Studies show that starving oneself causes changes in the brain that can lead to the inability to see oneself objectively. It’s “distorted body image,” according to Cleveland Clinic eating disorders specialist Ellen Rome, M.D., M.P.H.

Women suffering from anorexia, for example, tend to draw their silhouettes or estimate their hip width disproportionately larger than they actually are. This is not a coy way of denying their condition; when confronted with the truth, they will firmly deny their true size. Altered perceptions of body image are predictable and painful—but they are often reversible, says Rome.

For help, turn first to a medical doctor who is well-versed in eating disorders. Contact the National Eating Disorders Association (nationaleatingdisorders.org, 800-931-2237) for local specialists.

Distorted Body Image: Objects in Mirror May Appear Larger Than Actual Size The Saturday Evening Post

“Beverages can be an important source of energy, and those calories can add up quickly when the warm weather prompts people to drink more often,” says Richard D. Mattes, M.P.H., Ph.D., R.D., honored as a distinguished professor of nutrition science by Purdue University in 2011.

Fortunately, many affordable and palatable no-calorie and low-calorie beverage options are available to meet the need. The Beverage Guidance Panel, which ranks drinks based on their health benefits and costs, recommends water as your main beverage, followed by unsweetened coffee and tea. Soft drinks, fruit juices, whole milk and sports drinks are least advised.

“

Energy from beverages doesn’t produce as strong a satiety response—feeling full—as solid foods. Consequently, people may consume a large amount of energy before realizing they have done so.

“Because this source of energy has weak effects of appetite and is often consumed at non-meal times, beverages propose a unique challenge to weight management,” 
Mattes concludes.

Calories Count When Keeping Cool The Saturday Evening Post

Apparently, yes—but in quite different ways. Pounds tend to add up for women after marriage and men after divorce, according to the American Sociological Association.

Although the study data can’t explain why, researchers suggest married women have little time to exercise and divorced men lose out on the proven health benefits of marriage—including stability, regular meals, and reminders to take better care of themselves.

Love Surprise The Saturday Evening Post

Why? Or, as anyone who has tried and tried but failed and failed to permanently slim down might put it, “Why??!!” If you read the testimonials from people who lost 50, 100, or more pounds on a commercial diet or the seemingly sure-fire advice from health magazines (eat pistachios! try grapefruit!), losing weight is easy. But here’s the irony: There are almost as many ways to successfully lose weight as there are people who need to do so.

To name but a few examples, drinking lots of water does make you feel fuller and therefore likely to eat less. (In one study, drinking 16 ounces of water before a meal led to 5 extra pounds of weight loss after 12 weeks—people felt too full to eat more.) Eating soup for dinner does, indeed, fill you up (again, with water), making it easier to eat less. Covering two-thirds of your plate with vegetables (no cream sauce!) leaves less room for calorie-laden meats and starches, reducing caloric intake. Cutting out booze, sugar- or fat-laden drinks (that includes lattes), potato chips, baked desserts—you know the list—does help. But knowing what works and doing what works are two different things.

Just in time for 2012, research is finally addressing the “doing” part. From psychological tactics such as exploiting the power of groups to a new understanding of metabolism, science has more to offer dieters than ever before, providing guidance about which diet and exercise regimens offer the best chance to help you lose weight and become fitter.

Take the most fundamental of dieting basics: that weight drops when and only when the number of calories you burn exceeds the number you take in. Experts now recognize that both sides of the energy/balance equation—calories burned and calories consumed—are not as simple as how much you exercise and how many calories are in the food that passes your lips. “The conventional thinking about calories in/calories out is changing, as research shows that people have different reactions to different macronutrients,” says Dr. Richard Kreider, professor of health and kinesiology at Texas A&M University. “That’s why no one diet or exercise plan works for every individual. If everyone cut their intake 500 calories a day and exercised an hour more, it would have different effects on different people.”

Let’s start with calories burned. Don’t be discouraged by the paltry number you burn during exercise (for a 160-pound person, 288 calories in a leisurely one-hour bike ride, for example, or 317 in a one-hour walk at 3 miles per hour—in both cases, barely enough to burn off a couple of scrambled eggs on unbuttered toast). Instead, emphasize the kind of exercise that can increase your metabolism so you burn more calories doing “nothing.” Fidgety people tend to be slimmer; burning extra calories for, say, 16 hours per waking day, seven days a week, adds up to more than you get by brief and sporadic bursts of exercise. That doesn’t mean we should all start fidgeting. But the basic principle means that it helps to incorporate resistance (or strength) training into your regimen. Leg lifts, situps, squats, and the like build muscle, notes Kreider. A pound of muscle burns more calories than a pound of fat. Therefore, replacing fat with muscle will raise your baseline metabolism. “You burn more calories after your workout as well as during,” Kreider says.

Slashing your caloric intake, on the other hand, lowers baseline metabolism. This is why so many people are yo-yo dieters. They shed pounds by limiting their calories to, say, 1,200 a day, but because very low-calorie diets tend to take off muscle (in many cases, half or more of the lost pounds are muscle) the result is an increasingly lower metabolism. Eventually it gets so low, says Kreider, that you have to practically starve yourself to keep from gaining weight.

Starving yourself is not fun, in case you hadn’t noticed. And being miserable on a diet is also a big reason people give up, setting the stage for next year’s New Year’s resolution. Very low-cal diets can trip you up for another reason. A study published online last September in The Journal of Clinical Investigation found that when glucose levels drop, as happens when we consume too little, the brain’s hypothalamus senses the change and activates the brain’s insula and striatum, which are associated with reward, inducing a desire to eat. At the same time, the prefrontal cortex seems to lose its ability to put the brakes upon the “EAT! EAT!” signals coming from the striatum. That impairs the ability to inhibit the impulse to eat when glucose levels plunge, explained Dr. Kathleen Page of the University of Southern California, who led the study.

Different foods can raise or lower your baseline metabolism. To lose weight, you want more of the former without compromising nutrition. Green tea and caffeine raise baseline metabolism. And because muscle burns more calories than fat, foods that build muscle—namely, those high in protein—will indirectly raise your metabolism just as resistance training does. Calories from protein also take more calorie-burning energy to digest and leave you feeling fuller than calories from carbohydrates. High-fiber grains are a close second followed by fruits and vegetables with starches and sugars trailing badly. If a diet leaves you feeling full, you are more likely to stick to it, making it a true lifestyle change and not an eight-week crash program. The realization that foods differ in how full they leave you led Weight Watchers to revamp its famous points system a year ago. A PB&J on white bread with chips sets you back 11 points, but so does a heaping Greek salad, soup, pasta, and grapes, which is much more filling. The idea is to use your points on foods like the latter.

The protein effect helps explain why, in a 2011 Consumer Reports analysis, Jenny Craig, Slim-Fast, and Weight Watchers were all good to excellent at both short- and long-term weight loss and adherence (Jenny Craig came out on top). These diets are effective because they get 20 percent or more of calories from protein (experts suggest going as high as 30 percent) and include at least 21 grams of fiber for every 1,000 calories. How much of a difference can protein and resistance training make? Kreider put patients on a 2,600-calorie-a-day regimen—800 more than they’d been on during an earlier weight-loss diet—plus exercise. They had very low resting metabolisms, probably a result of their low energy intake. But the patients lost weight on the higher-cal diet; its higher protein content and resistance training built muscle and raised baseline metabolism. “Higher protein intake can also lead to changes in gene expression that make you burn fat more effectively,” says Kreider. It never hurts to have your DNA on board.

One reason Jenny Craig edged its competitors is that it offers single-serving entrees, desserts, and snacks (1,315 calories a day), removing the element of choice. That may sound restrictive, but many dieters are relieved to outsource such decisions. “They’re very effective for some people,” says Dr. John Foreyt, a professor at Baylor College of Medicine and director of its Behavioral Medicine Research Center. In fact, “some people” seems to be “many people.” Strictly prescribed plans tend to have lower drop-out rates both long-term (one year or more) and short-term (less than six months), Consumer Reports found.

On a structured eating plan you are also less likely to eat anything actively bad for you such as foods containing high fructose corn syrup (HFCS). Here is another example of how not all calories are created equal. Although HFCS has no more calories than other sugars, its effect on the brain and body seem to be different, says Dr. Richard Shriner, director of the eating orders and obesity program at the University of Florida, Gainesville. It reduces levels of leptin, the appetite hormone that signals us that we’re full. Shriner calls HFCS a “bariatric food”—a food that alters our physiology in a way that promotes more weight gain than its calorie count would indicate.

The most important factor in whether you will lose weight on a diet is whether you can stay on it. That may partly explain the edge that low-carb diets have over low-fat diets. Low-fat diets are necessarily lower-protein diets because most proteins (meat, dairy, nuts) come with fat. “A low-fat diet is like eating cardboard,” says Foreyt. “You feel hungry and unhappy. For long-term success, a diet has to be tailored to your likes and dislikes.”

Foreyt’s statement is supported by a 2010 study in the New England Journal of Medicine in which fewer people on high-protein diets (like Atkins) dropped out than on low-protein-high-carb diets (26 percent vs. 37 percent).

Exercise plays a role in adherence, too. It promotes a sense of well-being thanks to its ability to raise levels of endorphins and other feel-good chemicals in the brain. “And if you feel better about yourself, you’re more likely to stick to a diet,” says Foreyt. That said, it’s just about impossible to lose weight by ramping up physical activity if you don’t change what you eat. A 2011 analysis of 14 exercise studies, which included 1,847 overweight patients, with aerobic exercise programs ranging from 12 weeks to 12 months found an average weight loss of 3.5 pounds after six months and 3.7 pounds after 12. Or as the scientists from McGill University in Montreal concluded, “isolated aerobic exercise is not an effective weight loss therapy.” For exercise to help, it must be “in conjunction with diets.”

The realization that many diets work as long as people stick to them, and that what matters for any individual is whether he or she can do that, has led weight-loss experts to recognize the crucial role that psychology plays in efforts to slim down. Jenny Craig offers counseling sessions, and Weight Watchers has weekly meetings. Curves offers 30-minute structured resistance and aerobic exercise workouts—30 minutes, 500 calories, plus residual metabolism increase. The importance of exercise to build metabolism-raising muscle as well as burn calories means that social support making you more likely to work out can mean the difference between success and failure. “If you want to lose weight, don’t go it alone, especially for exercise,” says Kreider. Try a buddy system. “Trying to lose weight can be a very lonely experience,” says Shriner. “When you’re staring at the fridge at 2 a.m. and are about to binge, have a friend you can call.”

Research has now focused in on what other kinds of psychological support are most helpful, and the winner so far is cognitive behavioral therapy (CBT). In this approach, which has also proven effective in mental illnesses such as depression, a therapist helps people recognize the negative thoughts that may be keeping them from losing weight, especially the idea that having failed before (as is true for most dieters) means they will fail again. CBT “helps make people aware of what they are telling themselves, especially in the aftermath of a multitude of previous failures,” says Brent Van Dorsten, a clinical health psychologist at the University of Colorado School of Medicine in Denver. A 2005 review of 36 studies with 3,595 participants by the Cochrane Collaboration, an international group of scientific and medical experts, found that CBT “significantly improved the success of weight loss” compared to diet and exercise alone. “We now have years of research showing that cognitive and behavioral components make a real difference in weight-loss programs,” says Van Dorsten. “When therapists help you set a realistic and clearly defined weight-loss goal, combine several dietary and physical activity strategies, and keep you from catastrophizing”—that is, concluding from one slip-up at the dessert table that you are doomed to fail again—“all of these improve long-term weight loss.”

The use of CBT is part of a sea change in the science of weight loss, which recognizes that what happens inside your skull is as important as what happens inside your digestive system. For instance, a 2011 study by scientists at Yale found that when people thought of a food (in this case, a milk shake) as rich, indulgent, and loaded with calories, after drinking it people’s levels of the hunger hormone ghrelin fell off a cliff; they couldn’t eat another bite. But when people thought of the same food as low-cal and “sensible,” their ghrelin levels hardly budged after they drank it; they were still hungry. That offers another explanation of why “diet” foods don’t work—we think they’re about as filling as a carrot, and that becomes a self-fulfilling prophecy. Lesson: Persuade yourself that the foods on your meal plan are filling and indulgent.

At the end of the day, eating sensibly and exercising requires will power. Here, too, science is revealing previously unsuspected aspects of this precious commodity.

Psychologist Roy Baumeister of Florida State University has shown that will power is a finite resource just like, say, energy; if you use a lot of it for one thing you have less left for another. People who are on a strict diet have trouble resisting the siren call of buying, for instance. Having deployed their self-restraint on passing up dessert at lunch with friends, they have none left to resist that amazing pair of shoes calling to them from the shop window.

And, if all else fails, there’s always New Year 2013!

Lose Weight for Good! The Saturday Evening Post

Let the Adventures Begin

• Sign up for an outdoor exercise “boot camp.”
• Plan a kayaking trip.
• Search for products that put a new spin on fitness, such as FitDeck (24 decks of exercise playing cards ranging from Navy SEAL to Yoga workouts, available at fitdeck.com for about $15), BPA-free filtered water bottles($20 at BodyGlove.com), Five Fingers shoes ($75 and up at vibramfivefingers.com), and the Skaters Coach for inline skating (skaterscoach.com, summer special price $349 plus shipping).

Fitness enthusiast and researcher Dr. Tyler Cooper, CEO of Cooper Aerobics Enterprises, Inc., and co-author of Start Strong, Finish Strong with his father, aerobics guru Dr. Kenneth Cooper answers your questions.

Q: Does outdoor exercise offer different health benefits than indoor exercise?

A: Exercising outdoors clears the brain, relaxes the body, and frees the mind. It also breaks your routine—something that is especially important if you spend most of your day sitting in an office. A century ago, the majority of people worked outside. That’s not the case in today’s culture.

Fortunately, outdoor activity doesn’t cost much money and can be done in a short period of time. When people are outdoors, they are typically active. Exercise releases chemical messengers in the brain that are similar to how an antidepressant drug works. It actually makes you feel better! Exercising outdoors and enjoying your surroundings triggers a natural high.

Q: How do you motivate your clients to start with a fitness program?

A: At the Cooper Clinic, we tell people to focus on quality and quantity of life. Our institute released a landmark study in 1989 showing that 30 minutes of cardiovascular exercise three times a week (so not very much at all and any type you like) will increase your lifespan by about six years. Our studies also show that exercising three to five times weekly significantly improves quality of life by boosting energy and reducing the risk of depression and other health problems.

Eating well is a component of healthy living—one instrument, if you will, in the entire orchestra. But I tell my patients that their body weight is consequence of how much they eat and how much they exercise. In other words, diet plus exercise equals weight. I really don’t care how much they weigh if they are eating right and getting regular exercise.

People who focus solely on their weight will start working out and eating right for a couple weeks. Then they get discouraged and quit if they gain a pound or two. They are exercising for the wrong reasons! People often note a redistribution of fat and muscle as the body becomes attuned to an increase in its metabolism. We encourage people to focus on the long haul. Regular exercise will improve both the quantity and quality of life—and it doesn’t take that much. You don’t have to go out and run a marathon.

Q: What’s your advice for people who want get some exercise and have some fun outdoors?

A: Start with something small and easy. We teach moderation. An unattainable goal will lead to failure. Instead, just get out there and start working. Go for a 10-minute walk twice a week. Then, slowly build up to 30 minutes, three to five times a week. Do something outside that you already like to do inside. If you walk on the treadmill or ride an exercise bike, take a stroll or go cycling outside.

Plan active trips. My wife jokes that we take trips, not vacations. Our idea of a vacation is going somewhere to do something active, whether that is hiking, fishing, or skiing. We might sit on the beach and relax for part of the day, but we’ll also play tennis or golf.

Explore local options. People often don’t realize what their own communities have to offer. Go online and search for outdoor activities or local hikes. Chances are good that you’ll find beautiful walking paths, gardens, or parks to get outside, be active, and relax. Look for a nice little destination within a day’s drive to take a hike, have a picnic, and reset your mind.

Break out. It is very easy to get stuck in a rut. Work weeks blend together, home responsibilities become predictable, and we do the same thing each weekend. I believe it’s very healthy physiologically as well as psychologically to break out of those routines. It doesn’t have to mean planning a seven-day vacation. It can be, “Hey, on Saturday, let’s drive an hour and a half to a park I heard about and take a nice hike, relax, read, or whatever.”

People get caught in a routine about their health, too. That’s fine if it’s a healthy routine. But typically, it’s not. We get stuck eating the same foods or not exercising or making the same excuses. Breaking that routine is really important.

Q: Is more always better when it comes to exercise?

A: Again, we at the Cooper Clinic advise moderation. I used to think that more is better, but we’ve learned that going to extremes can be unhealthy. The general recommendation is 30 minutes of exercise on most days, and  you can break up that 30 minutes into two 15-minutes blocks and reap almost the same benefit. I tell patients that they don’t necessarily have to pull on the gym shorts and go to the club, or hit the trail. Put on some headphones and listen to music or a book on tape and walk for 15 minutes. Do it once in the morning and once in the afternoon, and you are done. As you get more consistent in a program like that, you are going to find that you want to do more and more because you are feeling better. Our studies show little if any benefit to training for a marathon as compared to exercising 3-5 times a week. The exponential growth is going from no to some exercise, as opposed to going from some to a lot. That’s really encouraging to me, and it seems to be encouraging my patients, too.

Q: What tips can you give our readers to stick with a fitness plan and stay motivated?

A: Be realistic. Beginners might set a goal to exercise three times a week, with the intention to bump it up to five days. If you are the type of person who benefits from having a routine, then pick a time every day that you go exercise.

Put it on your weekly calendar. On Sunday, block in your exercise time for the rest of the week. Put it as a meeting on your calendar. That way, when the time comes, you are going to do it. People often have every intention to exercise after work. Then, they get stuck in a meeting, something happens at home, or they are tired, and they end up blowing it off. That’s a big mistake. Exercise is the most important thing that you are going to do that day for your physical body. Putting it on the calendar and sticking to it is a good way to get it done.

Be accountable.If you have someone to work out with, whether a friend, a personal trainer, a spouse, or a sibling, you are much more likely to have success with an exercise (or dietary) program. It doesn’t have to be crack-the-whip accountability, but just a “Let’s get together tomorrow afternoon and go for a walk” kind of a thing.

One more thing: People who begin an exercise program for the fist time may not feel well during the initial three to four weeks. They may actually feel pretty crummy and ask why on earth they are doing this. But the reality is that they will start to develop good habits and, by the end of the month, they will feel some of the positive effects of the exercise and a healthy lifestyle.

Q: What is your favorite type of outdoor exercise?

A: I run every afternoon on one of the trails and paths that surround where we work—it’s my stress reliever. Sometimes I have to force myself to do it, but 100 out of 100 times, I feel better when I’m finished. I was a ski instructor in a former life, and I water and snow ski any chance I get. I also do a lot of hiking and mountain climbing. I joke that running was not optional in my family. On Sunday afternoons when families spent time together or whatnot, our family would get together for a 5K run. That’s what I am trying to instill in my children: be active and have fun. Make exercise a part of a healthy life that you enjoy and want to do.

Q: What’s new at Cooper Aerobics?

A: It’s an exciting year at Cooper Aerobics Center—we are celebrating our 40^th anniversary! We’re always working to advance the field of preventative medicine and research, to keep people healthy, and to detect diseases in the earliest stages, when we can treat it easily and affordably.

Cooper Corporate Solutions works with corporations to develop wellness programs and help control insurance costs by improving the health of their employees. Comprehensive health screening is another priority. I frequently tell my patients: Don’t die of something stupid. Skin cancer and colon cancer are dumb reasons to die, because easy screening can catch those cancers very early, when they won’t cause you a problem. But if you wait, they will kill you. We also focus our energies on the issue of childhood obesity. About 25 years ago, we developed a physical fitness test for schoolchildren called Fitness Gram. Data from that ongoing research show that children who perform better on this physical fitness test also do better on standardized testing than kids who are less fit. Five million school children took the fitness test in 2009. We are hopeful that this fascinating research will help contribute to turning around the problem of childhood obesity. Recently, Cooper Aerobics developed an association with the University of Texas Southwestern Medical School related to genetic studies. We keep blood samples on a large proportion of our patients. Working with UT researchers may help identify genetic markers associated with certain diseases, and determine the effect of preventive medicine and positive lifestyle habits on one’s health.

Today, the importance of exercise in overall health and wellness is a war cry. It just makes sense. But when my father wrote his first book, Aerobics, in 1968, he was accosted for promoting exercise. The difference in the way his message is accepted is night and day. It’s refreshing here. I have the great joy of seeing patients, catching diseases early, when we can do something about it, and keeping them healthy for a long time.

Get Out, Get Fit The Saturday Evening Post