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Duke Health News 919-660-1306

Starting the diet -- Winter's settled in and it looks like
an extra five or 10 pounds have settled on your middle. You
want to shed that extra weight along with the heavy clothing,
but how will you ever do it? Duke Diet and Fitness Center
nutrition director Franca Alphin says winter weight gain is
easier to manage than you might think -- most seasonal pounds
will drop off in a month or two. Instead of panicking over the
extra padding, first take a calm look at the problem. "If you
know why you gained, or just gained the weight over the
holidays, it won't be difficult to figure out how to lose the
weight," Alphin said. "You can simply omit those abnormal
calories from the extra sweets and alcohol we indulge in over
six or so weeks of holiday festivities. Going back to your
regular diet and normal eating schedule should gradually pull
you back to your usual weight over a couple of months."

If those pounds appeared as a surprise, figuring out where
they came from won't take long. Just monitor your eating habits
for about three days, including a Saturday or Sunday as one of
those days, Alphin advised. "You don't need to make it a
detailed production. Don't bother to count calories or figure
portions. Just be honest as you write down what you eat," she
said. "Then look at your `diary' and try to cut back on the
high-calorie, high-fat foods you've got in your diet."

With a little increased activity and moderate menu
adjustment, the extra weight will melt away with the winter
cold.

Taking the fear out of those first steps – It's not
laziness, but fear that takes the starch out of a couch
potato's resolve to start exercising. Michael Scholtz, fitness
director at the Duke Diet & Fitness Center, says people
equate exercise with a gym, fancy equipment, hours of pain and
sweat. They aim too high, take on too much. They fret over
target heart rates, the cost of machines and how they look
around the hardcore hard bodies. And the fear sinks them deeper
into the couch.

For some people, exercise is as intimidating as launching a
financial investment program. Scholtz says you beat the fear
the same way, taking small steps.

"A financial expert would say to an investment newcomer,
'OK, so stocks and mutual funds are foreign territory, too much
for you at first. But you can put a little aside in a savings
account, right?' There's a comfort level with the small step.
Apply that to fitness. Let's try going out and walking for five
or 10 minutes," Scholtz coached.

Look for opportunities in your day to be more physically
active – use stairs instead of the elevator; walk to do your
errands or deliver your messages; play with the kids outside
instead of with the computer.

The short periods of movement do make a difference. Scholtz
said accumulating 30 minutes of movement in bouts long enough
"for you to notice you're moving" will burn a couple hundred
calories. If your eating hits don't change a bit, you'll lose
about a pound every three weeks. At the same time, you're
building your fitness level so you'll be ready for that next
step – setting aside time for exercise alone.

The skinny on diet drugs – The FDA withdrawal a few weeks
ago of two diet drugs threatened to deplete the arsenal of
obesity aids, but weight treatment experts say good
replacements are on the way.

Dr. Michael Hamilton, who directs obesity treatment programs
at Duke, says new medications offer hope for the seriously
overweight who need help in their battle against
life-shortening obesity.

"Two new medications appear to help with moderate weight
loss -- around 8 percent of initial weight -- without the risk
recently associated with dexfenfluramine and fenfluramine,"
Hamilton said. "One drug, orlistat, works by reducing the
amount of fat absorbed by the body while the other, sibutramine
is an appetite suppressant."

Fenfluramine and dexfenfluramine were pulled from
pharmacists' shelves after a study found some an increase in
heart valve damage in patients who had been taking the drugs
for weight loss.

With orlistat, which was tested at several centers across
the country, including Duke, patients absorb nearly a third
less fat from their food. Hamilton says side effects appear to
be limited primarily to soft stools and increased
elimination.

Sibutramine has two actions -- it enhances two chemicals in
the brain, norepinephrine and serotonin, and acts as a
re-uptake inhibitor, meaning the chemicals stay in the brain
longer. Results from two-year trials show that sibutramine can
be taken in small doses for "good weight loss," and great
weight loss with a higher dose, Hamilton said. Side effects in
clinical trials included dry mouth, possible constipation and a
chance of a slight increase in blood pressure.

While the latest diet drugs appear not to carry the same
health risks as the two dropped from the market, Hamilton
cautions that a doctor's close scrutiny is important throughout
weight treatment with medication. "Prescription drugs are not
intended for minor weight loss," he said, "but for people at
least 20 percent over ideal body weight." Breaking the barriers
– Weight loss should be snap, right? Just a matter of a few
superficial changes in food choice and activity? Not so,
according to Susan Head, a psychologist with the Duke Diet and
Fitness Center. The hefty impact on your self concept that
comes with change can create a substantial barrier to success
in weight control.

"Individuals, in general, think in terms of weight loss
being easy. They don't realize they're trying to break a
pattern of behavior that's long established, and they start
without considering how such a change affects life and the
things they value," she said.

If you were overweight as a child, she explains, you may
have ruled out some parts of life as not fitting you and chosen
to hone skills you thought were more appropriate. If you
thought you couldn't be athletic or pretty, you might have
worked on being funny or smart. The smart, overweight kid could
grow up to become a workaholic, deriving satisfaction from
success in hard work.

So what happens when you decide to shave some pounds without
recognizing it's a big change in life?

"Say the workaholic decides to exercise more. Exercise takes
an hour or more out of the regular day. So you're doing
something you're insecure about – exercise – and giving up some
of what makes you feel good about yourself – work. That's a lot
of discomfort that builds into a barrier to changing habits and
weight," Head said, who leads workshops to help people
understand their motivations and goals in losing weight and
choosing a healthier lifestyle.

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