Healthy Weight Maintenance

By Keehn Hosier, MD

Somewhat lost in all of the furor over the recent Supreme Court ruling on health care legislation is one simple fact: we can dramatically reduce health care costs if more Americans attain a healthy weight.  But attaining such a goal has been more easily discussed than accomplished, often due to poor understanding of what actually constitutes a healthy diet and exercise regime.  Fortunately, with the proliferation of smart phones, we have educational tools at our disposal that make life much easier when we are trying to help patients (and ourselves!) reach our weight goals.

One of the critical components for anyone trying to reach a healthy weight is an understanding of how many calories are needed vs. how many are actually consumed.  Physicians have often advocated keeping food journals as a means of maintaining accountability, but there are several outstanding applications that make this chore easier.  Two that I have found work well are mynetdiary and myfitnesspal.  Both of these smart phone food journals will calculate the necessary daily caloric intake necessary to reach a desired weight.  Many foods are pre-loaded in the journals so that patients can simply type in something like “grilled chicken, 4 oz, hamburger bun, 14 oz sweet tea” and have an instant reading of how many calories may be consumed the rest of the day.  These applications will also calculate break down food into component parts: fat, protein, carbohydrate, cholesterol and sodium amounts.  These tools are very useful for helping patients maintain cardiac or diabetic diets.  As an added bonus, patients can also see how exercise affects net daily calories.  This often inspires people to exercise just a bit harder or longer to help accomplish their goals.  One trick that I have found useful is to slightly underestimate caloric expenditure, i.e. record 25 minutes of exercise rather than the actual 30 minutes that was performed, and slightly overestimate caloric intake, i.e when in doubt if that piece of chicken is 4 or 5 oz, record the higher value.  This gives the user a margin for error that helps reduce plateaus.  Both of these applications are available on both Apple and Droid platforms. 

Strength training is an often underappreciated component of healthy weight maintenance.  However many people approach strength training with trepidation, either out of fear of looking out of place in a gym or out of concerns about injury.  As a result, I frequently advocated short term personal training packages for those patients completely naïve to strength training.  A new application, Jefit, serves as a portable personal trainer.  Jefit is by far the best weight training tool I have encountered.  For each body part, there is a lengthy list of exercises that a person can try; some of the exercises require nothing more than body weight, a small hand weight, or a resistance band.  As a result, people can perform these exercises at home, eliminating the “I don’t have time to go to the gym” excuse.  Each exercise has a cartoon illustrating proper form with written instructions to prevent injury below each animation.  Users can construct their own workout routines or they can enroll, without cost or obligation, on the jefit.com website where there are user and trainer submitted routines that anyone can copy.  The days of pen and paper charting a workout routine are over, as the application keeps track of your workouts, your performance improvement, and your theoretical one rep maximum weight for each exercise. 

Anyone who has watched The Biggest Loser is familiar with the ubiquitous BodyBugg that the contestants wear.  The BodyBugg is a fairly complicated device worn on the upper arm that measures daily caloric expenditure.  There is an internal accelerometer, a skin conductivity sensor, as well as heat sensors, all of which combine to provide a fairly accurate measurement of a person’s basal metabolic rate and exercise expenditure.  I have found this device to be useful for people who grossly overestimate their daily activities then wonder why they can’t lose weight.  The BodyBugg is not for the timid or for those who are pinching pennies.  As a result, I more frequently recommend pedometers to keep track of daily walking.  These simple devices easily attach to any lace up shoe and generally come with rough formulas to help people estimate caloric expenditure. 

Perhaps the biggest benefit the new technological tools offer is the pure accountability that keeping track of the numbers provides.  When caloric intake visibly exceeds expenditure, it forces the honest user to make healthy lifestyle changes.  That, after all, is our ultimate goal.