Sunday, February 24, 2013

Top Ten: Weight and see.

I talk about weight a lot at work. I talk to patients about it when they're reluctant to start another blood pressure pill. When knees are aching and hips are ailing, it works its way into those conversations, too. I calculate BMI measurements and explain what it all means. And most times, I find myself saying this:

"The extra weight didn't come on overnight, so it's okay if it doesn't come off that way."

Then I try my best to see where my patient is in the "stages of change" cycle.


Now. Most folks see this cycle used when discussing addictive behaviors like tobacco, alcohol, and drugs. For example, when someone smokes cigarettes, we are taught to assess what kind of readiness state that person is in. Like, are they precontemplative like this man I saw last week who told me that he "loves smoking, end of story" and that "somebody might as well go ahead and plan to bury him with a pack of Marlboros in his shirt pocket." 

Uhhh, yeah.

So someone like that? They aren't there yet. So there's no point in writing for Chantix or telling them to spend their hard-earned cash on patches and peppery gum. Nope. When someone is precontemplative? The best thing you can do is educate them with hopes of moving them from the one stage to the next. And the good news is that it often helps. A lot. 

So, yeah. Even though weight is technically not like crack cocaine or malt liquor, tackling it does involve these stages. Because just like those other things, it requires a lifestyle change from what is already known. It requires more than just saying you think it's a good idea and that you understand  the reasons why it should happen. Managing weight involves action. 


So here's the deal. Unlike cigarettes and alcohol, most of the patients and people I know who could stand to shed a few pounds aren't exactly like my Marlboro man was. That man was precontemplation defined. I find those dealing with extra pounds to be stuck somewhere between contemplation and preparation. Or something nudges them into action, only to swing right back around to relapse. Either way, it's a complicated work in progress. 

The education part that we tackle when folks are precontemplative? That isn't really as necessary. I haven't met too many people who are above their ideal weight who don't fully recognize the benefits of losing some pounds. But, damn, it's so complex isn't it? Moving people from contemplation or preparation into some real, true action and maintenance? 

Maybe because it seems so daunting. There's the exercise component, the food component, and the mind component, too. All swirled together, it's a pretty big pill to swallow. 

So you know what? I break the pill up. Sure do. I look for ways to be encouraging for the mind part. I acknowledge the fact that people have different food relationships and that it's hard to change them. Then, for exercise, I tell people that the best exercises are the ones you'll do. Like walking. Or whatever it is you feel okay doing. And then there's the food component. 

Yeah, that.

So this is where I've developed lots of thoughts and strategies. And you know what? They are ones I live by, so I feel good about sharing them. I tell my patients, "I'm going to make a few suggestions. You can pick and choose what you want to incorporate into your life, okay? These are mostly simple things that, if you changed, could lead to a start in your weight loss." 

And a start in weight loss is encouraging. And encouragement moves people from preparation to action. Or relapse back to action. And the ultimately into maintenance. 

At least, that's what I think.

So this top ten? Pick from it what you like and leave what doesn't work for you. Today I bring you:


Like to hear it? Here it go!

#10   -- Sit down.

DON'T eat standing up. Anywhere. Period. And, unless it's water or coffee, don't drink standing up either.

Simple enough, right? Uhh, wrong.

Clearing the table and popping those chicken nugget leftovers into your mouth? Making a pot of chili and telling yourself that the "little cup" you just served yourself doesn't count? Standing in front of the fridge and popping some grapes/pineapple/lunch meat into your mouth or taking a few glugs of juice? It all adds up. And guess what? A lot of times it adds up to more calories than you realize.

Have a seat when you eat. Scoot up to a table and have both feet on the floor. Think about what you're having. Standing while eating? That leads to stealthy weight gain. That little change could shave a cool 500 calories off or your daily intake. 

Which means shaving a little of that junk out of your trunk.

#9  -- Separation of Church and Plate.

If you never go to church, no worries for you on this one. But for those who do -- try this: Eat before you go. This takes the urge (and tradition) of feeling like you either have to a.) go somewhere for a big azz brunch, b.) come home and prepare a big azz brunch, or c.) alternate between the two every other week.

For the non-church goers, the same can be said for the big azz breakfast that you prepare on one of the weekend days. Cut something out of it to make it less. . . I don't know. . .big azz. 

Now. I admit that this is one that I struggle with. We enjoy breaking bread together as a family after church and, almost always, we do. Instead of something shmancy, we hit our favorite Waffle House. Harry and I can make smart choices and the kids have their waffles.

#8  --  Don't eat it if it isn't worth it.

I believe in allowing yourself something tasty. I do. Like, at the BHE's restaurant (Mardi Gras Cafe) there is this white chocolate bread pudding that is a religious experience. Yes. It is full of gooey, warm, sweet goodness which means a ridiculous amount of fat grams and calories. 


It's worth it. Every last bite. And I feel zero guilt after enjoying it because it is just so dang good. 

Now. In contrast, I ordered some food at the Sweet Auburn Curb market last week. And for whatever reason, it wasn't that good. This was one of those things that needed to be good for me to be eating it. So you know what? I just stopped. I stopped eating it and that was that. 

And so. A dry azz cookie sitting in a boxed lunch? If you're trying to watch your weight, ask yourself if it's worth it. Don't eat anything "bad" that's not really, really good. 

Oh, and making kids clean their plates? That's so last century. So don't.

#7  --  Don't drink your calories.

Period. Not a juice. Not a soda. Not a sweet tea. Not a nothing. You want to drop a few pounds? Refuse to let drinks that have more than twenty calories touch your lips. You'd be surprised how much they stack up. 

#6  --  Diet Nope.

That's what I now call Diet Coke. I gave up Diet Coke two years ago this month. And let me tell you, I lost five pounds the month that I did and those pounds have stayed away. 


So the data on this? Okay. It's inconclusive. You can't say, like, all scientifically that diet pop leads to weight gain. But anecdote-ally? Man, please. 

The word on the street is that when you drink more diet soda, you eat more. Whether or not this is true remains a topic of debate but I know that drinking water instead made me lose weight.

And for the record? I am like the smoker who still loves cigarettes when it comes to Diet Coke. A super cold one still looks good to me and I feel very tempted to take a swig whenever one is in my presence. 

But fitting my clothes feels better.

The caveat? Adult beverages. But not really a caveat. I no longer order margaritas with reckless abandon or mojitos, like ever. Maaaan, I saw how many calories were in those drinks one day and just about passed out. So. If you must have an alcoholic beverage, learn to like wine. Or drink only half. Or drink a whole drink but factor those 550 calories into what goes onto your plate. 


Get creative. My cure for margarita cravings in hot Georgia summer months? Mexican beer with a salted glass and some lime. You'd be surprised how satiating it is to be only 110 calories. Margaritas and such? They've pretty much moved over to my "not worth it" list. I'd rather have some Key Lime Pie.

#5  --  Exercise for the heart, watch the food for the weight.

Unless you are like twenty one years old or less, if you are serious about weight loss it won't come primarily from exercise. Now. Before you go off on me, I'm not saying don't exercise. But here's what I am saying:

Want to lose weight? Then change your food intake. Because it ain't gonna happen from the treadmill alone. 

I remember a few years ago when Harry, the kids, and I all went out to cheer on the runners passing by our neighborhood in the Atlanta Publix Marathon. I was astonished to see how many of them were overweight. I said to Harry, "How can someone run 26.2 miles as fast as that guy and have a spare tire?" It was a rhetorical question, really. The answer was simple. That guy was eating too much food.

I read in this running book an idea that stuck with me. It simply said, "Don't exercise for weight loss. Exercise for heart health and to feel good." Now. I will say that the good thing about feeling good from exercise is that you sort of don't want to eat just any damn thing. You feel tempted to be good.

So my point? If you're exercising? Good. It will extend your life. But if you want to lose weight -- like for real lose weight? It ain't gonna happen just from that.


#4 -   If you can't say no to it once it comes into your pantry, then make it a no for the whole house.

So. Your kids love Cheetos, Lays, and Cheez-its. But guess what? So do you. But you're just getting it for their lunches, aren't you? And they're kids for crying out loud. They should get things like Cheetos and Lays and Cheez-its, shouldn't they?

Nope. Not if you can't keep your hand out of the bag or the box. Look. Kids are resilient. They'll get over the absence of Cheetos. Trust me.

Bottom line:  If somebody needs to lose weight in that house, things like that shouldn't make it home from the grocery store. Period.

#3 --  Make your husband's or wife's plate.

Hee hee. This is my pesky way of controlling the BHE's portions. I make plates and then put everything away. So, OH DARN, I already put it all away and can't give seconds. I heard him telling a friend recently,

"Yeah, bruh. My wife puts me on a plan without even telling me. She's all like, Alright baby you getting a little thick around the waist."

Bwaah ha ha. 

#2  --  Ration the bread.

You already have heard me say it here before. BREAD is NOT YOUR FRIEND. No, 'tis not. Here's what I say:  Just pay attention. If you have bread at breakfast, have a low carb lunch. Pace yourself with the bread because it is the great inflator. 


Putting down the bread? Best deflator there is. Yep. Whenever I feel the thighs beginning to thunder more than they should? The bread is first to go. And you know what? I'm back to fighting weight in no time. 

Bread. Is. The. Devil.


#1  --  Start a list of "not worth its" and get okay with not having them.

My kids love Cinnamon Toast Crunch cereal. And you know? I probably could, too, if I let myself. But 230 calories on a bowl of sugary cereal? Not worth it. 

A baked white potato? Not worth it. Pop Tarts? Not worth it. A whopper from Burger King? Not worth it. Pizza Hut Pizza? Not worth it.


Key Lime Pie? Worth it. White Chocolate Bread Pudding from Mardi Gras Cafe? Worth it. But everything CANNOT be worth it. That list has to be short. Pick a few indulgences and allow yourself to have them. 

Or, if you're super disciplined, you can allow yourself small tastes of many decadent things. Kind of like the French do. But me? I ain't French. So I can't have a long list of things.

Lastly--read the calories of a serving of whatever it is you're having. Then, allow yourself to be appalled at it. Here's a small part of my list of OMFG appalling things that I can no longer enjoy now that I've seen the damage:

  • Chick Fil A cookies 'n' cream milkshake:  690 calories, 33 grams of fat.

  • KFC chicken pot pie :  790 calories, 49 grams of fat.
  • Big Breakfast from Mickey Dees:  1097 Calories, 56 grams of fat.

So my point is -- find out the damage. It's a powerful motivator. And whatever you do, DON'T ignore the damage. Remember:  A good thirty minutes of cardio might burn you 300 - 400 calories, depending upon what you do. Imagine working out and then having that milkshake. If you decide it's one of your indulgences, then recognize that you have to balance everything else out to fit it.

Oh, shoot. I almost forgot something I like to call "friend-poundage." This is where you only meet your friends over food. Make a list and check it twice. Do you and your buddies only get together when food is involved? If so, you probably aren't paying attention to what you're eating. Try getting together at non meal times. Or going for a walk or run together. Or just hanging out in the park while your kids play. Friend-poundage is dangerous. Watch out for it -- especially during times like wedding engagements, happy times, etc. 

Mmmm hmmm.

Does any of this make sense?

I hope so. I say try a few of these things and see what happens. Or none of these if they don't suit you. Either way, let me know your thoughts. And your cool (but not overly hard core and oppressive) tips so that I can share them with my patients at Grady.

Happy Sunday.


  1. Dear Soror, I was introduced to your blog by a FB post that your sister once made. I quickly became a huge fan and must admit that I look forward to receiving the notification of your posts. Daily. I so needed THIS post, right now, as I learned a few hours ago that my 43 y/o best friend had a stroke. He's in Dallas, Texas. I'm in London, England. So, today will be hard. Very hard. But, for him, I will take this post to heart, for my heart. And I will start by examining the contents of my kitchen. Then, I will forward a link of this post to all of his friends and mine. Thank you! You educate, inspire and encourage me. And, we have never, ever met . . .

    1. Thanks, Kandace! That's brilllllliant. (Have I told you how much I adore British accents?)

  2. This all makes so much sense to me. My best tips are a couple like your "Don't bring the enemy home" and "Every bite counts". And someone once told me "It is hard to walk off a Coke"...ha! Sometimes I tell myself "If I don't eat this I wouldn't have to go jogging if I don't want to"..(which I never WANT to really) but I do usually and feel much better, of course. Bread (and Scotch) are my enemies.

    1. I'm no scotch fan, but I feel you on the bread, sista! I love "Don't bring the enemy home." I will tell that one to my patients for sure!

  3. As always, thanks for making lifestyle changes a recurring theme around here. Helps me move toward that stage of getting off my big azz :) This post motivates me to make a list of all of the little individual things I could stop doing or start doing to help with my weight and health. If I come up with 100 things and I'm able to pick 20 I won't feel like I'm suffering but I will be able to change.

    1. It's all baby steps, right? At least one of the suggestions was that you sit down. . . on your azz. Ha ha ha. . . .

  4. This is a fantastic list. Since I went gluten free and low carb two and a half years ago, I have lost 60 pounds. But that has been a large committment and not one that most people are willing to make. My big motivator has been watching my blood tests results. My A1c dropped from 7.4 to 4.9 and hasn't been over 5.2 since I did this. My triglycerides went from 375 to 74. Everything else is equally impressive. Every blood test shouts to me "yeah, this is how you have to eat!" I know, it's not for everyone, not even for most."

    I found it interesting that you said "they should get things like Cheeto's and Lays and Cheeze-its, shouldn't they?" The biggest regret that I have as a mother is every empty calorie that I allowed my children to consume. If I had it to do over again, my kids would never have walked into a McDonalds or even known that Ding-Dongs existed. There wouldn't ever have been white bread in my house. I hear that heart disease begins in childhood. Speaking of eating at church, I was at home group last night and I heard a kid say "zucchini? I love zucchini!" Then he and his brother kept running back to the crudite dish to snack on a few more vegetables. I strongly suspect that their mother doesn't have very many cookies hanging around in a jar in their home.

    My one suggestion is this. Make sick days your free day if you are inclined to not eat much when you feel like crap. Today I have cellulitis and allowed myself to have a banana and some dark chocolate because I wasn't going to have more than a couple bites of it anyway.

    Oh, and juice is a treat, as in to treat a low blood sugar only!

    Happy Sunday!

    1. Lisa, this is great. Kudos to you on bringing down that AIC. You completely are a rockstar.

  5. Thank you. I can work on 8 of these without much effort.

  6. Thanks for this, Dr. Kimberly, especially for telling the truth about exercise, that it won't make us thinner necessarily, but we have to do it anyway for a strong heart. I was so inspired watching all those superbly conditioned athletes this weekend at my son's track meet. I came home with a new resolve! Maybe I am in the preparation stage? Hopefully on the verge of action! Hugs, dear friend.

  7. Honestly ....this hurt my feelings.I love beer and any tequi
    based drink. I love bread and butter ...ugh and you gut punched me with the oreo shake. Im trying to do better ...I want to wear a bikini at 50. I've got 6 years to get it together.

  8. Thank you so much for this. You've provided useful hints for all of us to follow. Sometimes the admonitions from doctors feel sort of devastating but few offer usable suggestions like you've just done. And to know that someone who is a doctor and looks like you (simply beautiful) follows them herself is motivating and kind. You are an amazing doctor person. Joanne

  9. On Friday, March 1, I will celebrate my one year anniversary of being Coca-Cola sober. Mine was the fully-leaded version, I did drink Mexican Coke, so it was sugar and not HFCS, but I was addicted. I quit smoking 4 years ago and it is a toss up to which was the hardest. I told my friend who is in recovery that I felt like I needed to go to a meeting on Friday and get my "one year chip". I hear the diet Coke habit is even harder than regular Coke, so good for you, Dr. Manning. At 43, I'm the healthiest I have ever been, I lead a GodBod Squad workshop at church which is a holistic wellness program with a Christian foundation. We assume that people are educated about healthy living, but you know what they say about assumptions. You doing water running while that foot heals?

  10. I've really taken to not drinking my calories. It helps.


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