How Dieting Wrecked your Self Esteem and Made you Overweight

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This article is for all serial dieters. If you’ve been dieting on and off for years yet never achieved or maintained your “goal” weight, you’ve been handcuffed to the multi-billion dollar diet industry. I’m here to tell you why you need to break free and how to do it.

Why You Need to Break Free From Dieting

If you are a perpetual dieter, in search of the latest magic weight loss diet or pill, you may be doing more harm than good.

Dieting Slows Your Metabolism
Losing weight leads to a drop in the amount of calories you burn each day so you need to cut your calories even more after you lose the weight to maintain your new weight. This happens even if you preserve muscle (each pound of muscle burns about four more calories per day then a pound of fat) (9). This is termed metabolic adaptation and the reasons for it aren’t entirely clear though the decrease in metabolism is correlated with how many calories you cut and changes in the hormone leptin. Leptin is a hormone secreted by fat cells; it helps regulate body weight and energy balance (7, 8).

The more you cut calories the more your metabolism will drop.

Rapid and massive weight loss seems to lead to the greatest drop in metabolic rate.

Though this happens, it doesn’t mean you shouldn’t lose weight if needed for health reasons. However, the “Oprah” cycle of repetitive low calorie dieting followed by weight regain needs to stop.

Diets Over Promise and Under Deliver
Diets promise you’ll get ripped in no time. Research tells us you won’t lose all of the weight you expect to lose (1). And that’s ok. However, unrealistic expectations are a problem because they make you want to ditch the diet or worse, binge eat because you are pissed off that you’ve been lied to.

Reign in your expectations with these validated weight loss calculators:

Pennington Biomedical Research Center Weight Loss Calculator

USDA SuperTracker

Your Life Won’t Magically Change
Dieting tells you your entire life will get better once you lose 10 lbs. Sure, you might need to hem a few pairs of pants and your self esteem may improve a bit. However, you won’t turn into a GQ or Sports Illustrated swimsuit edition cover model. Your boss will treat you the same, your relationships won’t magically improve and everything else in your life might appear to be static if you are waiting for fireworks.

There are many times I run into people who want to lose weight and as I start asking questions and digging I realize they are attempting to control their weight and hyper control their food intake because there is something in their life that is out of control. They are transferring the focus on their body, food and exercise to calm their brain down and decrease anxiety about parts of their life that are raveling out of control.

Don’t use dieting as an excuse to avoid major life issues.

Dieting Tells You “You’re Not Okay”
Many popular diets, pills and programs marketed through airbrushed ads tell you one thing “there is something is wrong with you and this book, program or pill can help you fix it.” They are preying on your vulnerable self-esteem. Taking the bait is like jumping into a dark and depressing pit over and over, attempting to crawl out, losing your grip and getting kicked right back down. Every time you gain a little weight back or judge yourself based on the bathroom scale you’ll feel dejected.

“Where there is perfectionism there is always shame (guilt, regret, sadness),” Brene Brown.

Consistently feeding your mind with a diet of “I’m not good enough” is no way to live. Treat yourself with some respect.

“I’m not good enough” is also a mental roadblock to achieving your goals. One day you’ll have a tough day, come home and say “F this. I’m fat, I might as well eat this whole package of Milky Ways.” Next thing you know you feel like a failure and fall into the ultimate Feedback Loop from Hell. “Why can’t I stick with a diet? I suck.” Once stuck in this mindset, it’s hard to recognize there could be something wrong with the diet itself and the promises (lies) you’ve been told if you just follow it.

I’m here to say you are okay.

Letting Go of the Diet Crutch

If you’ve been dieting on and off for years, recognize that you will have some anxiety in letting go. That’s okay. There are steps you can take to combat anxiety over time and still achieve good health.

What if You Want to / Need to Lose Weight?
If you need lose weight for health reasons, yet you’ve dieted over and over in the past, without reaching your goal, it is time to do something different. Here are steps you can take to a healthier weight and life without dieting:

• Get Support – research shows people who have support are more likely to take weight off and less likely to gain it back.

• Keep in mind moderate weight loss can make a tremendous difference in health. Even small amounts of weight loss can lower blood fats (triglycerides), cholesterol, blood sugar, risk for diabetes and other chronic diseases.

• Start with exercise while focusing on the immediate benefits of exercise – improved mood, improved memory, greater self esteem.

• Be proud of small “wins.” If you haven’t exercised since recess in elementary school, it isn’t necessary to jump right into high intensity interval training three days per week. Start small and be proud of your changes along the way. Even 5 to 10 minutes of exercise each day plus one diet change will help build healthy long-term habits.

• Realize that nobody is looking at you in your bathing suit on the beach and judging your body. We are the harshest critics of ourselves. Someday you will look back and regret not wearing that bathing suit and enjoying the water.

• Go on a diet from the media. Constantly viewing “ideal” body images reduces body satisfaction. In other words, the more you look at popular magazines with airbrushed pictures the worse you will feel about yourself (2, 3, 4). This is true for both men and women.

• Find a physical trait you love and focus on it daily. You will feel better about your body when you focus on the parts of your body you like the best. Conversely, focusing on the parts of your body you do not like will increase body dissatisfaction (5).

• Check out the Happiness Trap – an empowering self-help book based on behavioral psychology.

Follow This Approach
There are two approaches to not dieting and both go hand-in-hand. The first one is Intuitive Eating. Intuitive eating breaks the dieting cycle and teaches you how to feed your body based on hunger and satiety cues. There are number of intuitive eating counselors who can help you with this.

The second approach is Body Kindness. This book is about creating a happier and healthier life. The focus is on spiraling up, the idea that your mindset and mood influences your choices and vice versa to help you stay more positive, optimistic and open to bring the best you to the world — and it has nothing to do with what you weigh. Author Rebecca Scritchfield, RDN, a former chronic dieter who broke free from the cyle of dieting and emotional overeating, believes dieting creates a downward spiral because it enhances your negative emotions. Body Kindness is based on three pillars: Love Connect Care. Make choices from a place of love, connect to your body to find out what you really need, and fully commit to your self-care plans.

I use diets, when warranted, and prescribed the right way for those who are not perpetual dieters. I do not recommend them for people who have gone on and off them for years and have a poor body image. I will never forget the time I counseled a woman in her 30s who had been on and off Weight Watchers since she was a pre-teen. She said, “it works for me.” And she was surprised at my response “no, it hasn’t worked for you because if it did you wouldn’t be sitting in front of me today.” She said she was ashamed about how she looked. My response, “let’s work on that. It’s time to let go, break free, give up emotional overeating and body shame.” That’s no way to live.

References

1 Dhurandhar EJ et al. Predicting adult weight change in the real world: a systematic review and meta-analysis accounting for compensatory changes in energy intake or expenditure. Int J Obes (Lond) 2015;39(8):1181-7.

2 Morry MM, Staska SL. Magazine exposure: Internalization, self-objectification, eating attitudes, and body satisfaction in male and female university students. Can J Behav 2001; 33: 269–279

3 Grabe S, Ward LM, Hyde JS. The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies.
Psychol Bull 2008;134(3):460-76.

4 Agliata D, Tantleff-Dunn S (2004) The impact of media exposure on males’ body image. J Soc Clin Psychol 23: 7–22

5 Smeets E, Jansen A, Roefs A. Bias for the (un)attractive self: on the role of attention in causing body (dis)satisfaction. Health Psychol 2011;30(3):360-7.

6 Lowe MR et al. Multiple types of dieting prospectively predict weight gain during the freshman year of college. Appetite 2006;47(1):83-90.

7 Zhou Y and Rui L. Leptin signaling and leptin resistance. Front Med 7: 207-222, 2013.

8 Knuth ND, Johannsen DL, Tamboli RA, Marks-Shulman PA, Huizenga R, Chen KY, Abumrad NN, Ravussin E, and Hall KD. Metabolic adaptation following massive weight loss is related to the degree of energy imbalance and changes in circulating leptin. Obesity (Silver Spring) 22: 2563-2569, 2014.

9 Johannsen DL, Knuth ND, Huizenga R, Rood JC, Ravussin E, and Hall KD. Metabolic slowing with massive weight loss despite preservation of fat-free mass. J Clin Endocrinol Metab 2012; 97: 2489-2496.

3 Weight Loss Truths

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If you haven’t been bombarded with weight loss ads over the past week, you’re probably on a remote island soaking up the sun with the waves gently teasing your feet (bring me next time). There’s something about the start of a New Year that makes people freak out, lose their senses and develop completely unrealistic eating plans they will never follow for more than a few days. Before you get sucked into a crazy diet or juice cleanse, you should know the top three truths about weight loss.


1) No One Eats “Clean” all of the Time

Instagram and Facebook are full of photos of broccoli, brown rice and chicken meals neatly placed in Tupperware and followed by #mealprep #eatclean. The only thing more boring than looking at these meals is eating them day after day. No one eats like this all of the time. No one.
I’ve worked with a number of elite athletes who cut weight before a fight, match or event. They diet down, compete then loosen up their diet a bit before they need to diet down again. They aren’t eating bodybuilding-type meals every day year-round.

2) There is No One Perfect Diet

Jenny Craig, Weight Watchers, juice cleanses, Paleo, Whole30. There is no “perfect” because what’s right for you isn’t necessarily right for me. Figure out what changes you can realistically stick with, combine these with the general principles of healthy eating and start there. Forget what everyone else is doing, how your neighbor dropped 50 lbs. or what the actress on the cover of a magazine did. If you can’t stick with a plan, it won’t work.

Progress, not perfection, is the goal.

Celebrate each “win,” those small changes you’ve made that will add up to a big difference. You won’t necessarily notice a weight loss right away by making a few simple switches in your diet. However, I would rather people focus on the immediate difference – more energy, feeling better, more sleep, than the number on the scale. Feeling better each day will drive you to continue when the scale isn’t moving much.

3) You Must Exercise for Weight Loss

Can you lose weight without exercising? Yes absolutely. However, if you do not exercise you will lose more of your weight as muscle then fat. In addition to burning fewer calories each day when you lose muscle, you will notice a decline in strength and as you get older and everyday activities will become harder to do – lifting groceries, gardening, washing your car.

If you are not an exerciser and typically fall off when you start a new workout program, figure out what you like to do and do it. Forget all of the back-and-forth “noise” about high intensity interval training, the amount of rest in between sets and if you should train until muscle failure (until you cannot possibly lift the weight again). Instead, determine what brings you joy. What do you love to do? Dancing, yoga, hiking? What did you love doing as a kid? Hula hooping, double Dutch jump rope?

Do what makes you happy. Get moving and stay moving.

In addition to following these weight-loss truths, spend time feeling good about your body every single day. I meet so many people that are hyper focused on losing 5 pounds or 50 lbs. As they rattle off the reasons why they want to lose body fat and how this will drastically alter their life and make them happy, my mind often drifts off. I wonder what percentage of their thoughts are consumed by losing weight and dieting and if they are hyper-focused on controlling this aspect of their life because something else isn’t right. A marriage, their job, a friendship, their child’s behavior. If I ask the right questions something else they are ignoring often comes up.

Maintaining weight within a good range is very important for overall health. Obsessing about weight and dieting isn’t. I’ve coached enough people to know that one day you’ll look back years from now and wonder why you wasted so much time hating your body.

You’ll look back and say, “damn, I looked good! I wish I felt better about myself.”

“I wish I wore shorts in the summer.”

“Why didn’t I go to the beach in a bathing suit?”

“I wish I went to that party.”

I promise you, no one is criticizing your body. Every one around you is too busy focused on themselves. So go out and wear shorts, put on a bathing suit, try on that dress.

If you don’t love your body now, you won’t feel your best every day. You won’t enjoy life to the fullest. Work in this first (or in conjunction with healthy eating / a healthy approach to weight loss).

Because it’s a waste of time to spend your days bashing the body that does so much for you.

Get off the Dieting Cycle and Lose Weight for Good

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Are you a yo-yo dieter, stuck in a seemingly endless cycle of losing weight and gaining it back again?  If so, you aren’t alone. I’ve met many people who say they are experts at losing weight but they just can’t seem to keep it off. So I’m going to share my top tips for taking the weight off and keeping it off for good – the very same steps I shared with Fox 5 viewers this week. But first, let’s talk about dieting….

All diets have one thing in common – they help you cut calories so you lose weight. And when you lose weight you’ll lose both fat and muscle. However, when you go on a juice fast or low calorie diet that doesn’t contain enough protein (and most don’t), you will lose a considerable amount of muscle tissue. And that’s a huge problem because muscle burns more calories at rest than fat (just a few but it adds up over time) so when you lose muscle you’ll need fewer calories each day just to maintain your weight. Over time, repeated bouts of protein poor diets could decrease your calorie needs even further, making it increasingly difficult to keep the weight off without dieting. And therefore, if you want to go on a diet there are two things you need to do:

  • Feed the Muscle to Keep the Muscle. You’ll need even more protein when you cut your calories to help ensure you are preserving muscle while losing fat. A good rule of thumb, start by consuming at least 25 – 30 grams of protein per meal. At breakfast consider mixing a packet of protein powder in 6 oz. of milk or higher protein soy milk, eggs (2 large egg whites + 2 large eggs = about 28 grams of protein and just 200 calories), plain Greek yogurt + 2 Tbsp. of peanut butter or eat foods that aren’t traditionally associated with breakfast (last night’s leftovers). At lunch and dinner, you’ll need about the serving size of a female’s palm worth of chicken, turkey or fish or mix and match proteins by adding tofu, tempeh, beans, bean pastas, nuts and seeds.
  • Have an exit strategy – a plan for transitioning off your diet. Don’t stay on a very low calorie diet for an extended period of time. You will decrease your metabolism – the amount of calories you need each day. If you are cutting calories for more than just a few months, take a day or two each week and don’t drop your calories – eat what you need to if you wanted to maintain your weight (bump up your calorie intake).

Now let’s focus on fitness. There are two mistakes I see people making over and over – spending hours on cardio machines and sitting around the rest of the day. If you spend some quality time burning calories on the treadmill, bike or other cardio machine, its time to trade in some of your aerobic sessions for resistance training – lifting weights, power yoga, or anything that requires you to exercise a muscle or muscle group against external resistance. As we age we lose muscle. Losing muscle means your body will require fewer calories each day (again, this means you’ll need to eat less over time just to stay at the same body weight). Maintaining muscle will be easier to maintain your weight. If you already lift weights, change your routine to continue to make gains. Incorporate different exercises, lift until failure – until you can’t squeeze out any more reps (you do not necessarily have to use a heavy weight but instead can lift lighter weights using more reps till failure) or try doing compound sets – two or more exercises in a row targeting the same muscle group without rest.

Last but certainly not least, get moving and stay moving. Simply going to the gym isn’t enough to help you maintain your weight or counteract the health hazards of sitting most of the day. Sitting for long periods of time slows blood circulation, increases your risk of developing blood clots, leads to tight muscles and, sedentary behavior is tied to an increased risk of heart disease. So get moving and stay moving all day long. Ignore modern conveniences including escalators, elevators, the drive-through, pay at the gas pump and more. All of these rob you of the chance to move your body, burn calories and improve your health. If you need a little motivation, buy a fitness tracker. I prefer the ones that show you how many steps you’ve walked on the device versus those that require you to log on to your computer or smart phone just to see how active you are.

Avoid Packing on the Pounds this Holiday Season

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If holiday parties tempt your desire to overindulge in mouth-watering creamy dips, comforting homemade casseroles and delectable desserts, you may find yourself panicking by the end of December and ready to crash diet on January 1st. Instead of doing something stupid (crash dieting), try a more sensible approach to avoid packing on the pounds this holiday season while still enjoying yourself. Follow these 3 tips for keeping calories in check this holiday season:

  1. Think “strategic placement” at holiday parties. While other people may worry about locating themselves near the life of the party, locate yourself away from the chip and dip bowl, especially if a meal will be served. Grab a small plate with a couple of appetizers, then walk away. Chances are you’ll get caught up in a conversation which will prevent the temptation to over-indulge in extra calories. Consider strategic placement strategy when filing your plate as well. Make half of your plate fresh fruits and veggies and the other half those higher calorie items that you can’t wait to dig into.
  1. Make smart swaps to traditional favorites. Admittedly, the holidays aren’t the best time to try an entirely different approach to cherished family menus, but you can make improvements. Try swapping reduce fat dairy for regular dairy, broth based soups instead of creamy versions and lighter versions of other ingredients as well. In addition, try adding grated vegetables (zucchini, carrots and onions often work well) in place of some ground meat in meat-based dishes.
    Not only will this enhance the nutrition value of your dish but it will also improve the flavor.
  1. Don’t drink away all your good efforts. No matter how great your strategy is for choosing healthier foods at the holidays, alcoholic drinks can be your calorie downfall. The best solution: alternate your beverages with a glass of water or club soda. You’ll stay better hydrated, keep calories in check and avoid a hangover. If plain water doesn’t sound very appealing, try sparkling water or club soda with a splash of 100% juice and a twist of lime. This simple strategy will help you reduce your calories and help you stay hydrated thereby preventing a hangover the next day. Also, if you are a wine drinker, take out a liquid measuring cup and measure 4 oz. of wine and pour it into a wine glass so you know what one serving of wine looks like. It is considerably smaller than you may think.

An Unexpected New Year’s Resolution

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By Sara Shipley, RD-to be, Nutrition Student at the University of Central Oklahoma

Yes, it’s that time again and the thought has probably crossed your mind as 2011 comes to a close. The annual New Year’s resolution. And, according to many popular media sources, losing weight tops many people’s resolution list. Yet our nation is in a major health crisis. Something isn’t adding up and though many people realize they should take charge of their health, they are not taking the right approach to fix the problem. If the majority of people continue to ditch their goals by February, we will continue to see the rate of obesity, diabetes and heart disease rise.

If losing weight is on your list of New Year’s resolutions, or even if it isn’t, I am going to tell you about one big dietary change that will yield big results: boosting your fiber intake.

Fiber is the indigestible part of a carbohydrate. We need fiber in our diet because our bodies do not absorb it. Rather, it acts as a vehicle to remove waste products from f our system.  Here are three reasons to eat more fiber:

Feel full longer: Fiber provides “bulk” to your diet which helps control hunger, as it takes time to move through your digestive tract leaving you full throughout the day. Eating a high fiber breakfast every morning will start your day off right.  Try oatmeal with berries and low-fat milk or whole wheat toast with peanut butter and a banana.

Digestion: Fiber will regulate your bowel movements and this helps keep everything moving out of your system, including some residual toxins.

Lowers LDL cholesterol levels and risk for heart disease: Increasing fiber may contribute to lowering LDL cholesterol levels, blood pressure and inflammation in the body. Controlling these health markers will help protect your heart.

Try this easy, high fiber hors d’oeuvre for your New Years Eve party. I have already made it for several holiday parties and it was devoured.

Bacon Wrapped Dates: Dates are dried fruit with a sweet flavor and chewy texture that will balance the salty bite of bacon. (Try turkey bacon if you want to cutback the fat, but it may not crisp as well.)

Yield: 30 pieces

  •  15 slices thick bacon
  • 30 pitted dates (Dole brand was perfect bite-size and a bag usually has approx. 30)
  • toothpicks

Pre-heat the oven to 425 F. Slice each bacon piece in half, short ways. Roll a piece of bacon around each date and pierce with a wooden toothpick. Place wrapped dates on a sprayed baking sheet (set ½ inch apart). Cook for 13-16 minutes, turning once to ensure the bacon crisps on all sides.

Place on a rack to slightly cool and serve warm.

Peas are also a high fiber food and Black Eye Pea dips and dishes are a big New Years Tradition here in Oklahoma. Get your fill of fiber with peas as you ring in the New Year!

 

 

 

 

 

 


 [SS1]What other word can you think of? I feel like ‘diet’ has already been over-used.

 [SS2]Marie- isn’t that right? Please delete if you think it sounds weird/incorrect.

Getting a Better Body Image

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As a sports dietitian, the majority of my individual clients are male pro or college athletes – guys who have no major issues with their body image. However, among my female clients and women in general, I’ve noticed increased body bashing coinciding with a not so great body image. From comments on facebook about needing to start a cleanse or strict diet to not wearing clothes that show certain body parts, I am stunned at the number of women who don’t feel comfortable in their own skin. So, I turned to my fellow dietitians for words of wisdom to help women get a better body image. And, here’s the expert advice I received:

  • There is no such thing as a “perfect” body but, is your body good enough? Does it get you through your long days and tough workouts? Do your muscular thighs help you excel in sports and your strong shoulders help lift your small children into bed? Focus on what your body can do and does for you. (from Karin Kratina)
  • To compare is to despair. If fashion magazines or certain TV shows make you focus more intensely (in a negative way) about your body, it’s time to start reading something else or turning the channel.
  • Don’t allow negative comments about your body (from yourself or anyone else). When you catch yourself saying “I have big thighs” or “my cellulite”, stop and make a positive comment about your body. And, when you are around girl friends who make these comments, looking for a reaction from you or equal self loathing words, stop the chain by saying nothing and switching the topic.
  • Throw out the scale. You can measure your body changes by how your clothes fit. But, living your life by a number on the scale (or worse yet, comparing this # to other people’s weight) will intensify a negative perception of your body.
  • Be aware of the people around you. If you grew up with a mom who is a chronic dieter, resolve to break that chain. If you surround yourself with people obsessed with dieting, either ask that they don’t talk about this constantly when you are around or, find other people with more engaging topics of discussion.
  • Love it and flaunt it. There’s nothing more attractive than self confidence (well, and a beautiful smile). When you continuously work on 4 simple steps, your body image will improve over time.

 


The pictures are from Nike ads I just love! This clothing manufacturer not only produces awesome sports clothes but they encourage a better way to view your body. For more, click here.

And finally, if you are a parent reading this, please encourage a healthy body image in your child or teenager. After all, more than half of U.S. teens have had an eating disorder.

Best Weight Loss Program: Weight Watchers

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The absolute best way to lose weight is to get a customized nutrition program from a Registered Dietitian who specializes in both weight loss and whatever else you need help with (PCOS, kidney disease, PKU, diabetes, sports nutrition etc. – there are a number of specialty areas) and combine that with a good training program that meets your current state of health and physical capacity.  However, for a multitude of reasons, some people like what I call Canned Weight Loss Programs. Programs that work with the masses and give a one size fits all approach. And, there’s nothing wrong with this but, you should go into it knowing what to expect.

Programs that give you meals like Nutrisystem, work if you follow them.  And, they take the guesswork out of dieting if you just want to lose weight asap without having to put any thought into it. These programs are fantastic for busy people on the go but those who need variety may get sick of the meal options sooner rather than later. Nutrisystem like programs get you used to appropriate portion sizes but, they do not teach you how to pick and choose and put together your own meals.  And while that sounds easy, it is typically where people fail.  They fail to plan and end up making poor choices because they are hungry and have no food with them or come home and can’t figure out what to make for dinner.

As a professional who has worked with many clients who are on Weight Watchers, I feel this is one of the better, more sound dieting approaches out there.  While you count points (which are determined based on calories, fiber and fat in food) versus calories, you’ll get used to sticking within a basic calorie budget with some room for those days you go out to eat, hit a party etc. (each person gets 35 extra points per week). And, aside from learning portion sizes and re-training yourself with how much food you should be eating in a given day, Weight Watchers forces you to plan at least some of your meals.  When you choose a higher calorie breakfast, you’ll start thinking about how many points you have left and what you should eat for lunch and dinner to stay within your point allotment.

Like all canned programs, Weight Watchers falls short in a few areas. First, you are only required to eat 2 dairy per day. In a world where many people have blood levels of vitamin D that are deficient or insufficient and we aren’t consuming enough of this vitamin:  55% and 68% of U.S. men and women aged 31-50 consume below the Adequate intake for vitamin D, 2 dairy just aren’t enough. In addition to making it more difficult to get vitamin D, dairy is your best bet for getting calcium and 42% and 67% of U.S. men and women consume less than the Adequate intake for calcium*.  Secondly, Weight Watchers encourages a high fiber (good), higher carbohydrate diet. Many women I’ve met with are falling short on protein and healthy fats on this diet. And, high carbohydrate (even if you cut calories) just doesn’t work well for some people especially those with blood glucose issues, PCOS (polycystic ovarian syndrome) or insulin resistance. Anyone who fits in one of these categories needs an individual tailored program that manages their blood sugar levels.

For a Canned Diet Program, Nutrisystem works, Jenny Craig works, and Weight Watchers works and teaches you something about portion sizes in a supportive group environment. But, if you choose Weight Watchers, know ahead of time you are very likely to fall short on both vitamin D and calcium (a multivitamin will not make up for the calcium shortfall and in many people it won’t help your vitamin D levels too much either) and if you have PCOS, insulin resistance, pre-diabetes, diabetes or any blood sugar abnormalities, I do not recommend Weight Watchers. Instead, talk to a dietitian who specializes in weight loss and these issues. It’s worth the time and cost – you’ll end up less frustrated and with a better chance of being successful.

*NHANES data 2005-2006.