge Amanda Holden: “Just when you think things couldn’t get worse.” You see, Jonathan is clearly obese, hides behind long curly locks, and is wearing drab, baggy clothes. Watch the audience reactions, including eye rolling and obvious discomfort. But pay special attention to your own thoughts as you first see him. This is a very special test of how, at first, we tend to judge others based only on appearance.

Cowell’s initial impression is clear. Appearing disinterested, he asks the perfunctory questions of all new guests and his demeanor indicates he wants this over with quickly. Jonathan’s partner does most of the speaking and it’s clear she’s there to offer him comfort and security to neutralize his lack of confidence. When asked if he’s shy, Jonathan nervously indicates “sometimes” followed by a sidebar interview in which he opens up about how years of bullying about his weight have taken their toll on his sense of self-worth. Finally, Cowell, looking bored, barely looks up as he offers a rushed “good luck”. A hush descends on the vast theater.

And then a miracle occurs. As the first chords of “The Prayer” began to play, Jonathan’s eyes close and he leaves us, going to some place of passion and joy far from anyone’s criticisms. Then he begins to sing with the most incredible operatic baritone I have ever heard. Now watch Cowell’s face and how the audience responds. With every phrase, this young man stuns everyone with a magnificent voice. Suddenly, no one cares about his unkempt appearance, physical flaws, and initial lack of composure. Instead, they are mesmerized by his glorious gift, a voice that will no doubt enthrall audiences for years to come, housed in the body of this young man, emerging from very difficult times.

I’m writing this blog to remind people that we all need to do reality checks on our own biases toward others, and in this case, those whose appearance is not fulfilling some kind of “ideal”. I’m also bringing up the issue of bullying and its devastating consequences. As Jonathan noted in one interview, every time someone made fun of him, “it was as though they took another piece of me.” The bullying about his size became so intense that Jonathan left high school after suffering a “nervous breakdown.” Under the care of a therapist now, he’s beginning the healing process. Thankfully he had his singing lessons to provide a base to build self-confidence and a sense of self-worth. And kudos to the singing teacher who knew he had this gift and that he needed to share it with the world.

Olympic swimmer Michael Phelps went through something similar when he was young. Constantly tormented by kids who mocked his larger-than-normal ears and his attention deficit issues, Michael sought solace in the comfort of the water. And, as they say, the rest is gold-medal-winning history.

The American Academy of Child and Adolescent Psychiatry estimates that over half of all children are bullied some time during their school years, and approximately ten percent are regularly mistreated. When kids are different in any way, a bully will seek to control and dominate this child or teen, noting their difference, such as being large, as a vulnerability to be taken advantage of. For many, it’s led to life-long post-traumatic stress as well as suicides. This cruel behavior has to stop.

To Jonathan’s credit, despite profound pain and anguish associated with social isolation and the verbal taunts he continuously took from his fellow classmates, he kept singing. He also showed he’s an honorable young man. After having wowed the audience that night, Cowell remarked that Jonathan should dump his partner who, although a “good” singer, was nowhere close to his level of talent. “We’re going to continue as a duo,” was Jonathan’s response, to the shock and amazement of the judges and audience. I pray that Jonathan gets all of the help he needs to help him heal from years of emotional challenge and turmoil.

Between you and me, it’s now irrelevant whether he and his partner win. Record companies everywhere are already banging down his door, and truth be told, I’ll be first in line to buy any CD this young man produces. At the end of the day, he not only gifted us with his uniquely rich and powerful voice, but also gave many hope that, in each of us, regardless of how far we may be from some faux ideal thrust upon us by society, there is a greater self than can be seen from the outside. Take a moment right now and ask yourself: “What is my own unique talent, my own gift to the world around me?” Find it, believe in yourself. Reject criticisms and negative speak. Push to achieve and finally succeed. Like Jonathan, find your own voice and rejoice in it.

By Pamela M. Peeke, MD, MPH, FACP

Three months ago I posted a discussion forum on our Diet Community entitled: “Should government be involved in obesity prevention and treatment?” I was seeking input from WebMD members to incorporate in an upcoming debate on this subject. I teamed with former U.S. Surgeon General David Satcher, arguing that the government did have some valuable and effective roles in the prevention and management of obesity. The opposing view was represented by Fox TV’s John Stossel and author Paul Campos, both of whom felt the government was ineffective and therefore should not have a role in obesity. To all of the WebMD members who contributed a wide array of priceless comments and heartfelt thoughts, I want to extend a hearty “thanks!” We heard you loud and clear and integrated your words into our dialogue throughout the event. I also encourage you to read the WebMD forum so that you can enjoy the comments from your fellow WebMD members.

The debate took place at NYU as part of the Intelligence Squared forums, eventually airing on PBS as well as NPR. ABC Nightline anchor John Donovan did a great job moderating the teams in front of a sold out audience of 800 New Yorkers, including an army of media. This is a hot topic, to say the least, as was evidenced by this fun interview I did with Slate entitled “Twinkies are science fair projects…and other reasons why the government should play a role in America’s war on obesity”

All of us agreed that the government functions as an imperfect entity, as flawed as the humans who write the rules and strive to execute them. However, where our colleagues saw hopeless ineptitude, we saw predictable problems, but also potential and opportunities. So, what was the bottom line?

Most would agree that the government alone cannot solve the obesity crisis. A problem of this magnitude requires all sectors of society to bring our best thinking to the table. This is a collaborative effort connecting private and public entities to increase our chance for long term success.

WebMD members identified several key areas of opportunity for effective public and private roles. We added a few more to round it out.

1)   Leadership: There are countless examples of places where leaders in society can inspire others to change. Let’s Move has helped raise awareness about childhood obesity and opened a national dialogue. When public officials, health care providers, and sports and entertainment celebrities are seen being physically active, they help inspire others. And there are rewards to be had. The President’s Council on Fitness, Sports, and Nutrition offers the President’s Active Lifestyle Award to individuals and families who commit to get more active.

2)   Education: A full spectrum of government departments (e.g. DHHS, CDC, FDA, USDA) provide free information about healthy living. This education process needs to be carried right into the school classroom from kindergarten on up through high school. And it’s got to be fun and engaging to keep it memorable and important to kids and teens. Families together need to have better access to this kind of education so that whole communities can adopt healthier habits.

3)   Protection: Scams abound and it falls upon the government to identify harmful and illegal activities as they relate to purported weight loss supplements, food products, and equipment. Food labels have to be exact and precise, detailing ingredients and macronutrient breakdowns.

4)   Providing Options/Opportunities: There are many government sponsored programs that offer communities opportunities to improve nutrition. The school nutrition program is one example. If a school district accepts the offer and the government finances, they must abide by the stated rules: more veggies, lean protein, and fruits for kids.

5)   Physical Infrastructure: If there’s no sidewalk, it’s a challenge to walk. If there’s no park, there’s no play. The same holds true for biking, walking, and hiking paths. Only the government can provide these invaluable gifts to any community. Public and private groups can work together to establish garden plots throughout a town or city to foster locovore farming and emphasize whole foods.

6)   Public Private Partnerships: New York City is a model for these P-P Partnerships, including the FRESH (Food Retail expansion to Support Health) program, in which 14 new supermarkets were opened to increase access to healthy foods throughout inner city locations. Working to support the White House initiative to inform consumers, the beverage industry launched the Clear on Calories campaign providing beverage calories on the front of each product.

Clearly the public and private groups have ongoing activities in each of these sectors. Our point was that we need to keep pushing these them to do a better job where they can, and to continue to expand their efforts.

At the end of the day, the best strategy is a collaborative one and, happily, everyone agreed on that! We didn’t solve the problem, but we had a heck of a great time debating it!

What do you think government’s role is in controlling and combating obesity? Share your thoughts in the comments below or join the chat in our Diet community.

By Pamela M. Peeke, MD, MPH, FACP

Beginning in January, we provided a series of blogs and videos to show you some simple ways to strengthen specific muscle groups as you strive to increase your overall physical fitness. The sole purpose of this series was to help you become aware of important muscles you use every day and appreciate their role in allowing you to stay strong and independent, as well as how to maintain them for a lifetime.

As I noted in the very first blog, any new exercise regimen like this always needs to be supported by a holistic program that includes healthy nutrition and effective stress management. No one can ever expect to achieve their healthiest, most fit body by executing a few exercises every week. This is a team effort on the part of your mind, nutrition, and physical activity.

This brings up another issue. Most people would love to drop weight in one or more particular body regions. Heck, wouldn’t we all! From bouncing belly to thunder thighs, men and women are constantly seeking ways to “spot reduce”. Well, there’s no such thing. Here are some facts to keep in mind on your journey to a healthier, fitter body.

Muscle and fat are two different tissues. Exercise will strengthen and even increase the size of muscles. However, these muscles do not have any direct control over the fat around them. If you start to exercise on a routine basis, combining both cardio and strength training, you’ll be decreasing the amount of fat throughout your body. Some areas may drop fat first. That’s because where you store fat is highly influenced by your GAGA— gender, age, genetics, anything else.

1)   Gender and Age: Look at your body shape and where your prime fat depots are located. If you’re a woman, this is highly associated with a pear or hourglass figure, where your fat is primarily deposited in your chest, hip, thigh and buttock regions. Once you’re perimenopausal, typically as you pass through your 40’s, due to the combination of hormonal fluctuations and lifestyle habits, women notice that fat is now localizing in the abdominal area, resulting in a more apple-shape appearance. Men, on the other hand, were born with more fat cells in the belly area and more active fat storage enzymes in this region. Therefore, all of their lives they are more prone to gain and shed fat in this region. Once men reach 40, their male hormone testosterone begins to decline, making it even easier to pack on the girth-expanding pounds.

Suggestion: It’s very important to consider your gender and age as you create goals and expectations on your fitness journey. Women, most men at any age will most probably drop more weight more rapidly due to their increased muscle mass and the higher circulating levels of male hormones. Everyone needs to take their patience pill and shed any excess fat pounds by gradually incorporating healthy nutrition and consistent physical activity.

2)   Genetics: Take a moment and look at yourself in a full-length mirror. Regardless of your age, just observe what your body shape looks like. Then, grab a photo album and look at pics of yourself over the years. Now look at other members of your family. Note any similarities. If many women in your family had a larger behind or thighs, and you look like them, then you know that’s going to be a place on your body that will likely be more of a challenge for fat reduction. It’s usually not possible to actually shape change. That is, if you’re a pear, you’ll become a leaner, fitter pear. As you pass into your 40’s, you may accumulate more fat around your belly, but relatively speaking, you’re still likely to keep more fat on your bottom half.

Suggestion: Take a reality check. Look at your family members and honor your genetics. Happily this genetic effect is very positive as well. You may have inherited some great muscularity, so put that to good use to rein in your body fat.

3)   Anything Else: From pregnancy to medical conditions in which weight was gained and/or shed, the body will make shape-related adjustments. Many women note the “jelly-belly” related to pregnancy, the magnitude of which depends upon how much weight was gained, the number of pregnancies, and the genetics of skin elasticity. Yo-Yo dieting with significant swings in weight shed and regained will influence body shape. As well, when people drop large amounts of weight through any intervention, there are changes in body shape due to the resultant excess skin and primary fat deposits during weight gain.

Suggestion: Women planning to become pregnant should optimally be fit and keep their weight increase to 25 pounds, unless there are multiple fetuses (check with your obstetrician). Any shedding of pounds, and especially people shedding at least 50 pounds of weight or more, really need to strive to exercise consistently for a more fit body composition and optimal re-deposition of muscle and fat.

Have some fun reviewing the video-blogs from our six-week campaign. As you do so, please remember that it is imperative that you combine any exercise with healthy nutrition. I recommend you log onto WebMD’s Food and Fitness Planner and incorporate the basics of optimal nutritional quality, quantity, and frequency. You cannot drop excess weight and get fit if you eat well and then don’t exercise, or exercise and don’t pay attention to what, how and when you’re eating. You need both. That’s the essence of the energy balance equation. This is a familiar theme in most of my blogs. And, like a broken record, I’ll keep messaging this forever. Why? Because it’s that important. Good luck!