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Talking with the Experts: On Nutrition, Health and Fitness

Dartmouth-Hitchcock's Heather Wolfe, registered dietitian with Dartmouth-Hitchcock's Live Well/Work Well program, and Amy Huelle, registered dietitian and certified diabetes educator, share their expertise on nutrition—what works and what doesn't.

What diet trends are hot, or still warm?

Along with the lingering love handles, what fades but never goes away? Diet fads and trends. "I still see a lot of low-carb people," says Wolfe. "That's ongoing from Atkins and South Beach, or just remnants of those ideas." There are Weight Watcher-type plans, as well as the more limited NutriSystem and Jenny Craig-type programs. Now, the trends include gluten-free and the Paleo Diet based on the food groups eaten by our hunter-gatherer ancestors. Every day, celebrities are touting the latest miracle diet, drug or supplement.

"This year we'll hear more about 'clean eating,'" says Huelle. "Eating foods close to their original states, very minimally processed, off a tree or out of the ground, and asking ourselves: 'how many times a day does my meal come from a package?' We're also paying attention to the environmental impacts of our food, and where it's coming from. There's more focus on local eating and supporting local farmers. People are also asking about genetically modified foods (GMOs) foods, and organic foods."

We all make excuses. So what are the obstacles, or perceived obstacles, to healthy eating and living?

"Some people—no matter their education or economic status—don't know what a healthy diet looks like," says Huelle. Due to the proliferation of fast food and packaged foods, Huelle believes that "part of it stems from the fact that a lot of people, especially the 20-to-30 year age groups were raised not knowing how to cook a meal, since often they weren't eating at home."

Both Huelle and Wolfe agree that two of the perceived main obstacles to a healthy diet are cost and time. In an age where you can buy a burger at the drive-thru for a buck and wolf it down before prime time, health took a back seat … on the couch. "What people don't understand," says Huelle, "is that with just a little bit of planning they can put together healthy meals; it doesn't have to be gourmet."

Wolfe suggests buying what's local and in season, when they are less expensive. "But there are other options. Plant-based items tend to be less expensive than animal products. Canned and frozen fruits and veggies can be nutritious options. Think about incorporating more beans, nuts, and whole grains."

You may also want to consider how much you are actually spending on processed and fast foods, and the true cost of those choices to your health.

What are people's biggest mistakes when trying to lose weight or eat healthy?

Skipping and skimping early on in the day is at the top of the list. "So many people say 'I do so well during the day, but when I get home I'm ravenous.' So they eat and snack on less healthy choices," says Wolfe. "They are really setting themselves up."

Huelle says she sees people who "don't eat enough during the day because in their minds they think they should eat less to lose weight, so they say I'm going to have a salad for lunch. But a salad is not enough to hold them over for the afternoon. So when they get home they overeat.'

The solution according to Wolfe: "Distribute caloric intake more evenly throughout the day. Have that breakfast, build in healthy snacks eating something every 3-4 hours. That way they're not going home starving."

What is the best way to manage or lose weight?

Don't just look at the effect; look at the cause, says Huelle. "I think the first thing a person has to do is to take a good look in the mirror and say 'what is really going on in my life, environment, or lifestyle that is creating this unhealthy weight?' It could be psychological or medical. You have to find that out first."

Then, says Wolfe, "It's not flashy. It comes back to the basics: a healthy well-balanced diet in combination with exercise. It's not a fad. It really is lots of fruits and vegetables, whole grains, plant-based or lean proteins, healthy fats from vegetable-based oils, fish, and nuts, all in moderation, along with regular physical activity. It's about the daily choices that we make. Can you see yourself doing this for the rest of your life?"

What is the best way to get started?

Focus on just one goal. "It might seem too simple and like it's not going to make a huge difference," says Wolfe, "but we know it's the little goals that add up to making that change. Pick one thing to focus on and really flush it out. There's power in writing your goal down. Think of the barriers, be specific, and then trying it for a month. Keeping yourself accountable in some way, you know checklists are great."

Or give yourself a gold star. When you have a calendar month of gold stars, the challenge seems more surmountable.

One useful thing, Huelle says, "is that many people have smartphones or access to a computer. There are some wonderful apps that really can help people track their calorie intake. You may think you only took in 1,200 but in reality it's more like 1,800, or 2,000 or more. Apps like LoseIt and MyFitnessPal are free."
A lot of technology is available not only for tracking calories, but also for nutritional information, goal setting, and more. Some, like CalorieCount, even reward you with discounts to your favorite stores when you have reached your weekly goals.

What are your tips for a nutritionally sound diet?

"Always look for color," suggests Wolfe. "There is so much supporting evidence on how fruits and vegetables benefit us weight-wise to health-wise, including disease prevention. Moving toward a plant-based diet incorporates more nutrition and is a low calorie package. Every time you eat, meals and snacks, ask yourself, 'is there something of color?' Try to get those deep greens, the yellow-orange-reds, blue-purples, the whites, because we know the variety of colors have different nutritional values. The first level is to add color, and then you're ready to take it to the next level, and try to make at least half of your plate fruits and vegetable in line with Choose MyPlate, the new dietary guideline icon that replaced the food pyramid."

Huelle agrees and adds, "Eating plant-based foods can also be filling and help with weight control. Minimally processed foods—whole grains and high fiber foods–provide essential nutrients, and keep you full. Also, if you have a little bit of lean protein with your meals it can help keep you more satisfied that just a salad.

I ate my healthy foods, but I still want my comfort food. How do I combat the cravings?

"The first thing I would ask people who are having major cravings is if they are eating meals full of refined carbs—like white flour or macaroni and cheese—and not having any proteins." Huelle points out, "If you're having more refined carbs, you're going to crave more refined carbs. If you're having a combo of protein and carbs with your meal, often that can help with cravings. But if they still feel they need to have something sweet, then they need to get a handle on portion control. There's nothing wrong with having what the government calls 'discretionary calories,' but you can't just snack randomly because it adds up quickly. You need to be mindful of the extras and limit them to 100-150 calories daily; so learn to identify what those portions look like. If we're going to look at things that really taste good, and are good for you, a square of dark chocolate can be 50-75 calories and is a decadent after-dinner treat. It's okay to give into your craving sometimes, but it's all about moderation and awareness."

"Deprivation is the downfall of any diet," agrees Wolfe. "It sets us up to binge and overeat on the forbidden foods. When cravings come up we have the discretionary calorie budget for the day; it can be added sugars, added unhealthy fats, or alcohol, but then again its moderation and a limited budget. Think where you want to spend that."

But remember it's a craving and not real hunger.

"Try to give yourself 20 minutes. That's how long it takes to outlast an urge. Distract yourself with some alternative to eating: read, take a walk, do a puzzle, make a call. Prepare a list of alternative activities in advance. Write it down," emphasizes Wolfe, "because when you're in the moment that's really when you need to be able to pull those out quickly, otherwise we give into the impulse.

"I see a lot of people who feel guilty and may give in and then feel like all is lost, but it doesn't have to be that way. We know that if you are able to reflect on that slipup in a positive light, saying 'Okay, what was it that set me up or off?' 'How can I do better next time?' rather than negative self-talk, guilt and other emotions that lead to a downward spiral, we can look and learn. It can still be a constructive time."

What should people absolutely not do?

Huelle: Any time that you're asked to completely cut a particular food group out of your diet, that is a red flag because nobody can sustain that long-term. We do need to cut back, but not necessarily eliminate. Don't skip meals during the day and eat a lot at night.

Wolfe: The latest fad diets that promise a quick fix or sound too good to be true. Or if they are trying to sell a product like a supplement or a cleanse. There is no evidence for a magic pill.

Huelle: First, many of these pills are not regulated by the FDA, and the cost of them is exorbitant. You need to take that money and spend it on fruits and vegetables.

Wolfe: It's okay to read the latest dieting books, but be savvy, because many of them come down to being overly restrictive. If they are just too regimented and saying you have to do it THIS way, that's a red flag.

Shopping Tips?

Huelle:

  • Shopping the perimeter of the grocery store is still the best tip.
  • Consider how many packaged items you're buying? Are your snacks Cheez-its or are they apples?
  • Buy produce in season when you can save some money.
  • Know what you're eating; read the labels. Can you pronounce it? Are there multiple ingredients? Start asking yourself: what am I eating?

Wolfe:

  • Plan and prepare.
  • Thinking about your meals for the week. A simple structure for meal planning:
    • Is there something of color, a fruit or vegetable?
    • A grain, half of the time guidelines say to make it a whole grain
    • And a protein, which should be more of a side dish—this goes back to the ChooseMyPlate
    • Look through your pantry, fridge and freezer, and then based on your meals make a list around that. Then stick to your list so you are not tempted by extra, likely processed, items.

Cooking Tips?

Wolfe:

  • From a calorie stand point: bake, broil, boil, and steam
  • If you're making a healthy meal cooking extra and freezing can save you extra time.
  • Move toward more plant-based items, or beans, like meatless Mondays, and experiment with new foods.
  • Use vegetable oils, plant-based oils versus animal. Butters are higher in saturated fats; some margarine contains trans fats, so use both in moderation. But having some fats (like nuts, seeds, fatty fish, like salmon and tuna, avocados) help us to feel fuller, and it's important to include them in a healthy diet.

Huelle:

  • Try new things. Look through some cookbooks (vegetarian and otherwise), or check a few out from the library.
  • The American Heart Association website has some healthy recipes
  • Ask some healthy friends for suggestions and advice.
  • There's an app for that! Several apps are available that offer healthy recipes and tips for healthier eating.

What works for you?

Huelle: I eat small amounts throughout the day, proteins and carbs. And I always tell myself 'pack in the produce.' I'm not sitting there thinking 'oh, I can't ever have this' or focusing on what I have to take out all the time; I focus on what do I need to pull into my diet to be a healthy person.

Sundays I really enjoy making a plan for the week. You want to be purposeful and intentional with your eating. Even if a person plans Monday through Thursday, that's when we're the most vulnerable.

I schedule my physical activity in as well. It's all really important to me. I think about these things at the beginning of the week, and how my week is going to go. As a grad student I can understand what a busy day is, so planning is essential for me. I'm not saying I don't have weeks that are bad, but most of the time that's where I'm at."

Wolfe: On Sundays I make my meal plan for the week for my family and build my shopping list so that when I'm is the midst of my busy work and family life I can just look at my plan. I try to chop things up ahead of time. I chop up my pineapple and put it into 5 little Tupperware containers so I can have one a day, same with my yogurt. Just having it ready to go I'm much more likely to eat well.

I try to build activity into my day because I'm not a gym person, and I have a one-year-old, and I know at the beginning and end of the day I'm not going to be exercising. But, I avoid the closest parking spot, and park in the back and walk a bit, I take the stairs rather than the elevator, I work in the activities of daily living, and I try to take a walk break with a buddy, for maybe 20 minutes at some point in the middle of the day.

Final Thoughts from our Experts:

Huelle: "If you don't care enough about yourself than why would you take care of yourself? Prioritize your own health. It doesn't have to be all or nothing. But you have to be realistic; you can't continue to do the same things and expect that you're going to change your results—whether it's a medical condition or your weight. You really have to start with staring yourself in the mirror and asking what am I doing?"

Wolfe: "Do you have to be 100 percent? No. But you should be making progress. Be present in your life; avoid mindless eating while you're multi-tasking. It's important that any health goal you take on seems reasonable and can be modified as needed for your specific lifestyle and goals. This is a lifelong journey, being patient and positive are important."

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