Monday, July 26, 2010

Your brain on drugs. Errr. I meant food.

As referenced in an earlier post, I had the opportunity to attend the recent International Congress on Obesity in Stockholm, Sweden a couple of weeks ago.  There was some research shown that demonstrates what our brains looks like when we're hungry.  It's a fascinating new angle on understanding obesity that uses the technology of functional Magnetic Resonance Imaging (fMRI's).  Said differently:  brain scans with cool colors that show neural activity as it is actually happening.

Researchers have used this technology to attempt to better understand the parts of the brains that get activated by different systems and pathways.  Some researchers now theorize that there are two pathways that show how brain activity relates to feelings of hunger:

  1. Homeostatic:  this is basically the control mechanism our bodies use to manage our energy balance. They largely rely on hormones to either stimulate or suppress hunger depending on whether we have excess energy stores (i.e., have eaten enough).  Leptin levels are elevated to suppress hunger while grehlin levels are elevated when we need food.  Said differently, this system was designed to help us figure out when we need food or not.  It is not to say that the system works perfectly in guiding people to their swimsuit-fantasy selves, but it generally works on some level.  
  2. Hedonic:  appropriately named, the hedonic system is theorized to stimulate people to consume "highly palatable" foods (and drugs) through dopamine release through something called the mesolimbic dopamine pathway.  Basically, when you see a picture of chocolate cake your brain goes fuzzy.  And you eat.  Or you really want to eat.  Badly.  
Recently, there has been research done that demonstrates that the hedonic system goes into overdrive for people who struggle with their weight vs. people who don't.  Apparently, those of us who are challenged with excessive food intake (like me) have brains that light up like a Christmas tree when we see something yummy.  Apparently, the naturally thin do not have this neural-fireworks display to nearly the same degree.  

Interesting, there has also been research that seems to indicate that those who have lost weight and kept it off have a different part of our brains that also lights up when we see something yummy.  It is basically, the part of the brain (the dorsal lateral prefrontal cortex in case you were wondering) that helps us regulate against our impulsive behaviors.  A friend of mine asked me if such a part of the brain could be implanted or purchased.  Presuming that medical technology for this kind of quick fix does not yet exist, it sounds like the way to get this part of the brain activated may be more like developing a new muscle, presumably through practice and training.  

So what's my professional take on all of the above?  fMRI is a hot new area in obesity research that holds a lot of interesting long term promise.  It's still new technology (as it relates to obesity), and the brain is a complicated piece of equipment.  As a result, curiosity into these studies is definitely warranted, but a wait-and-see scientific patience is as well.  It's very new stuff.  

So what's my personal take on all of the above?  I totally relate to these theories.  My brain totally gets fuzzy when I see my favorite trigger foods.  I cannot look at a muffin without my heart skipping a beat and my head getting a weird buzzing sensation.  To be clear, I haven't had a muffin in years, and I still have a frenzied response when I see one.  

At the same time, I seem to have gotten pretty adept at not eating said muffin.  Therefore, it's possible that my self-restraint brain biceps have gotten at least a little bit toned.  That said, if I were locked in a closet with a blueberry muffin for a day, I would surely eat it.  So I cannot rely on my restraint muscle completely.  I also need to keep myself out of harms way by avoiding being around those foods that make my brain-heart go pitter-pat.  

It's all common sense stuff, but it's interesting to see how it's correlated to neuroscience.  Does that mean it's not brain surgery?  Let's hope surgery isn't required.  

How do  you manage your own dopamine pathways to keep yourself from spiraling into a food frenzy?



Monday, July 19, 2010

My doctor, my weight and cool stuff from Sweden

As noted in my last post, I was a crazy traveling person last week, including a day spent in Stockholm, Sweden at the International Congress on Obesity (ICO).  It was a big day for Weight Watchers for reasons that I will get to in a little bit.

Before, I talk about Sweden, I wanted to share my own personal experience with my doctor as it relates to my weight.  The year was 1998, and I was getting my first physical in many years.  At the time of said physical, I weighed about 40 pounds more than I do now, and I had both high cholesterol (the bad kind) and high blood pressure.  It was in that visit that my doctor told me that it was time to lose weight and get my lifestyle together, or I would be looking at a lifetime of medication.  Suffice to say, it was an alarming conversation for me and was a clear wake-up call.  I have to say that if there was one single event that pushed me to get my physical life together, it was this conversation with my doctor.

If there was one issue with that conversation with my doctor, it was simply that I did not know what to do next.  She gave me a target number of calories to consume each day, and sent me on my way.  To be clear, my doctor is pretty amazing, and I trust her implicitly.  She is an incredibly committed physician, and I don't blame her for not giving me more specific advice.  The reality of her world does not easily afford the opportunity to provide nutrition counseling for her myriad of patients.  Further, it's not obvious that this kind of weekly counseling would be the best use of her (or her nurse's) time.  What she did provide was a much needed push.  What she also provided was a reason for me to come back with better numbers:  my next physical.  In other words, my doctor played a critical role in my weight loss process in creating a sense or urgency and a sense of accountability to lose the weight.

The "doing" part of losing weight did not happen until I joined Weight Watchers as employee and member.  The week-in and week-out of participating in the program, keeping track of my points, attending my meetings and measuring my progress (or not) on the scale was what generated the actual results.  This is the Weight Watchers zone of excellence, and it delivered for me big time.

For me, the combination of my doctor and Weight Watchers is ultimately what made the difference.

So what does this have to do with Stockholm, Sweden?  For the past couple of years, a team of highly regarded academics in the UK, Germany and Australia have been working on a multi-country, large scale (n = 772) randomized clinical trial (RCT) efficacy study.  Here is how the study worked:

  • Doctor sees patient who is overweight and talks to the patient about the importance of losing weight.
  • Doctor randomly assigns patient either to 1) the "standard care" that ideally they would normally provide or 2) Weight Watchers.  In this case, "standard care" is defined by government public health guidelines that typically include having a nurse or nurse practitioner teach the patient how to follow a healthy diet and then have follow-up coaching visits.  Sadly, "standard care" does not always happen, often due to time pressures faced by over-burdened doctors' offices.  
  • The study was done over a 12 month period
The results?  Those who were assigned to Weight Watchers lost twice as much weight as those assigned to standard care through the doctor's office.  Further, of the 56% of those completing the trial (a really good result, by the way) in the Weight Watchers arm, 60% lost 5% or 10% or more.  A 5% weight loss is the point where medical benefits begin to evidence themselves, so this is a big deal.  That compared very favorably to 33% on the doctor standard care arm, again a 2X improvement.  To be clear, this does not mean that those who completed the Weight Watchers arm were actively doing the program each week for 12 months.  It merely meant that they showed up for the last weigh-in of the research project.  

Does this mean that Weight Watchers some how does a better job than doctors in treating patients?  Of course not.  What it does mean is that Weight Watchers has a structure in place that makes providing weekly support, education and weigh-in's very straight forward and easy to facilitate.  Further, Weight Watchers has meetings literally everywhere in each of its markets making it pretty convenient for the vast majority of doctors' patients.  What this study conclusively showed is that the combination of doctor and Weight Watchers is a winning one in creating weight loss that is significant from a health perspective.  The clear implication of this is that there is a valuable partnership to be formed between doctors and Weight Watchers.  

It worked for me, and the study showed that it can work for most others.  

What role (if any) has your doctor played in your weight loss process?  



Thursday, July 15, 2010

Happy, so very happy (for the little things)

We were able to retrieve my original URL.  No more picture of the weird body builder guy and all the random links.  That is good.


Sunday, July 11, 2010

Planes, trains and automobiles. Getting a plan for a whacky travel week.

(me in about 6 hours -- hoping for a volcano free ocean hop)

I've got a crazy week in front of me (as of right this minute on Sunday morning).  I'm getting in a car and heading off to the airport at 2 PM, and I've got a 5:30 flight to Stockholm, Sweden.  The lineup this week is fairly harried:

  • Fly out tonight and get into Stockholm at 7:30 AM
  • Spend Monday at International Obesity Conference (ICO).  Give speech.
  • Fly out Monday night at 9 PM to London
  • Spend Tuesday in London doing media interviews about some amazing research we are presenting this week
  • Fly out Tuesday night to Boston
  • Take a morning train on Wednesday to spend the day with our team in Providence, RI.  Give a town hall meeting with local staff.
  • Take train back to NY area Wednesday night
Not looking for sympathy on this craziness as I love everything I am participating in over these three break-neck days.  However, from a healthy life perspective, I am going to have to manage a few challenges:
  1. No sleep.  5:30 PM red-eye flights to Europe are just flat out harsh.  I'm not expecting to get much more than 3 hours sleep tonight.  I will be running around pretty furiously on Monday, so that should help me from sudden narcoleptic fits.  However, no sleep = mindless eating risk zone.  
  2. Airplane travel.  I've talked about this one a thousand and twelve times, yet I still have fairly atrocious eating habits on planes.  
  3. No workout on Monday.  Horrors!!!!  What if my limbs fall off from lack of use?
So what's an overwrought, type-A guy to do?  Have an awesome plan!  
  • Airplane strategy:  choose the fish-like choice on the flight service.  Don't eat junk in the airport while waiting for the plane.  Skip desert and/or ask for the fruit instead.  No nuts!!!!
  • Train strategy:  see airplane strategy.  In fact, one-up the airplane strategy by skipping the food all together.  I get into NY around 7 PM, so I should be able to hold off until I get a normal meal at home.  Just because they offer the cup-O-nuts doesn't mean I have to take one (or two).  
  • Workout strategy:  my hotel in London's got a good gym.  Further, I'm staying at a hotel in Boston which has a local Equinox gym within walking distance.  That means I get two solid workouts in on Tuesday and Wednesday.  Go me!  
  • Stay busy:  the more I an running around, the better I eat.  Kind of paradoxical somehow, but it's true.  
As I have noted before, summer is a perilous eating time for me, and so is travel.  But neither has to be.  What if this time could be replete with healthy food and abundant exercise that made me feel healthy, happy and well?  It's a positive thought that I will do my noble best to keep in a non-perishable place over the coming week.  

On a side note, I'm listening to my 12 year-old daughter loudly singing with Rick Springfield to Jesse's Girl.  That makes me smile and think even more positive thoughts!  



Monday, July 5, 2010

Heart rate shopping: my Lifecycle, spinning class, road bike show down.

2009 and 2010 have been the years in which I have finally embraced cardiovascular exercise.  I've been good about hitting the weights for the better part of the past 10 years (since I joined WW).  Further, I'm a fairly prolific walker, so I have been able to secure my move-around exercise that way.  However, I could never seem to force myself to really embrace the art of raising my heart rate (except during frightening movies).  I always felt that it was a missing piece of the exercise version of myself that I wanted to be.

Sometime around late 2008 and early 2009, I rediscovered my mild romance with two wheeled exercise devices, otherwise known as bikes.  I had purchased a nice road bike in the summer of 2007, but I am guessing that I took it out a grand total of three times (maybe) that summer.  

About 18 months later, I started to see the light.  I began to partake in periodic spin classes and occasional solo trips on the Lifecycle.  Last summer, I started to take my bike out in earnest, and I discovered that I really enjoyed the whole being-outside-and-get-a-workout thing.  I'm now good for some sort of meaningful cardio exercise about five times per week.

All of my cardio consists of some variant of a bike:  1) Lifecycle, 2) spinning class or 3) road bike.  While I get something out of all three, I have always suspected that they were not created equally in terms of work expenditure.  I get a good sweat with all three, but I think I always knew that the Lifecycle was not nearly as demanding as the spinning class or the road bike.

About two weeks ago, I finally buckled and bought a Garmin heart rate monitor (FR60 for those who are shopping -- I like it!).  There is nothing like data to get a view into the truth of your life.  It can be in the form of counting POINTS or it can be in tracking your heart rate.  What I found with my new fangled HRM was not surprising, but it was still eye opening.

First, a quick review of my heart rate basics, based on my age according to CDC physical activity guidelines:

  • Moderate intensity activity = 88.5 bpm (50% of max) to 124 bpm (70% of max)
  • Vigorous intensity activity = 125 bpm (71% of max) to 150 bpm (85% of max)
Vigorous activity roughly corresponds to what is referred to as the aerobic zone (70% max to 80% max) while anything north of that would be in the anaerobic zone.  

OK, so without further adieu, here is what I discovered:
  • Lifecycle:  45 minutes at an average of 137 bpm and a maximum of 159 bpm.  This works out to an average of 77% of my age-adjusted max heart rate (MHR)
  • Road bike:  73 minutes at an average of 144 bpm and a maximum of 164 bpm.  The average was 81% of my MHR.  
  • Spinning class:  50 minutes at an average of 150 bpm and a maximum of 171 bpm.  This is an average of 85% of my MHR.  
So what are my conclusions:
  1. Value accepting punishment from a teacher:  The effect of having my good friend Emma (the spinning instructor from the depths of Hades) hammering on me works out to about a 9% increase in average heart rate vs. the Lifecycle.  Further she was able to push me way into my anaerobic zone for extended periods of time.  
  2. Duration counts:  The road bike trip was the calorie consuming winner.  I put in 62% more minutes on my bike than I did on the Lifecycle, yet my average heart rate was still 5% higher.  
  3. Time to man-up on the stationary bike:  I clearly need to up the average resistance on the Lifecycle.  Points #1 and #2 demonstrate that I can clearly push myself harder.  
My other conclusions are that:
  1. I am truly a geek for spending this much time analyzing all of this stuff.    
  2. The old adage of What Gets Measured Gets Done is true.  Having the heart rate monitor is giving me useful information that will be hugely helpful in taking my exercise to the next level.  Which is good.    
Any thoughts or tips on how you use heart rate monitors for the benefit an HRM newbie like myself would be great!