Making New Year’s Resolutions that Stick

*Photo credit: blog.linkedin.com

All those grandiose goals—lose 30 pounds, cook all of my own healthy meals, etc.—may sound good after some champagne on New Year's Eve, but are they DOABLE?

Yes and no.

We’ve all been determined to improve ourselves in some way, but without setting specific, measureable, attainable, realistic, and timely (or S.M.A.R.T.) goals, there’s often not enough planning to make them stick.

The idea of SMART goals has been around for nearly 35 years. Isn’t time that we made use of them?

An example of a non-SMART goal is:

I will lose 30 pounds.

An example of this same goal transformed into a SMART goal is:

I will lose 1 pound per week for 30 weeks by cutting out 500 calories per day from my diet (3,500 calories=1 pound, 7 days/week x 500 calories=3,500). I will figure out how to do this by using an online calculator to figure out how many calories I need per day to maintain my weight and will then subtract 500 calories from that to come up with my total daily calories. I will make sure that I’m eating 500 calories less per day by using MyFitnessPal to track my calorie intake.

Specific—check

“I will lose 1 pound per week for 30 weeks by cutting out 500 calories per day from my diet.”

Measurable—check

“…using an online calculator to figure out how many calories I need per day to maintain my weight and will then subtract 500 calories from that to come up with my total daily calories. I will make sure that I’m eating 500 calories less per day by using MyFitnessPal* to track my calorie intake.”

Attainable—check

Except for those whose weight maintenance calorie level is very low (e.g. those of us who are vertically-challenged), most people can cut 500 calories per day.

Realistic—check

A healthy level of weight loss for most people is 1-2 pounds per week. More than that is not only not realistic, but can also set you up for a weight yo-yo where you gain back everything that you lose and more.

Timely—check

“…1 pound per week for 30 weeks”

In addition to SMART goals, I find it useful to take lessons from motivational interviewing, health coaching, and the Transtheoretical Model and plan for the following:

• How will you stay accountable?

o   Solution: enlist a partner in your goal—either someone who also needs accountability in achieving their own goal or someone who cares about you and wants you to succeed.

• Do you need help to achieve your goal? Identify the help you need and make a connection.

o   If you want to quit smoking, you may need help from a physician to get nicotine replacement and they can refer you to a support group of others trying to quit smoking.

o   If you want to eat healthier or exercise, you may benefit from the help of a wellness coach, personal trainer, or by taking healthy cooking classes. 

•  What will keep you motivated?

o   Solution: create a list of the reasons you want to achieve your goal and look at it when tempted to go off-track, or post an inspirational picture or phrase where you’ll see it regularly.

• Envision your life if you are successful at your goal. What will you gain and what will you lose?
• Identify the things most likely to get you off-track. Plan ahead how you will deal with them.

o   Solution(s): if you snack on junk food, get all of the junk food out of the house. If exercise is part of your goal, get the workout gear for your next workout together immediately after you finish working out and put it in a place that you can’t miss it. This may help motivate you to exercise when your activation energy is low.

• What will you do if you get “off track”?

o   Create a plan to get back “on track” before you even begin. Modify the plan, if needed, after your first bump in the road.

• What if you discover that your goal is too difficult (e.g. 500 calories per day is too difficult to cut out)?  Make a “plan B.”

o   Example: Instead of cutting 500 calories from your diet, try cutting out 300 calories from your diet and walking briskly for 30 minutes (burns 150-200 calories) to add up to the 500 calories. Alternatively, just plan to cut fewer calories and stick with your plan longer than 30 weeks.

• If your goal takes time, how will you make time?

o   We’re all busy, but I believe that whenever we want something bad enough, we can make time to achieve our goals. Stop making excuses and make a plan.

This post highlights the most common mistakes and frustration-prevention points I see with people trying to make positive changes. The above goal setting and achieving tips are not meant to be encyclopedic. The example solutions are meant only to illustrate the point, but many other solutions may be a better fit for you. These tips offer a place to start.

Now, go get started!   

*There are many other calorie and fitness trackers available for free out there. This post is not an endorsement of MyFitnessPal.

Radio Interview on WSRQ, Part 1 - Sugar, salt, fat and weight control

Recently, I was interviewed about risk factors for heart disease and diabetes on Health Check with Heidi Godman.

Here is a link is to Part 1 of the interview - Click to here to Listen or Read Transcript below.

Oil, Salt, Sugar*

10/8/2014 -- Transcript:

Heidi: Welcome to Health Check, I’m Heidi Godman. You know doctors are always telling us to eat a healthy diet and that sounds fine until you’re trying to figure out how to make your dinner taste great, too. But, we have some help for you today. Dr. Michelle Hauser is an internist who also went to culinary school and she joins us now from Stanford University.

Michelle: Hi, Heidi. How are you?

Heidi: I'm great! I'm glad you're here. I interviewed you when you were at Harvard University and we did a number of nutrition stories together when you were at the medical school. Oh wait, it was your residency, right, when you were at Harvard Medical School?

Michelle: Yes, that's right we first met when I was in residency.

Heidi: Okay, so you just going to Stanford. Tell us what you're doing.

Michelle: Okay, so now that I'm done with my internal medicine residency, and I'm feeling like a real doctor with a license and whatnot…

Heidi: Yes, congratulations.

Michelle: Thank you. I'm doing a postdoctoral research fellowship where I am basically studying the effects of healthy lifestyle change on disease prevention like diabetes and heart disease.

Heidi: Well, that's very interesting. So, what is it that you are hoping to do with the rest of your career?

Michelle: For the rest of my career, I'm hoping to have a mix of doing the sort of research that I just mentioned, seeing patients in an academic medical center where I'm able to teach med students and residents, and hopefully take what I've learned from research and help change public-policy to help make it easier to make healthy lifestyle changes.

Heidi: Fantastic, and I know you also have that policy background. Tell us about that.

Michelle: Oh, so while I was in the middle of med school, quite a few years ago now, I went to the Harvard Kennedy School of Government and got a degree which focused on public policy and public administration.

Heidi: Fantastic. You are so well-rounded and you have this wonderful approach -also made even more wonderful because you went to culinary school. In fact, you went there long before you went to medical school, right?

Michelle: Yes, definitely.

Heidi: Tell us about that. Why did you go to culinary school?

Michelle: That was about 15 years ago, now. Oh my gosh. And, I went there because I - it's a longer story than we have time for today, but the gist of it is that I grew up in a pretty poor family and no one had a lot of faith that I would really end up being a doctor. I was trying to find my second passion to focus on so I ended up going to culinary school because I thought that would be what I would do with my life. Now, I guess I'm still doing something with it. But, I decided I would try out the medicine and that’s working out okay.

Heidi: Yeah, I think you've done very, very well. Congratulations on all of your success so far. So this nutrition approach, I know gives you a really great perspective on treating all kinds of diseases - especially heart disease which is what you're focusing on now. Tell us about that perspective.

Michelle: So, that perspective really stems initially from some personal changes that I made. That is, when I was growing up I had some extra weight and was doing all the unhealthy things that we talk about. I was drinking a lot of soda, eating a lot of fried and fast foods. When I made the changes in my life, when I learned what they were and figured out ways to do them, I just feel like a totally new person. So, while I was in my premed classes, I was also teaching at a culinary school. At that time, I started researching nutrition on my own. My students at the culinary school would ask a lot of questions about what they could do to make something healthier.  After awhile, their family members started telling me stories about how they didn't have to be on a blood pressure medicine or that they were off insulin - or they cut down their insulin - for their diabetes, or were off anti-depressants. I think I was really hooked for the long term at that point on. When I really realized I could make a big difference if I focus on healthy lifestyle changes.

Heidi: Incredible. Well, what about the mistakes that people have been making that you've noticed. Have you been able to help them change their diet, change what they’re eating? But what is it that they were doing that wasn't right?

Michelle: There are quite a few things, and I mean we really pay people a disservice by focusing on people not having enough "willpower.” But, it's really over the years as we've grown more obese and overweight as a nation that the food environment has really changed. The things that are easiest to eat and easiest to make are the things that tend to be the least healthy for us. They also tend to be less expensive because of the way we subsidize our food in this country. So, you know, things like sugar sweetened beverages – which are sodas and juices - fast food, fried food and basically anything that's really far away from how it started out when it grew from the ground. Things like cookies and things that come in boxes and packages in the store.

Heidi: Things that are very processed.

Michelle: Very processed, yes.

Heidi: Well, I do want to talk about some of the consequences of eating this food because we know, generally speaking, it's bad for us. But, let's get down to the nitty-gritty. So, you mentioned sugar sweetened beverages. The statistics on how much added sugar people are eating everyday are very disturbing. So, let's talk about sugar and what it can do to our bodies. Why is too much sugar not a good thing?

Michelle: So, the biggest risk of too much sugar - and I think you made a good point that the sugar were talking about is added sugar. So, I'm not telling anyone they should be cutting out fruit or sugars that are naturally occurring. That's a separate issue. Added sugars, we don't actually need any to survive and they do present an increased risk of diabetes and weight gain. And the weight gain plays into the risk of diabetes and also into heart disease and other risk factors that go along with that like high blood pressure.

Heidi: What is it about sugar when it gets into the bloodstream? I know it's making high blood sugar, and what else is it doing physiologically to us?

Michelle: So, when we eat added sugars what happens is that an organ, kind of right where you would point to your “stomach” if you said, “oh, you know, I'm really hungry,” is an organ called the pancreas which makes our natural insulin. When we have a bunch of sugar, it will spit out a bunch of insulin - usually more than you would really need to digest and use that sugar. What happens then is that after your blood sugar goes up really high, that extra insulin makes it go down really low, really fast. What that does is it makes you hungry right away, as soon as your blood sugar gets low, even though you didn't do enough work for burn off enough calories to take care of whatever it was you just ate. It's a vicious cycle.

Heidi: Sure.

Michelle: You don't have enough willpower to fight that. It’s a thing that’s been there as long as we've been humans. We can't really fight it.

Heidi: And sugar is also linked to inflammation and diabetes and heart disease and there was a big study that just talked about the link between added sugar and heart disease. So yeah, added sugar - you definitely want to avoid that. What about the consequences of fat? Fat, I think, it's a very confusing topic. Some fat, the unsaturated fats, are good for us in a limited amount. Of the saturated fat, the trans fat, what are the problems with those?

Michelle: Right. As you said, fats are a complicated thing. There are a lot of experts who are very well respected who will say low-fat diets, or higher fat - as long as they are good fats - are fine. So where everyone agrees, I think, is that we should be cutting out trans fat as much as possible. The government says that we should get less than 1 g per day. But, really, if you get none, that would be best. That's because trans fats cause our bad cholesterol to go up and our good cholesterol to go down. It has the worst effect of any type of fat on our cholesterol. That means, I think that one of the statistics was, 200,000 heart attacks and deaths could be avoided, at the peak of our trans fat consumption, if we cut trans fat out of our diets. It really  leads to a lot of cholesterol problems. Where you get trans fat in your diet is mainly hydrogenated vegetable oils. There's a little bit naturally-occurring in beef and red meat and dairy fats. But I think the jury is out for little bit on whether or not those are quite as bad as the ones that are artificially made with the vegetable oils.

Heidi: Right, right, and what about the saturated fat? Because, because you're mentioning beef and things like that which, of course, are full of saturated fat.

Michelle: So, saturated fat. So, we know saturated fat, it's found in things like meat and dairy products, like butter and cheese, and fast foods and desserts, that puts us at increased risk of things like heart disease, bad cholesterol going up, and what not. But, it's not as bad for you as trans fat, and, I think, the studies really give a complicated picture. The way that I read through them is that it's good to cut out saturated fat - if you replace it with how the fat with fruits and vegetables. But, if you just replace the saturated fat with things like added sugars and a lot of processed food, it actually makes you less healthy. So, you really have to be careful when you cut out saturated fat, what you're putting your diet to replace it.

Heidi: Excellent point. And I think a lot of people don't think about that. They just think, “oh, I'm getting rid of this one thing and now I can fill it with all this other stuff.” So, very good to bring that up. Then we should also mention salt, sodium. So many foods have it - restaurant food and so many different things – but salt is also a risk for high blood pressure and our heart. Tell us about that.

Michelle: The thing is with salt is that we eat about 1 1/2 to 2 times twice as much as we should per day. And, that is, when we say how much we should eat, it's actually a maximum of what we should eat. So, we actually need a very, very tiny portion of what we take in to actually survive, because we need a little. I don't think there's anyone out there that has to be concerned about getting enough salt - unless you're a marathon runner or some sort of really elite athlete. The main problem with salt is that it raises blood pressure, and for some people it raises blood pressure a lot and for some people it doesn't have quite as much of an affect. The tricky part is just that testing it out on yourself you don't really know whether or not you're one of those people that it affects a lot or little. So, anyone that has high blood pressure would really benefit from trying to cut out - even if it's for a short time, as much as they can and really get the level down low to see if their blood pressure improves. If it doesn't improve that much, they should still stick to the recommended amount, but, you know, maybe they need to look elsewhere, like weight loss and exercise and what not to get at lifestyle factors that affect their blood pressure.

Heidi: Yes and weight-loss and weight control, at least, we should say has a huge impact on good health. Tell us about that.

Michelle: Yes, weight control is one the most important things we can do, because a lot of the risk factors that we talked about before really are tied to, and you can't separate them from, weight control. Because a lot of bad habits and things that we do to ourselves travel together. Many of them lead to increased weight, so if you're gaining weight, or you're quite overweight or obese, then you're a much higher risk of not only heart disease and stroke, but diabetes, cancer, worsening arthritis for sure, infertility - which a lot of people don't think about - and a lot of problems with sleep, like sleep apnea. Then, when you don't get enough sleep, or enough good sleep, it actually makes you hungrier and you eat more and that's also a vicious cycle. So, it's very important.

Heidi: Alright, well these are all excellent points, and now we want to find out what to do about it, but we need to take a quick break. So, everybody don't go away. More with Dr. Michelle Hauser from Stanford in just a minute. You're listening to Health Check with Heidi Godman on WSRQ.

*Photo credit:  http://www.fstjournal.org/features/27-1/natural-ingredients

Adding Extra Protein to the Diet

Earlier this week, I was interviewed by Heidi Godman of the Harvard Health Letter and the Harvard Health Blog about adding extra protein to the diet in a effort to lose weight.  This comes on the heels of a study published in the Journal of Nutrition Education and Behavior showing that middle-aged women commonly believe adding protein to the diet is a solid weight-loss choice. I would like to add a correction to one misquote - "unprocessed" and "unrefined" carbs should be replaced with "minimally processed."  Grains (aka. carbs or carbohydrates) in their completely unprocessed form are often difficult to digest and laborious to deal with in the kitchen. Opting for minimally processed to improve both of these factors is a good way to go. The full post is below and can also be found at Harvard Health Blog:

Photo credit: lisamasson.photoshelter.com

Extra protein is a decent dietary choice, but don’t overdo it

POSTED MAY 01, 2013, 3:14 PM

Heidi Godman, Executive Editor, Harvard Health Letter

Diet-wise, I was good yesterday. I had a scrambled egg with salsa for breakfast; spinach salad with grilled chicken for lunch; a handful of almonds for a snack; a small piece of salmon, broccoli, and brown rice for dinner; and fruit for dessert.

I say “good” because I like to limit my carbohydrates to one meal a day—dinner, in this case. It makes me feel better than having carbs throughout the day. I’m not following any particular diet, but just trying to eat in what I think is a healthy way. That means having more protein-based meals than carb-based meals. It turns out I’m not alone.

The International Food Information Council Foundation reports that 50% of consumers are interested in including more protein in their diets and 37% believe protein helps with weight loss. A study in the May/June 2013 issue of the Journal of Nutrition Education and Behavior found that 43% of women surveyed are using the practice of eating more protein to prevent weight gain, and this strategy was associated with weight loss.

But just because people are doing something doesn’t make it healthy. I asked Dr. Michelle Hauser, a clinical fellow in medicine at Harvard Medical School and a certified chef and nutrition educator, if it’s a good idea to eat extra protein and cut back on carbs.

“If you’re eating more protein but you have a good mix of fresh fruits, vegetables and whole grains to make up the rest of it, that’s fine,” Dr. Hauser told me. One of the advantages of eating more protein-rich foods is that people who do it also tend to eliminate overly processed carbohydrates, such as white breads and prepackaged foods like cookies and crackers. Such foods are rapidly digested and turned into blood sugar, and tend to be low in healthful nutrients.

But it isn’t necessary to eliminate all carbohydrates and focus only on protein. Such an eating strategy may have a short-term payoff for weight loss, but it may also come with some long-term risks.

Understanding protein

Protein is a critical part of our diet. We need it to build and repair cells, and make healthy muscles, organs, glands, and skin. Everyone needs a minimum amount each day. The Institute of Medicine recommends 0.8 grams of protein per kilogram of body weight. For someone who weighs 150 pounds, that means 54 grams of protein per day. Another guideline is to make sure at least 15% of your daily calories come from protein.

How might more protein and fewer carbs in the diet make a difference for weight loss or weight control? “Protein takes more energy for you to digest than refined carbohydrates, and also gives your body a feeling of satiety,” says Dr. Hauser. Low-carb diets have been shown to help some people lose weight.

But over the long term, too much protein and too few carbohydrates may not be the healthiest plan. This kind of eating pattern has been linked to an increased risk of developing osteoporosis. That’s because digesting protein releases acids into the bloodstream. The body neutralizes these acids with calcium—which can be pulled from bone if necessary. Eating too much protein also makes the kidneys work harder. In healthy people, this usually doesn’t pose a problem. But those with kidney disease or diabetes (which is associated with kidney disease) need to watch their daily protein intake so they don’t overload their kidneys.

Depriving yourself of carbohydrates can also affect the brain and muscles, which need glucose (the fuel that comes from digesting carbs) to function efficiently. The fiber delivered by some carbohydrate-rich foods help bowels move. And remember that healthy sources of carbohydrates, such as fruits, vegetables, and whole grains, come with a host of vitamins, minerals, and other nutrients.

Making wise protein choices

It’s okay to cut back on carbs and eat more protein, but make sure you’re also getting some carbs in your daily diet. “If you take any healthy diet, 40% to 60% of calories should come from minimally processed carbs,” says Dr. Hauser. For someone on a 2,000 calorie-a-day diet, 40% would be 800 calories or 200 grams of carbs. (Note to self: increase servings of carbohydrates.)

But there are good carbs and bad carbs, as well as good proteins and bad proteins. Foods that deliver whole, unrefined carbs, like whole wheat, oats, quinoa, and the like, trump those made up of highly processed wheat or other grains. Lean meats, poultry, seafood, and plant sources of protein like beans and nuts are far more healthful than fatty meats and processed meats like sausage or deli meats.

The good-bad thing can be confusing, so Dr. Hauser suggests a few simple principles.

Pick the healthful trio. At each meal, include foods that deliver some fat, fiber, and protein. The fiber makes you feel full right away, the protein helps you stay full for longer, and the fat works with the hormones in your body to tell you to stop eating. Adding nuts to your diet is a good way to maintain weight because it has all three.

Avoid highly processed foods. The closer a food is to the way it started out, the longer it will take to digest, the gentler effect it will have on blood sugar, and the more nutrients it will contain.

Choose the most healthful sources of protein. Good protein-rich foods include fish, poultry, eggs, beans, legumes, nuts, tofu, and low-fat or non-fat dairy products.

Photo credit: mybodyhealth.net

These three strategies fit in with the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets. The DASH diet includes 2 or fewer servings of protein per day, mostly poultry or fish. “The Mediterranean diet uses protein from fish as a centerpiece of a meal, and other meats as more of a component of a meal,” says Dr. Hauser.

I had to ask if it’s important to spread carbs throughout the day or if it’s okay to limit them to one meal, the way I do. “If it makes you feel better to eat carbs at one meal a day versus spreading them throughout the day, that’s fine. You can scatter the carbs as you see fit,” says Dr. Hauser.

So I learned that while I was “good” yesterday when it came to eating, I now know that I can be better.