Sit Down a Lot - Die Sooner and Fatter

Our bodies were not meant to sit down a lot, but in modern life that's increasingly how we spend our time. In the past 18 months, several scholarly studies have begun to shed light on just how bad sitting around on our butts can be, but these papers haven't gotten much coverage because they're a little dry and too "sciencey" for the general press. Let me assure you: THIS IS REALLY IMPORTANT INFORMATION!

Recently, Women's Health magazine did the best and most concise writeup on this information that I've seen, so I'd like to share some of it with you here.

According to a poll of nearly 6,300 people by the Institute for Medicine and Public Health, it's likely that you spend a stunning 56 hours a week planted like a geranium — staring at your computer screen, working the steering wheel, or collapsed in a heap in front of your high-def TV. And it turns out women may be more sedentary than men, since they tend to play fewer sports and hold less active jobs.

Even if you think you have an energetic lifestyle, sitting is how most of us spend a good part of our day. And it's killing us — literally — by way of obesity, heart disease, and diabetes. All this downtime is so unhealthy that it's given birth to a new area of medical study called inactivity physiology, which explores the effects of our increasingly butt-bound, tech-driven lives, as well as a deadly new epidemic researchers have dubbed "sitting disease."

The modern-day desk sentence

"Our bodies have evolved over millions of years to do one thing: move," says James Levine, M.D., Ph.D., of the Mayo Clinic in Rochester, Minn., and author of "Move a Little, Lose a Lot." "As human beings, we evolved to stand upright. For thousands of generations, our environment demanded nearly constant physical activity."

But thanks to technological advances, the Internet, and an increasingly longer work week, that environment has disappeared. "Electronic living has all but sapped every flicker of activity from our daily lives," Levine says. You can shop, pay bills, make a living, and with Twitter and Facebook, even catch up with friends without so much as standing up. And the consequences of all that easy living are profound.

When you sit for an extended period of time, your body starts to shut down at the metabolic level, says Marc Hamilton, Ph.D., associate professor of biomedical sciences at the University of Missouri. When muscles — especially the big ones meant for movement, like those in your legs — are immobile, your circulation slows and you burn fewer calories. Key flab-burning enzymes responsible for breaking down triglycerides (a type of fat) simply start switching off. Sit for a full day and those fat burners plummet by 50 percent, Levine says.

That's not all. The less you move, the less blood sugar your body uses; research shows that for every two hours spent on your backside per day, your chance of contracting diabetes goes up by 7 percent. Your risk for heart disease goes up, too, because enzymes that keep blood fats in check are inactive. You're also more prone to depression: With less blood flow, fewer feel-good hormones are circulating to your brain.

Spending the day on your rear is also hell on your posture and spine health, says Douglas Lentz, a certified strength and conditioning specialist and the director of fitness and wellness for Summit Health in Chambersburg, Pa. "When you sit all day, your hip flexors and hamstrings shorten and tighten, while the muscles that support your spine become weak and stiff," he says. It's no wonder that the incidence of chronic lower-back pain among women has increased threefold since the early 1990s.

And even if you exercise, you're not immune. Consider this: We've become so sedentary that 30 minutes a day at the gym may not do enough to counteract the detrimental effects of eight, nine, or 10 hours of sitting, says Genevieve Healy, Ph.D., a research fellow at the Cancer Prevention Research Centre of the University of Queensland in Australia. That's one big reason so many women still struggle with weight, blood sugar, and cholesterol woes despite keeping consistent workout routines.

In a recent study, Healy and her colleagues found that regardless of how much moderate to vigorous exercise participants did, those who took more breaks from sitting throughout the day had slimmer waists, lower BMIs (body mass indexes), and healthier blood fat and blood sugar levels than those who sat the most. In an extensive study of 17,000 people, Canadian researchers drew an even more succinct conclusion: The longer you spend sitting each day, the more likely you are to die an early death — no matter how fit you are.

The non-exercise answer

So if exercise alone isn't the solution, what is? Fortunately, it's easier than you think to ward off the perils of prolonged parking. Just ramp up your daily non-exercise activity thermogenesis — or NEAT. That's the energy (i.e., calories) you burn doing everything but exercise. It's having sex, folding laundry, tapping your toes, and simply standing up. And it can be the difference between wearing a sarong or flaunting your bikini on your next beach vacation.

In his groundbreaking study on NEAT, the Mayo Clinic's Levine used motion-sensing underwear (hot, huh?) to track every single step and fidget of 20 people who weren't regular exercisers (half of them were obese; half were not). After 10 days, he found that the lean participants moved an average of 150 minutes more per day than the overweight people did — enough to burn 350 calories, or about one cheeseburger.

Fidgeting, standing, and puttering may even keep you off medications and out of the doctor's office. Think of your body as a computer: As long as you're moving the mouse and tapping the keys, all systems are go. But let it idle for a few minutes, and the machine goes into power-conservation mode. Your body is meant to be active, so when you sit and do nothing for too long, it shuts down and burns less energy. Getting consistent activity throughout the day keeps your metabolism humming along in high gear.

When you get out of your chair and start moving around, you turn on fat burners. Simply standing up fries three times as many calories as sitting on your butt, according to Levine. And, he adds, "NEAT activity can improve blood flow and increase the amount of serotonin available to the brain, so that your thinking becomes sharper and you'll be less likely to feel depressed."

Get your move on

Shake things up throughout the day by interrupting your sedentary stints as often as possible. "Stand up every half hour," says Neville Owen, Ph.D., of the University of Queensland. "If you have to sit for longer than that, take more extended and active breaks and move around for a few minutes before sitting back down."

When you're reading e-mail and taking phone calls, do it standing. Walk with colleagues to brainstorm ideas. And consider trading your chair for a large stability ball. "It forces you to engage your muscles, and you're likely to stand up more because you're not melting into a chair," Lentz says.

At home, it's simple: Limit TV time to two hours a day or less. Better yet, watch it from a treadmill or exercise bike. Among women, the risk for metabolic syndrome — a constellation of health woes including high blood pressure, high cholesterol, and high blood sugar — shoots up 26 percent for every hour per day they spend watching the tube.

Not sure how much of a difference these mini moves will make? Swapping a more active approach for just a few of your daily activities can help stave off the one-to two-pound weight gain most women accumulate every year — and it can keep your metabolism buzzing the way nature intended it to.

Body mass, waist size do predict heart disease

Measuring body mass index or waist size does accurately predict the risk of heart disease, Dutch scientists said on Monday.

A large 10-year study found that half of all fatal heart disease cases and a quarter of all non-fatal cases are linked to being overweight and having a high body mass index or large waist.

Body mass index and waist circumference are well known risk factors for cardiovascular diseases but the Dutch researchers said their work showed BMI and waist size could actually help predict the risk of dying from or developing heart disease.

"What this study shows is the substantial effect which (being) overweight and obesity have on cardiovascular disease, whether fatal of non-fatal," said Ineke van Dis from the Netherlands Heart Foundation, who led the study.

"In the near future the impact of obesity on the burden of heart disease will be even greater."

Dis and colleagues at the monitoring project on risk factors for chronic diseases at the Dutch National Institute for Public Health and the Environment measured both BMI and waist circumference in 20,500 men and women between 1993 and 1997.

When age-adjusted BMI and waist sizes were correlated with hospital records and cause-of-death data over 10 years, more than half (53 percent) of all fatal heart disease cases and around a quarter (25-30 percent) of all non-fatal cases were in people defined as overweight and obese.

Overweight people are defined as having a BMI of between 25 and 30 and obese people of 30 or more, according to the World Health Organization. BMI is calculated by dividing weight in kilograms by height in metres squared.

Waist circumference measurements in men were defined as between 37 and 40 inches for overweight and more than 40 inches for obese. In women these measurements were 31.5-34.5 inches for overweight and more than 34.5 cm for obese.

Obesity is increasing throughout the world and is now recognized as a major global public health concern.

"These findings underline the need for policies and activities to prevent overweight in the general population," Dis said in the study, which was published in the European Journal of Cardiovascular Prevention and Rehabilitation.

Thanksgiving’s Most Diet Damning Dishes

Everyone knows Thanksgiving can undo a diet. So how do you make sure there isn't more of you around the middle to be thankful for after the holiday?

One obvious possibility is exercise. Nutrition experts advise working out on the days before and after Thanksgiving, and, if possible, on the holiday itself. Taking a walk before or after dinner can help shed pounds. Maybe play a little touch football before sitting down to watch the game.

In my experience, Thanksgiving is absolutely the day where everybody should be exercising. Everyone should at least go for a big walk after Thanksgiving dinner. It's not optional on Thanksgiving!

On the food side, health-conscious hosts may avoid serving fatty dishes, but you can't control that if you're a guest at someone else's house.

You can take at least one step before the food arrives, when you are offered drinks: Get your enjoyment from the food and keep that alcohol to a minimum! Spend your calories on those dishes that you may not see again until next Thanksgiving.

Here are some specifics that we’ve learned over the years and want to pass on to you…

Turkey

The turkey is the centerpiece of the traditional Thanksgiving dinner, and while it certainly isn't the unhealthiest item on the menu, it does its fair share of damage to dieters.

While the first turkey decision many Thanksgiving diners face is white meat or dark meat, both can be part of a healthier meal.

First, let’s dispel a myth - It doesn’t make that much of a difference if you have light or dark meat. There's just a little bit more fat in dark meat. Some people avoid that and only eat white turkey meat, which I really don't understand. The difference is minimal, so people should select their meat based on taste. You should take off the skin, because the majority of fat is in the skin.

Preparation counts too, since adding butter or certain gravies to the turkey will raise its fat content, no matter what type of meat you're eating. Calorie-wise, most of the turkey meat is going to be lean enough that the concern shouldn't be there, it should be with the gravy that you might smother it with or the sides that are really packed with calories.

A serving of turkey is four ounces, so four to six ounces may be a wise limit, but turkey is probably not the biggest concern at the Thanksgiving table. I think it's better if you're indulging, even overindulging, to have a bit too much turkey than too much mashed potatoes or anything else.


Stuffing

Often going from the turkey's insides to ours, stuffing may be the number one culprit behind holiday weight gain.

Stuffing can be so unhealthy that Keith-Thomas Ayoob, an associate clinical professor of pediatrics at Albert Einstein College of Medicine, once devoted an entire magazine column to discussing its potential downsides.

"There's also no better name for this dish," he wrote. "First, it stuffs the bird, then it stuffs our bellies, then it stuffs our thighs. A culinary trifecta if there ever was one."


"Stuffing is often the most calorically expensive side dish you'd ever imagine," Ayoob wrote. He said fattier versions can contain up to 500 calories per serving.

He included a number of suggestions for a healthier stuffing, including leaving out the meat, using chicken stock (adding it slowly) instead of fat, putting small amounts of butter on the surface of the stuffing before cooking, using regular bread in place of corn bread, and adding vegetables like celery, onions, apples or pears to the dish.

Oh, and don’t actually stuff it into the turkey! It's leaner if cooked separately and it won’t be potentially loaded with Salmonella or other germs.

And one of his suggestions, for those who cannot do without stuffing and can't control how it's made, is to treat stuffing like dessert, since it has the calories of one.

"Save the best for last," wrote Ayoob. "Before you dive into that single portion of tasty but calorie-laden stuffing, hit the turkey breast and veggies first."


Potatoes

Whether sweet, mashed or baked, potatoes are a fixture at virtually every Thanksgiving dinner, but some varieties are far better for losing weight or keeping it off than others.

Remember, when you eat a potato, you're actually getting more sugar, more glucose, than if you ate table sugar.

The reason is that table sugar, or sucrose, is roughly half fructose and half glucose, while potatoes have a much higher concentration of glucose, which goes directly into the bloodstream when ingested.

Take it easy on the portions-- large amounts will increase blood sugar a lot. Don’t have a lot of potatoes!

When it comes to mashed potatoes, what I would suggest is to use the Yukon Gold potatoes and use fat-free buttermilk. They're very light and airy and offer fewer calories than traditional or instant potatoes.


Vegetables

Vegetables are always recommended as a healthy part of a balanced diet, but that doesn't mean that any dish with vegetables is a healthy one.

Dishes that include vegetables can also include heavy amounts of cream or butter for flavoring, adding copious amounts of fat to the vitamins and minerals. When one does that, either with canned soups or too much cream or butter, you're defeating the benefit that the vegetable has to your body.

Remember, a lot of our traditional vegitable recipes came about in the 1950s, 1940s, when we had a lot of canned food and didn't know what we know now about foods.

Vegetables can, of course, be part of the plan for a nutritional Thanksgiving meal, as can any healthy option you can make yourself.

In 2004, Molly Kimball, a sports and exercise nutritionist at the Ochsner Clinic Foundation in Harahan, La., recommended that if you want a diet-friendly Thanksgiving meal, you "offer to bring a healthy dish such as a salad or vegetable, so that you know you're guaranteed to have at least one healthy option available to you."

Diekman said that ideally, two thirds of the plate should be filled with vegetables and whole grains -- which can be provided by the stuffing if it is made right -- with the other third devoted to meats and sauces. Following that rule of thumb, she said, keeps the plate -- and, therefore, the meal -- balanced.


Cranberry Sauce

Cranberry sauce is another fixture on the Thanksgiving table, so it might be reassuring to know it has some health benefits.

The sauce, however, can be laden with too much sugar -- though cranberries do need some. Cranberries themselves are very tart; generally, you need some sugar in the cranberry sauce. I don't think that's so bad a thing, and you can always use a sugar substitute too.


Pumpkin Pie

Some of the desserts served on Thanksgiving can be found year-round, but pumpkin pie is a fall tradition.

Fortunately, it also presents less of a challenge nutrition-wise than other desserts.

If you love the pumpkin pie, either take a small wedge or consider just eating the filling. The crust is where you get a lot of your calories.

You could do far worse than pumpkin pie. In fact, back in 2006, it seemed almost as if the agriculture department had Thanksgiving in mind when it set its guidelines, since the pie falls in line so well with allowances for discretionary calories.


Desserts

Pumpkin pie may be the most recognizable Thanksgiving dessert, but people are forgiving when it comes to adding variety to the end of the meal.

Brownies and pecan and apple pies are also familiar Thanksgiving desserts, and most people can typically find room for dessert, even if their explanation of where they found that space doesn't mesh with medical science.

Unfortunately, not all desserts can be as calorie-friendly as pumpkin pie. Probably the biggest challenge for a most people is the dessert piece of the meal. For example, calories can't be avoided in pecan, cream and mince-meat pies by simply not eating the crust.

But rising to the challenge doesn't necessarily mean skipping dessert since, after all, it is Thanksgiving!

10 Tips for Beating Winter Weight Gain

While many of us welcome the winter chill, the change in seasons means more time indoors, more family gatherings and holiday parties, more temptations and less time for fitness.


Most of us gain at least a pound or so over the winter, but studies have shown that those who are overweight or have ever lost weight seem to be more vulnerable and may gain even more. Some weight fluctuations may be normal, but the pounds we gain during the colder months tend to linger long after we shed our layers and welcome warmer temperatures. This can set us up for a pattern of weight gain that eventually gets out of control, leading to obesity and other diet-related diseases.

Whether you’re overweight, at a normal weight or have recently lost weight, here are my favorite 10 simple ways to avoid winter weight gain.


Stock Up and Be Prepared

To help you resist the urge to order take-out or grab dinner from a drive-thru, make sure your refrigerator, freezer and pantry are well-stocked with a variety of healthful foods that make meal prep quick and easy. Stock up on fresh fruits such as Apples, grapefruit and oranges. Veggies such as broccoli, cauliflower, cabbage and artichokes are low in calories and high in water content, which help fill you up faster. On top of that, cauliflower, broccoli and cabbage are cruciferous veggies rich in substances that can help reduce risk of some cancers. Low-fat dairy foods like skim milk and cottage cheese deliver highly absorbable calcium and protein that can keep you satiated. Also, choose lean meats such as turkey or chicken breast, soy foods like tofu, hummus, and 100 percent fruit juices like orange, cranberry or grape.


Fill your freezer with whole grain waffles and whole wheat English muffins, frozen fruits and vegetables (made without added sugar or fats), lean meats (such as flank steak or sirloin) and fish (like salmon).


Keep your pantry shelves well-stocked with low-sodium or no-sodium canned foods, including broth- or vegetable-based soups, beans, tomatoes and tomato sauces; canned fish like salmon and tuna; nuts, seeds and nut butters; beans; and whole grain pasta, cereal and rice.


Eat Six Times a Day - That Means Snacks!

As I’ve always said, eating six times a day is a better way to loose fat, but during the winter months, when you’re more prone to colds and the flu, healthy snacks in-between meals may be even more important. More frequent eating not only helps keep your metabolism revved up, but also provides more opportunities to get key nutrients and antioxidants into your diet.


Keep your blood sugar steady with two protein- and fiber-rich snacks a day from the key food groups — which include fruits, vegetables, grains, meat and beans — and low-fat dairy foods. That helps satiate you and can provide satisfying, nutrient-dense alternatives to the cakes, cookies and other high-calorie, high-fat fare typical of the holiday season.


Also, try to stick to small amounts of healthful snacks from all the key food groups. Some examples include: cups of unsweetened applesauce, containing 60 calories or less; low-fat granola bars, containing 110 calories or less; a 1-ounce serving of roasted unsalted nuts and seeds (28 peanuts, 18 cashews, or 24 almonds); 1 tablespoon of cashew or almond butter; and whole-grain cereal with at least 4 grams of fiber per cup and no more than 8 grams of sugar.


When in Doubt, Keep Track

The mere act of logging your food and beverage intake can help you lose weight, studies have shown. When you find you’re indulging more than you expected, keeping tabs on everything you eat and drink and how much and your exercise regimen is a quick way to get back on a healthy eating track. Got a weakness for late afternoon cookies? Logging your intake can alert you to times of day or meals that are challenging.


Until recently, we written food journals, but now we recommend free online calorie tracking sites like www.sparkpeople.com - its much easier and much more accurate. Your iPhone or smartphone can also help. Apps such as “Lose it” can be a great way to track your daily intake.


A recent study in the Journal of the American Dietetic Association found that using on-line calorie tracking was more accurate in terms of food intake than writing it down. It means you’ll be more likely to succeed with weight and fitness management.


Don't Overindulge at Grandma’s (or Anywhere Else)


Just because you’re off from work or going home to family does not mean you should abandon all diet restraint. In fact, having consistent dietary patterns on weekdays, weekends, holidays and during vacations greatly predicts long-term weight loss maintenance, according to findings from the National Weight Control Registry (NWCR), the largest prospective investigation of long-term successful weight-loss maintenance.


What you put in your suitcase can help you maintain your diet and fitness routine too. Simply packing your sneakers and scoping out fitness facilities at your destination can go a long way towards helping you get out of an unhealthy travel mindset.


And don’t cop out if there’s not fitness equipment where you’re going. Exercises like jumping jacks or running in place that can be done anytime, anywhere. You can even prop a chair against the wall and create a perfect platform for squats, steps ups, dips and push-ups — no dumbbells required.


Don’t Overestimate Your Willpower

Confident you can resist all the holiday party and food temptations? You may be setting yourself up for trouble. Surprisingly, a recent study in Psychological Science found that those who felt most confident in their self-control were, in fact, most likely to give into temptation. In other words, those who feel most secure in their ability to resist temptations tend to expose themselves to more indulgent or undermining food situations that can get them into trouble, researchers suggest.


At home, only keep foods whose portions you can control. If there’s a particular treat you like, buy single-serve portions, or keep them behind closed doors on a high shelf or in an opaque container. The idea is to make those temptations hard to reach.


To help you fight splurging when you’re not hungry, chew sugar-free gum, suck on a strong mint, have a breath strip or brush and floss. Before a party or other event, dampen hunger ahead of time with a protein- and fiber-rich snack such as 2 tablespoons of nuts and an apple or a string cheese and about five whole grain crackers.


Move It and Lose It

The dramatic drop in physical activity is one of the biggest contributors to winter weight gain. Cold temperatures and shorter days, combined with family, work and other obligations, make it tough to fit exercise into your schedule. But, exercise offers a triple defense against winter weight gain: It burns calories, offers a temporary distraction from food, and boosts your mood, which strengthens your resolve to make smarter food choices.


Exercise also bolsters your immune system. While it may not specifically help you lose weight, exercise is effective at helping keep the pounds off. Exercise can also provide a defense against depression or seasonal affective disorder by lifting mood and self-esteem.


You don’t need formal exercise to burn at least a few calories: Playing catch or running around outdoors throwing snowballs or sledding with the kids helps. Winter sports like ice skating, ice hockey, or skiing are also stay-fit options. Or just take a brisk walk — the cold air can encourage you to move faster and burn more calories.


Of course, for many people, winter becomes a great time to begin a formal personal training program. Your inside where it’s always warm and dry, you’ve got to be accountable to someone who cares about your fitness goals, and you’ll have months before beach season to get in great shape. Why not get a head start on your new year’s resolution and start now?


Pick Your Poison…So to Speak

The Holidays can be a minefield for overeating, so plan your indulgences ahead of time. A typical adult requires about 2,000 calories a day to maintain a healthy body weight. The average woman requires even less, about 1,700 calories a day in our experience. Of those, only about 150 calories are allotted for discretionary or extra calories that can come from any foods, including those made with added fats or sugars.


Don’t waste calories on foods or beverages you don’t love just because they’re there. Choose how you’ll spend those extra calories wisely. You may want a glass of wine with dinner, some butter on your bread, or some fried appetizers or cookies at your next holiday party. Just make sure the rest of your daily calories are coming from low-fat, low-sugar selections from the basic food groups.


Eat on Time

Eating most of your calories late in the day or at night (as opposed to during the day) is a recipe for weight gain. That’s how Sumo wrestlers have been packing on pounds for over 1,000 years.


Mice who were fed a high-fat diet when they should have been sleeping showed a 48 percent weight gain over six weeks, compared with a gain of 28 percent in those fed a high-fat diet at normal eating times.


Although more human studies should be done, researchers speculate that when you eat plays a big role in the development of obesity. Instead of loading up on food once or twice a day, spreading it out evenly throughout the day when you’re most active allows your body to efficiently burn calories, prevents overeating, and keeps energy levels up.


Get Vitamin D

More time indoors and fewer daylight hours mean less exposure to the sun’s rays that help our bodies produce adequate amounts of vitamin D (specifically D3). Vitamin D is a fat-soluble vitamin that helps control levels of calcium and phosphorus in the blood to help the body build and maintain strong bones and teeth. It also increases the absorption of calcium and studies suggest that inadequate blood levels of vitamin D can contribute to the development of obesity.


Many people don’t even get 400 International Units (IUs) a day (the current daily value for vitamin D officially recommended by the U.S. government. In reality, many experts urge much more than that to protect against everything from osteoporosis, hypertension, cancer, and autoimmune diseases, it’s wise to up your consumption of vitamin D-rich foods and vitamin D3 supplements.


Good natural sources include fish such as sardines or tuna (canned in oil); skim milk; and fortified foods such as margarine and ready-to-eat cereal. If you eat few of these foods, or want more vitamin D than your diet can provide, discuss whether you should take supplements with your physician. A simple and inexpensive blood test can tell you definitively.


Step on It - The Scale I Mean

Most of the time, we don’t recommend getting on the scale too often, but this time of the year may be different! Weighing yourself frequently can help you avoid packing on the pounds and can be a good predictor of moderate weight loss, according to a recent review of 12 studies published in the International Journal of Behavioral Nutrition and Physical Activity. People who step on a scale regularly are also less likely to regain weight they’ve lost.


People in the National Weight Control Registry (NWCR) — the largest, long-term study of people who have lost at least 30 pounds and kept it off — weighed themselves frequently. When you weigh yourself regularly, you're more likely to notice a couple of extra pounds and can take the necessary steps to fight them. On the other hand, people who stepped on the scale less often were more likely to report greater weight gain.


Some experts argue that relying on the scale too much can result in diet sabotage — some people may react negatively to slight weight gain. However, a daily morning weigh-in (in the nude, before you’ve eaten), weekly use of a tape measure, or trying on a pair of your favorite skinny jeans can be a good way to help fight weight gain in the winter — or any season.


Good Luck, and Happy Holidays!

The Fat Tax Comes to North Carolina

North Carolina is poised to become only the second state (after Alabama) to impose a fat fee on its state employees by placing them in a more expensive health insurance plan if they're obese. I predict we won’t be the last, and I know that such plans for private business employers will soon be popping up everywhere.

Smokers will feel the drag of higher costs, too, as North Carolina state employees who use tobacco are slated to pay more for health insurance next year.

North Carolina officials, coping with a steady uptick in health-care costs for state employees each year, are aiming to improve state workers' health, which saves money in medical expenses.

"Tobacco use and poor nutrition and inactivity are the leading causes of preventable deaths in our state," said Anne Rogers, director of integrated health management with the N.C. State Employees Health Plan. "We need a healthy workforce in this state. We're trying to encourage individuals to adopt healthy lifestyles."

State workers who don't cut out the Marlboros and Big Macs will end up paying more for health care. Tobacco users get placed in a more expensive insurance plan starting in July of 2010 and, for those who qualify as obese, in July 2011.

Some state employees, though, are criticizing the planned changes. The State Employees Association of North Carolina opposes the tobacco and obesity differentials as invasive steps. "It's my understanding they're talking about testing [for tobacco use] in the workplace which, to me, would create a hostile environment," said Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury. "And it's an invasion of privacy. This is America, the land of the free. I don't think [body mass index is] a very good measure. I know some folks who would have a high body mass index because they're muscular." It’s interesting to note here that North Carolina will at the same time ban ALL smoking in prisons - even by inmates! I guess you’re out of luck Sarge.

The health plan covers more than 600,000 state employees, retirees and teachers at a total cost last year of $2.6 billion. Last spring, the legislature bailed out the plan with an infusion of $250million to pay the bills after rising costs and inaccurate projections left little money for claims. Over the next two years, the state general fund will pump about $408 million into the health plan.

Although officials have not yet estimated any potential savings from the obesity requirement, the higher costs for smokers could save $13million in the 2010-2011 budget year, Rogers said, emphasizing that the plan's priority is to improve health and save money in the process.

The idea of penalizing unhealthy lifestyles and rewarding healthy conduct is hardly new among insurance plans. Public health insurance plans in other states already penalize smokers or reward nonsmokers in insurance costs. South Carolina's state employees health plan is scheduled to add a $25-per-month surcharge on smokers in January. Elsewhere in the Southeast, Kentucky and Georgia impose surcharges, and Alabama gives nonsmokers a discount.

Weight checks

Alabama was out front on weight testing. Starting in January, state workers will have their blood pressure, cholesterol, glucose and body mass index checked by a nurse. If they're in a risk category, such as a body mass index of 35 or greater or a blood pressure of 160/100 or greater, they are charged an extra $25 per month on their insurance premium. If they go to a health screening, either offered by the state or by their personal physician, then the $25 is subtracted, according to Gary Matthews, chief operating officer for the Alabama State Employees Insurance Board.

North Carolina will allow state workers with a BMI of up to 40 to keep the discount, although some experts consider anyone with a BMI of 30 to be obese.

Private sector employers appear to have been targeting tobacco and weight in their insurance pricing ahead of state health plans.

Two risk factors

"We're beginning to see a lot of employers extremely interested in this," said Tim Smith, president of BioSignia, in Durham, which provides for private employers a system of measuring employees' risk factors for the onset of chronic disease. The company presents only aggregate data to the employers and does not disclose information about individuals, Smith said.

Tobacco and obesity are leading risk factors for ailments such as heart disease, stroke, type 2 diabetes and chronic breathing disorders. BioSignia is not under contract with the state health plan, but Smith said that employers like the state are trying to catch employees who are in pre-disease stages to save both lives and money.

Only a fraction of employers, though, offer financial incentives for healthy behavior or wellness programs, such as gym memberships or smoking cessation, according to a Kaiser Family Foundation study last year. Differences in employees' education, health literacy and access to basic health care could affect the usefulness of financial incentives in reducing health-care costs over time, the study said.

The results are not yet in. The higher costs for smokers and the obese don't appear to have been in place long enough for any state to boast of a healthier workforce yet, according to officials in several states.

Where is the data?

"I don't know that any states have a lot of hard data on this," Rogers said.

The policies have generated a backlash among at least a portion of state workers. Some workers are anxious about the idea of tests for smoking. The tests involve examining a saliva sample for cotinine, a derivative of nicotine found in the system of tobacco users. Health plan officials recognize those concerns and are getting ready to take bids from companies that will perform the tests. The state plan has not yet developed a procedure to monitor members for the obesity standard due to take effect in 2011.

"We're going to have to work out those logistics," Rogers said, “…but the plan is hear to stay.”

More Ways to Look Foolish While Trying to Look Good

Chances are someone you know has tried a weird weight loss product. From the 1990s' ThighMaster to the 1950s' vibrating belts, entrepreneurs have long known that the public is willing to look stupid if promised an easy way to lose weight.

Now, with 21st-century technology, people have only found more mesmerizing and ridiculous weight loss products.

Weird Weight Loss Product 1: The Hula Chair

Dance-exercise classes, such as Kukuwa dance, or Zumba, have gained traction in recent years. But one company hopes people who don't want to haul themselves down to the gym may want to sit in the Hawaii Chair for an exotic dance workout.

The Hawaii Chair, also popularly known as the hula chair, made its debut in comedy programs such as "The Ellen DeGeneres Show" in early 2008. DeGeneres tried to pour a drink of water and conduct an interview while using the Hawaii Chair on its highest setting.

A person has two choices once they're sitting on top of the patented 2,800 RPM Hula motor made by T&L Perfect USA. They can either be thrashed around in an amusement park ride fashion or attempt to keep their head straight while the chair swivels their hips about.

Dr. Steven Blair, a professor of exercise science at the University of South Carolina, admitted he hasn't tried the Hawaii Chair, but he had some doubts.

"Obviously, it is possible to sit in a recliner and scarcely move at all. It's also possible to sit in a regular office chair and twirl around and around and you'd be burning calories, too, for free," Blair said.

Blair thought the chair might burn more calories than lying down, but he wasn't quite impressed and pointed out there are cheaper ways to burn calories while working.

"Standing, you'd be burning even more calories, and standing on one leg, you'd be burning even more calories than before," he said.

Instead of buying specially designed chairs, Blair recommended going out for a walk.

Weird Weight Loss Product 2: Vibration Plates

This is my personal favorite and gets my award for "exercise product most likely to detach a retina." Don't be deceived by the static appearance of this most curious of fitness machines -- it moves enough to make most users nauseous in about 15 minutes..

The Power Plate is priced at $4,500 (or a mere $2,499 for home models) and its manufacturers assure customers that the platforms only look like they're stationary. In fact, the plates are vibrating millimeters in distance back and forth under your feet.

"A person can stand on it and do a simple squat and still get a benefit from the vibration," said Julie Devin, marketing coordinator for Power Plate. "But it's intended for people to do exercises on it."

Devin explained the vibrations force the body's muscles to contract in order to keep the person's balance -- adding another level of work in addition to the muscles required to do a pushup, squat or stretch on the machine.

Standing on a whole body vibration platform as a way to shorten workouts is a scam that has already spread through Europe and now is hitting California (much like the H1N1 flu).

But Blair, the exercise science professor from South Carolina, remains skeptical (he's more tactful than me).

"I don't demean sitting less and standing more," said Blair. "But you'd spend a lot more calories, I think, even going for a walk than by standing on the vibration platform."

You'd also be a lot less likely to throw up on the walk.

Weird Weight Loss Product 3: Thermal Suits

Here's a blast from the 70's past. For better or worse, the "Rocky" movies brought mainstream America boxing fitness "secrets" such as eating raw eggs or jogging up stairs decades ago.

However, it took much longer for the public to glom onto the vinyl suits used by boxers and wrestlers to lose weight.

Makes and models vary from flashy silver suits to more subdued colors, but the point of every suit is to lose weight quickly.

What the buyer may not understand, or care to understand, is that they're really losing water weight through sweat.

"But they've been used forever. A lot of wrestlers use them in order to make weight, and I think that's how it filtered down to where the general public has seen it in athletes," said Richard Davis, co-founder of GoFit, maker of the GoFit Thermal Training Suit.

The vinyl suits make for great insulation, and little evaporation, when worn. Exercise long enough in the suit, and one might take off several pounds in water sweat.

"The premise and purpose behind it is weight loss, and the primary weight loss a user would experience would be water weight loss," said Davis. "Then again, if you go back and drink some water, you may gain it back."

Now, I can see some use in the suits for warming up muscles in very limited circumstances. For example, a relief pitcher might sometimes wear these things if they're trying to warm up quickly. As for weight loss, it would all be water weight. Once you start drinking it would come back, and the suits certainly don't speed up losing body fat.

Overall though these things are actually DANGEROUS!

People have DIED from heat stroke wearing these things, and the suits are counterproductive during a strength training workout. You're going to have more difficulty regulating your body heat, you're going to get tired sooner, and you're not going to get as far.

Weird Weight Loss Product 4: The Tongue Patch

Some people still take the "no pain, no gain" slogan to the gym. But it takes a certain type of bravery to take the theory all the way into the doctor's chair as he stitches a prolene patch to your tongue.

Dr. Nikolas Chugay, a plastic surgeon in private practice in Beverly Hills, Calif., (of course) developed the tongue patch as a temporary way to lose "20 to 40 pounds."

"The tongue patch is a prolene mesh [the] size of [a] stamp," Chugay said. "All you need is about four stitches to attach it to the tongue."

The prolene patch makes it uncomfortable, if not painful, to chew solid food. Chugay has implanted the patch in more than 10 patients, and sells a liquid drink mix (just protein powder meal replacement, but at a really high price) to the dieters to ensure more calories are cut.

Chugay said his drink is "about 700 calories per day, so it's a low caloric intake. It has carbs, proteins, fat, vitamins and minerals.

"Some people still manage to eat solid foods even despite of the patch, but it's a good way of helping people not to cheat," he said.

After a month-long liquid diet, Chugay will snip off the patch, releasing his patients into the world of solid food again.

Of course, who's not going to loose weigh on only 700 calories a day? Dr. Blair thought the approach seemed short-sighted for a person's general health, or even as an attempt to lose weight and he's right.

"If you make it painful to eat, maybe people won't eat so much -- in the short-term," he said.

"But it won't work long-term, unless somewhere in this world there is a crazy person who would wear this for their whole life," Blair said.

If you're that person, please email me now.

Why Do We Eat So Much?

We all know we're supposed to eat healthy portions. So why is it that a rough day at the office or even just the smell of chocolate-chip cookies can cause us to throw our best intentions out the window?

Well, here's what we've observed over the years as to why so many of us overdo it -- and you can use this information to break the cycle and prevent an unwanted "pile-on of pounds".


YOU'RE NOT GETTING ENOUGH SLEEP

Missing out on your zzz's not only puts you in a mental fog, it also triggers a constellation of actual metabolic changes that may lead to weight gain. A lack of shut-eye harms your waistline because it affects two important hormones that control appetite and satiety--leptin and ghrelin--says Kristen L. Knutson, Ph.D., a research associate specializing in sleep and health at the University of Chicago's Department of Medicine.

According to a study published in the Annals of Internal Medicine, people who slept only four hours a night for two nights had an 18 percent decrease in leptin (a hormone that signals the brain that the body has had enough to eat) and a 28 percent increase in ghrelin (a hormone that triggers hunger), compared with those who got more rest. The result: Sleep-deprived study volunteers reported a 24 percent boost in appetite. Short sleep can also impair glucose metabolism and over time set the stage for type 2 diabetes, Knutson notes.

How to get control:

When we're exhausted, we hunger for just about everything in sight, especially if it's sugary or high in carbs. That may be because these foods give us both an energy boost and comfort (since lack of sleep is a stressor), Knutson says. To quell the urge for fattening foods and still get the energy kick you need, reach for a combination of complex carbs and protein.

"If you're feeling tired, you want carbs. But go for high-fiber carbs for long-lasting energy," says Keri Gans, R.D., a spokeswoman for the American Dietetic Association (ADA). "Fiber burns slower than simple sugars, and adding in some protein keeps you satisfied longer."

At breakfast, have whole-wheat toast with egg whites or a high-fiber cereal with fruit and a yogurt. And for a food-free way to perk up during the day, take a 10-minute walk outside. You also can prevent uncontrollable cravings in the first place by prioritizing a good night's sleep -- get seven to nine hours a night in a slumber-friendly bedroom (one that's as dark and quiet as possible and reserved for shut-eye and sex only).

A final tip: If you're plagued by sleep problems, ask your doctor for a referral to a sleep specialist.


YOU'RE SABOTAGED BY STRESS

Constant stress causes your body to pump out high doses of hormones, like cortisol, that over time can boost your appetite and lead you to overeat. "Cortisol and insulin shift our preferences toward comfort foods--high-fat, high-sugar, or high-salt foods," says Elissa Epel, Ph.D., an associate professor at the University of California, San Francisco (UCSF), Department of Psychiatry and a leader of the UCSF Center on Obesity Assessment, Study, and Treatment.

Fat cells also produce cortisol, so if you're overweight and stressed, you're getting a double-whammy in terms of exposure. Overweight women gained weight when faced with common stressors such as job demands, having a tough time paying bills, and family-relationship strains, according to a study published in the American Journal of Epidemiology.

Cortisol, together with insulin, also causes your body to store more visceral fat, which is a risk factor for heart attack and stroke, Epel notes. What's more, stress makes it harder to stick with a healthy eating plan. "It's a reason why people go off diets," notes Marci Gluck, Ph.D., a clinical research psychologist at the Obesity and Diabetes Clinical Research Section of the National Institutes of Health in Phoenix, Arizona. Folks who normally restrict their eating, tend to overeat in response to stress.

How to get control:

Sure, real-life pressures can put you in nonstop-nibble mode. But working stress-reduction techniques into your busy days can really help. Yoga, meditation, and deep-breathing exercises are powerful tools that keep tension in check. And spending 20 minutes doing progressive muscle relaxation--alternately tensing and relaxing muscle groups--significantly lessens stress, anxiety, and cortisol, according to a study published in the International Journal of Obesity and Related Metabolic Disorders.

Exercise will also do the trick. "Try dancing to your favorite tunes, running in place, playing a sport, or taking a simple walk," says Elisa Zied, R.D., an ADA spokeswoman and author of "Nutrition at Your Fingertips." When you're feeling edgy, make a habit of turning to these activities rather than diving into your candy stash. If you're feeling completely overwhelmed by stress, talk to a counselor who specializes in stress management.


YOU'VE GOT FATTY FOODS (LITERALLY) ON THE BRAIN

We're hardwired to hunger for fatty, sugary, salty foods because, back when our ancestors were foraging for every meal, palatable eats meant extra energy and a leg-up on survival, says Dr. David A. Kessler, former commissioner of the Food and Drug Administration (FDA) and author of "The End of Overeating: Taking Control of the Insatiable American Appetite."

So it's not just a lack of willpower that's tripping you up, but rather your outdated survival mode. In fact, when you eat fat-rich foods, your brain not only gets a signal that your body is satisfied but also forms long-term memories of the experience, according to new research published in the Proceedings of the National Academy of Sciences. What once helped early humans survive is now giving us ever-expanding waistlines.

Adding to the challenge to control overeating, the mere sight of food can cue up a craving. "[Cravings] are based on past learning and memories as well as the sight or smell of food, time of day, or location," Kessler says. "You'll walk down the street and start thinking about chocolate-covered pretzels because you've had them before on the same street."

How to get control:

Avoid eating your favorite treat if you're in a particular mood, if it's a certain time of day, or if you're in a specific place; this will prevent you from creating a triggering link between those feelings or locations and that treat, Kessler says. And since the smell and sight of fatty, sugary foods is pure temptation, try to keep yourself from passing the bakery or ice cream shop you can't resist.

Also, pay attention to what you're thinking when temptation strikes. "Once the brain is activated [by a craving], having that inner dialogue of, 'No, I shouldn't have that,' only increases the wanting," Kessler notes. Instead, focus on something you want more than that slice of cheesecake--from being healthier for your kids to feeling less winded when you walk to work--to help override the urge. If logic is out the window, indulge in healthier, high-protein versions of your favorites such as low-fat frozen yogurt with almonds when you crave a sundae or a fat-free protein shake when you need a chocolate fix.


YOU ATE IT ANYWAY, NOW WHAT?

Forgive yourself. "Having one overindulgent meal should not derail you from your healthful eating habits, while being too negative will make you more likely to throw up your hands in despair and overindulge at the next meal or several meals for days to come," Elisa Zied, R.D., says.

Give yourself a do-over. Blowing it at one meal or snack is not a convenient excuses to eat bad for the rest of the day and "start over tomorrow"!

• Immediately start over with lean protein, veggies, whole grains, and fruit, and drink plenty of water, Zied suggests.

• Learn from it. Think about what triggered your overindulgence--not to punish yourself, but to choose smarter next time. "If you keep a food journal, you might see you ended up pigging out because you waited too long to eat," Keri Gans, R.D., says.

• Add on exercise. To feel in control again, simply tack on a few extra minutes to your regular walk, gym routine, etc. At the same time, "try not to think of exercise as a punishment for overindulging," Zied says. If you do, you'll grow to dread the gym.