At least half of all Americans are overweight or obese. Excess weight poses many health risks. Obesity increases the chance of developing numerous diseases such as diabetes, but can include:

  • Type 2 diabetes
  • Hypertension
  • Lipid Abnormalities
  • Coronary heart disease
  • Peripheral vascular disease
  • Stroke
  • Gallbladder disease
  • Osteoarthritis
  • Sleep apnea and respiratory problems
  • Certain cancers, including endometrial, breast, prostate, and colon

Input versus Output

If the calories you eat are roughly equal to the calories you burn, then theoretically, you will stay about the same weight. When caloric intake exceeds the body’s requirements, excess calories are stored as fat.

One pound of body fat stores roughly 3,500 calories! Ouch! To get rid of one pound of body fat requires using 3,500 calories out of storage. That wonít happen in a day. Weight takes time to put on and takes time to take off. A caloric deficit of 500 calories per day can mean losing one pound per week. To achieve this, it’s best to combine caloric restriction with an increase in energy expenditure through regular exercise.

Small dietary changes can make a difference over time. Giving up 150 calories per day saves you 54,750 calories per year! (150 calories is the amount of calories in either 1-ounce of regular potato chips, or 12 ounces of regular soda.) When cutting back on calories, be sure to eat a varied and well-balanced diet. You still need the recommended amount of vitamins and minerals. The food pyramid is one tool to assist you in following a balanced diet.

A suggested rate of weight loss is 1-2 pounds per week. Health benefits can be realized with even modest amounts of weight loss. Health experts recommend an initial weight loss goal of 5-10 percent of current weight. I usually advise women who are working on weight loss to eat at least 1,200 calories per day, and men who are limiting their diets to eat at least 1,400 calories per day.

Eating for non-hunger reasons

Sometimes people eat in response to situations or events other than hunger. Situational eating and emotional eating at times is normal, but if not kept in check can contribute to weight and health problems. Individual counseling, classes, workshops, and support groups may be valuable in breaking patterns that lead to overeating.

Behavior Change Tips

  • Identify what triggers ìnon-hungerî eating.
  • Create a strategy for making a change.
  • Predict challenges and devise a plan to overcome them.
  • Act on your plan.
  • Get support, if needed.
  • Evaluate your progress.
  • Donít get discouraged, and donít give up!
  • Refine your plan, or make changes to your plan as needed.

100 Tips for Successful Weight Management

    • Set realistic goals.
    • Take it one day at a time.
    • Keep a food record.
    • Donít use food as a reward.
    • Donít eat on the run.
    • Take small bites and savor each bite before swallowing.
    • Donít eat in the middle of the night (unless, of course, youíre experiencing hypoglycemia).
    • Make an appointment with a registered dietitian.
    • See a counselor about behavior change.
    • Make crafts instead of baked goods.
    • Ask your family and friends to be supportive of your weight loss efforts.
    • Use smaller plates, cups, bowls, and glasses.
    • Serve food from the stove and not from serving bowls at the table.
    • Set your fork down in-between bites.
    • Eat slowly.
    • If hungry, have a small, lowfat snack an hour before the meal to curb your appetite.
    • Drink a glass of water before each meal.
    • Drink a glass of water before each snack.
    • Limit sweets and desserts.
    • Donít skip meals; it sets you up for overeating later.
    • Choose calorie-free beverages.
    • Donít eat for emotional reasons such as anger, depression, or stress
    • Donít shop for food when youíre hungry.
    • Donít shop for food when youíre tired.
    • Donít overeat at holidays or celebrations.
    • Be patient with yourself.
    • Choose smaller portions of high-calorie foods and larger portions of low-calorie foods.
    • Keep meat portions the size of the palm of your hand, up to twice a day.
    • Keep fat portions the size of your thumb for each meal.
    • Packaged snack foods should have less than 3 grams of fat per serving.
    • Use a measuring cup to measure reasonable portions.
    • Think positive thoughts.
    • Take a field trip to the grocery store to look for lower-fat, more healthful options.
    • Use lowfat cooking methods.
    • Choose lean meats.
    • Choose nonfat and lowfat dairy products.
    • Read food labels to compare calorie content and fat grams.
    • Limit fast food restaurant dining.
    • Eat vegetables at every meal.
    • Choose higher fiber foods.
    • Donít buy tempting foods.
    • Limit alcohol intake.
    • Let your friends and family know what your food needs are.
    • Include regular exercise in your life.
    • Take the skin off the chicken and turkey.
    • Donít eat fried foods.
    • Start your meal with a broth-based vegetable soup (choose low sodium, if appropriate).
    • Bring a healthful snack along when traveling or away from home.
    • When at work, donít eat at your desk.
    • Skip the butter, margarine, and mayo (or use nonfat/lowfat varieties).
    • Use diet soft drinks.
    • Share dessert when dining out.
    • Join a support group.
    • When served large portions, put half of your restaurant meal in a to-go bag before you eat.
    • Donít eat standing in front of the refrigerator.
    • Donít eat in front of the television.
    • Donít eat standing up.
    • Chew a piece of gum while preparing meals.
    • Brush and floss your teeth right after dinner.
    • Love and accept yourself.
    • Strive for five: eat at least five portions per day from the fruits and vegetable groups.
    • Reward yourself for making progress (but donít use food as the reward).
    • Visualize yourself losing weight.
    • Donít eat a larger portion just because itís a reduced-fat version.
    • Bring a healthful dish to parties so that you know there will be an appropriate choice available.
    • Drink at least 8-10 cups of fluid each day.
    • Weigh yourself first thing in the morning, but no more than once a week.
    • Snack on raw vegetables and fat-free dip.
    • Make a plan in advance for how youíll handle a tempting situation.
    • Make a list of reasons why you want to lose weight and review it often.
    • Avoid fad diets.
    • Look for the words lowfat, nonfat, or fat-free on the package.
    • Divide your food evenly throughout the day; donít eat heavy evening meals.
    • Donít go to sleep right after a meal.
    • Finish your meal with a walk instead of dessert.
    • Call a buddy when things get tough.
    • If you do eat a food that isnít a good choice, limit the portion size.
    • If you feel like youíve fallen off the wagon, get back on.
    • Donít give up.
    • Pick up new hobbies.
    • Keep healthful snacks handy.
    • Plan your menus in advance.
    • Buy a lowfat cookbook.
    • Shop from a list; donít impulse buy.
    • Package and freeze leftovers for future use.
    • Donít strive to be a member of the clean plate club.
    • Wait at least 15 minutes after you finish your meal to decide if youíll have seconds.
    • Start your meal with a salad; use lowfat dressing.
    • Fill at least half of your dinner plate with vegetables.
    • Have fresh fruit for dessert.
    • Donít skip breakfast.
    • Eat only when youíre truly hungry.
    • Stop eating when youíre satisfied.
    • Donít arrive at a restaurant or party too hungry; have a small snack first.
    • Schedule main meals 4-6 hours apart.
    • Schedule snacks at least 2 hours after a main meal.
    • Use a small teaspoon to sample while you cook.
    • Politely refuse, rather than feel obligated to eat something you shouldnít.
    • Ask the waiter which menu selections are low in fat.
    • If itís a high-fat but favorite item, include it in small portions and infrequently.

The use of sugar, sweeteners, and sugar substitutes has often been a topic of hot debate. Until recently, using sugar has been discouraged in diabetic meal planning. Current scientific studies have not supported the necessity of completely abstaining from sugar, and now itís becoming widely accepted that sugar may be used in moderation without causing deterioration in blood sugar control. Countless studies have investigated the safety profiles of artificial sweeteners.

Misinformation is rampant regarding the safety and acceptability of using both sugar and artificial sweeteners. A fair amount of alarmist propaganda is out there, mixed in with medical facts. Listen with a critical ear. Try to review the scientific studies, not the hearsay. Consider the source of the information. In the end, the decision of what to use is up to you.

Sugar Historically, people with diabetes were advised to completely avoid eating sugar, in hopes that this would control their blood sugar. More recently, itís become clear that strict avoidance of dietary sugar is unnecessary. Studies have shown that when sugar is eaten in reasonable amounts and in the context of a healthful diet, blood sugar control is not jeopardized. Keep in mind that all carbohydrates (except fiber) are digested and then absorbed as sugar into the bloodstream. Blacklisting one form of carbohydrate will not cure diabetes. Whatís more important is eating a reasonable amount of total carbohydrate. How much carbohydrate you eat and how it is spaced throughout the day are much more influential on the blood sugar than the specific type of carbohydrate you choose. Although you may include refined sugar in the diet, itís wise to moderate the amount of sugar that you consume. Sugary foods are often low in nutritional value, high in fat or calories, or all three.

There are naturally occurring sugars, as well as added sugars. Fruit and milk both have natural forms of sugar (fructose and lactose, respectively). Naturally occurring sugars and added sugars affect the blood sugar similarly. Lightning wonít strike you down for eating the occasional cookie, but the diet police (well-intentioned family, friends, and strangers) may swarm around you, scolding that people with diabetes canít eat sugar. Everyone has been so conditioned to believe that sugar is evil that itís been hard to dispel this myth.

Some sugar-sweetened items do tend to raise the blood sugar quickly. For example, it doesnít take long to digest liquids, so the sugar from regular sodas and sugary drinks can enter the bloodstream rapidly. A 12-ounce can of soda (45 grams carbohydrate) is roughly equal to 9 teaspoons of sugar. Fruit juice has almost the same amount of sugar; itís just a different type of sugar. Use caution with both regular soda and fruit juice. You may find that your blood sugar is easier to control if you use diet drinks instead. Also, be aware that goopy, frosted goodies can have a large amount of carbohydrate concentrated in a relatively small portion.

Other Calorie-Containing Sweeteners Honey, maple syrup, pancake syrup, malt syrup, corn syrup, Karo syrup, corn sweeteners, molasses, jelly, jam, and marmalade are all concentrated forms of sweeteners. Thereís no advantage or disadvantage to using any one of these over another. Theyíll all affect the blood sugar similarly. They each contribute approximately 15 grams of carbohydrate per tablespoon, which is about the same as white sugar.

Fructose Powdered fructose may have some advantage over white sugar because it produces a smaller rise in blood sugar than the same amount of white sugar. Since fructose tastes sweeter than sugar, less can be used. Fructose can be used in baking.

Fructose doesnít require digestion in the intestines. It gets absorbed into the bloodstream as fructose, not glucose. Fructose is then transported to the liver, where itís converted to glucose and stored as glycogen for later use. Itís released into the bloodstream as needed.

Studies have shown that when a very large intake of fructose was eaten (20 percent of total calories), the LDL cholesterol went up. Donít give up fruit if you have high cholesterol, though. Just use moderation in the amount of fructose-sweetened products you use.

Sugar Alcohol

Mannitol, maltitol, lactitol, xylitol, sorbitol, hydrogenated starch hydrolysate, and isomalt are all sugar alcohols. Sugar alcohols donít contain sugar or alcohol, but they are a type of carbohydrate. Sugar alcohols donít impact the blood sugar as much as regular sugars, but they do still eventually produce some glucose in the blood. Since sugar alcohols arenít technically a form of sugar, products sweetened with sugar alcohols can boast that they are ìsugar-free.î That doesnít necessarily mean the product is ìcarbohydrate-freeî or ìlow calorie.î Most chocolates that are sweetened with sugar alcohols have just as much fat, calories, and total carbohydrate as regular chocolate candies. However, sugar alcohols donít promote tooth decay.

Sugar alcohols may have a laxative effect, causing gas, bloating, and diarrhea. Tolerance varies from one individual to the next but is usually related to the amount of sugar alcohol consumed.

Artificial Sweeteners

The FDA has approved the following artificial sweeteners for use in the United States. The acceptable daily intake (ADIs) has a built-in 100-fold safety factor. The amounts that people actually consume are well below what has been determined to be safe.

Aspartame is sold under the brand names Equal, NutraSweet, SweetMate, and NatraTaste. The FDA approved aspartame in 1981. It is 180 times sweeter than sugar. If heated at extreme temperatures, aspartame loses its sweetness; therefore, it is not acceptable for use in most cooked or baked goods.

Aspartame is made of two amino acids: phenylalanine and aspartic acid. Amino acids are the natural building blocks of proteins. When aspartame is digested into its amino acid components, the body cannot distinguish whether those amino acids came from aspartame or from dietary proteins like chicken, milk, or eggs.

Small amounts of methanol are produced as a by-product from digesting aspartame. Methanol is a by-product that is also produced from digesting the regular foods that we eat. Natural juices, including fruit juice and tomato juice, produce three to six times more methanol than an equal portion of aspartame-sweetened soft drink.

There has been a lot of finger pointing in the direction of aspartame, but claims that it is harmful havenít been substantiated. Whether to use aspartame or not is a matter of personal choice.

Patients with a very rare metabolic disease called PKU (phenylketonuria) should not use aspartame because they need to limit all sources of phenylalanine. Acesulfame K is sold under the brand names Sunett, Swiss Sweet, and Sweet One. Gaining FDA approval in 1988, acesulfame K is 200 times sweeter than sugar. It is heat stable and can be used in baking.

Sucralose is sold under the brand name Splenda. The FDA approved Sucralose in 1998. Itís actually made out of sugar but has been modified so that it doesnít affect the blood sugar or provide any calories. Itís 600 times sweeter than sugar. Itís stable at high temperatures and can be used in baked goods. Like the other artificial sweeteners, sucralose doesnít promote tooth decay.

Saccharin is sold under the brand name Sweet íN Low. Saccharin has been around since 1879. Itís approximately 300 times sweeter than sugar. Itís stable when heated, so can be used in baking. In the 1970s its safety came under question, as some studies showed that rats that were fed large amounts of saccharin developed bladder tumors. Saccharin has been scrutinized and studied over the past several decades and has now been determined to pose no cancer risks to humans. In May 2000, saccharin was removed from the governmentís list of carcinogens (cancer-causing substances). The label warning that appears on saccharin will likely soon be dropped.