How to Lose Weight and Improve Health

Weight loss is always high on most people’s New Year’s resolution list. For something that is desired by so many of us, it is surprising how difficult it is to achieve and how controversial or ineffective the proposed methods are. Half of all Americans ages 20 and over say they've attempted to lose weight in the past year.  Exercising more and eating less are the two top strategies people use to try to lose weight. Yet so often we fail.

Our focus needs to shift to healthy living as opposed to weight loss alone. No single diet can be recommended for everyone, because – and you knew this already – what works for one person may not work for another.  Of all the individual diet programs out there, Weight Watchers (now called WW, to move the emphasis away from weight loss) seems to be more effective than others, at least according to US News & World Reports.  Noom is a more recent (and expensive) addition to the behavioral change and app-integrated weight loss arena. What these programs recognize is that weight loss is more than just counting calories (or, as is the case in the WW system, points). Weight loss requires behavioral change, community, and a lifestyle of eating healthier and moving more.

Though we don’t know enough about the genetics involved in weight loss and weight gain, the observation that some people have to work harder than others to stay thin or lose weight appears to be supported by scientific data. Apart from genetics, some people’s intestines are 50% longer than others. (Shorter guts absorb fewer calories.) Differences in gut microbiomes can alter how people process food.  Cooking increases digestion of food and absorption of calories.

All of this means that just counting calories is not the answer to weight loss. The old adage calories in, calories out is simply false. That’s because a calorie is not a calorie. If that were the case, a diet of donuts alone would be fine. But it turns out the rate your body absorbs calories may be as important as the amount of calories you take in. In other words, that sugary donut hits our bloodstream far faster than calories from more complex carbohydrates or from fat and protein.  And, those quickly absorbed sugars are far more likely to create body fat – and make you paradoxically hungrier in the process.

For years, the culprit of the obesity epidemic was thought to be dietary fat. Low-fat, high-carb diets were all the rage. Only recently has it come to light that sugar companies secretly funded studies designed to blame fat for making us fat. But low-fat, high-carb diets didn’t work; we kept getting fatter. For an entire polemic on the subject, check out The Case Against Sugar by Gary Taubes. It is enough to scare anyone off sugar. That is not to say that we know for certain the extent to which sugar is responsible for the obesity epidemic. Gina Kolata, writing in the New York Times, notes that a number of societal factors may have contributed to the obesity epidemic, from growing portion sizes, the popularity of restaurants and fast food, snacking, the cultural acceptance of obesity, and even the decline in smoking.  The science is not settled.

That’s not to say that you shouldn’t watch what you eat. Keeping a food diary can help you understand what and how much you are eating and the types of calories you are consuming. A study of nearly 1,700 participants showed the best predictors of weight loss were how frequently food diaries were kept and how many support sessions the participants attended. Those who kept daily food records lost twice as much weight as those who kept no records.  I wrote about my so-called Bar Code Diet many years ago and that if I couldn't scan it or enter it into my phone, I didn't put it in my mouth.  That – along with regular exercise with a group of friends, who kept me accountable – did help me lose weight and keep it off.

What can you do realistically on your own and without added expense?

1. Keep a food diary. You may not be aware of just what you consume in a given day. For the technologically savvy, phone apps like MyFitnessPal and Lose It! can be helpful. Remember, some days you may have more success than others. Just keep going.
2. Avoid high fructose corn syrup and sugary drinks, and cut your daily sugar intake significantly.  Having an occasional celebratory dessert is fine. But make it a rare and portion-controlled treat, if for no other reason than sugary foods are seductive and lead to overeating.
3. Focus on overall healthy behaviors, eating fewer processed foods, and increasing physical activity as opposed to weight loss per se. That includes avoiding smoking and excess alcohol intake as well as taking advantage of a host of other preventive, screening, and early detection programs. Weight is just a number; health is a lifestyle.
4. Be a part of a community or small group. Accountability – both for diet and exercise – is a great motivator and reinforcer. Fat shaming doesn’t work; encouragement and support does.

Emphasizing physical activity and healthy behaviors at all ages is key to reducing morbidity and improving health outcomes in communities. Far from ignoring obesity, when we emphasize a lifestyle that includes awareness and adjustment of eating habits and sets exercise goals (such as increasing walking speed, strength gains, etc.), our overall health – and the health of our community – will improve. And you know what? We will lose weight along the way.

Moving the Needle on Health in Angelina County

Back in January, I wrote about the abysmal county health rankings in Deep East Texas and the fact that Angelina County has been named the county with the highest obesity rate in Texas. Almost four out of ten of us aren't merely overweight, we are downright obese. Let’s just admit it; we’re fat. And that fatness is a major factor in the development of high blood pressure, diabetes, heart disease, and many cancers, among other illnesses. 

Obesity is a two-edged sword that is both killing us early and costing us a lot in terms of ongoing healthcare expenditures and lost productivity. Smoking is, of course, another huge factor in our high cost of healthcare and poorer health outcomes. We must do better.

The rhetoric on the national stage is all about the skyrocketing cost of health insurance and how to tweak (or get rid of) Obamacare, as if that would solve our healthcare problems. The government can’t do it for us, folks. Regardless of what happens with healthcare reform, we need to collectively get off our fat behinds and take more responsibility for our own health. We need to do this individually, yes, but we also need to work on this as a community.

I mentioned in January the groundwork being laid by the Texas Forest Country Partnership. They hosted a series of strategic planning sessions to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Part of their healthcare recommendation was to raise our county health rankings in the region.

Since then, the $1 billion Episcopal Health Foundation, whose goal is to improve the health of the 10 million people living throughout the 57-county region served by the Episcopal Diocese of Texas, hosted a community meeting in Nacogdoches specifically to deepen their relationship with organizations working to improve community health in this area. Other foundations have expressed a similar interest.

But let’s be very clear: no foundation or partnership is going to do the work for us. We all have to be involved. The amazing thing about Angelina County is the number of resources we already have, along with the incredible people behind them! These resources need to intentionally focus on both individual and community health and work in a coordinated effort to put the pieces of our health puzzle together.

Hospitals must strengthen community outreach, especially with diabetes, heart disease, stroke, and cancer education. Physicians must expand care for the indigent in our communities. It is our duty. The Angelina County & Cities Health District deserves our full support for the incredible care they already provide, but they can and must do more. That requires funding, whether from grant support, state government, or from within Angelina County. Their primary care outreach is crucial to the health of our county.

Organizations like the American Cancer Society, The Coalition, ADAC, and the Burke Center must expand outreach and education about healthy lifestyles and disease prevention, cancer screening, smoking cessation, and immunizations. Women’s Special Services at CHI St. Luke’s Health Memorial will continue to apply for grants for low income women to get breast and cervical cancer screening. 

Lufkin went smoke free years ago and is better off for it. What about other cities? Diboll? Angelina County? Texas? Our state legislators need to use that proposed bathroom bill as toilet paper and instead pass smoke free legislation, which we know will both improve the health of our communities and save taxpayer dollars.

Chamber businesses need to provide or strengthen wellness programs for their employees, encouraging healthier lifestyles, diet, exercise, and smoking cessation. Maybe if people had to climb two flights of stairs to buy their cigarettes rather than drive through a barn or stop at a convenience store, fewer people would smoke. And they’d lose weight while they were at it! Is it just as easy for us to shop for healthy foods as it is tobacco and junk food? How do we encourage and facilitate healthy eating?

Our educational institutions from elementary school through college should have comprehensive, intentional programs to promote health and exercise. It is discouraging when I see employees at both our local hospitals riding the elevator to go up one floor when taking the stairs is much more beneficial.

Active events like the Neches River Rendezvous, Pineywoods Purgatory and Relay for Life are fantastic. What other events can we organize that will involve an even larger and broader swath of people year round? Find a reason to get outside. Participate in a fun run, even if you simply walk a mile or two. A stroll around the zoo can be good exercise and lots of fun. Or, spend an hour or two hiking the trails at Kit McConnico Park. It’ll do your heart and soul good! 

City sidewalks have been a great addition in recent years. Use them! Our Parks and Recreation Department has a website with programs and classes as well. Do we have a master plan for parks and recreation activities? If not, maybe we should.

I have a dream of a coordinated community effort where healthy living concepts infuse everything we do. Will Angelina County catch the vision to join in this effort? Lifestyle changes are hard. Nothing happens overnight. Changes in community health are measured over years - decades, even. We cannot get discouraged. Slow, meaningful progress over time will make a difference.

One early step coming up is the Texas Forest Country Partnership Economic Summit November 7-8, 2017 at the Pitser Garrison Convention Center. Included in that Summit will be a Rural Healthcare Symposium. Though it will address more than just Angelina County healthcare, it will be an important venue to discuss and brainstorm together. The Texas Forest Country Partnership should continue to take the lead in bringing groups together, applying for and administering grants, and monitoring progress and effectiveness.

As we plan for a healthy new direction in Angelina County, I encourage everyone to get involved. Be prepared to work! Come up with concrete ideas that you (or your business or organization) are willing to implement. Where philanthropic support is necessary, we will approach local, regional, and national foundations for assistance.

We must become the change we want to see and move the needle on health in Angelina County out of the red zone and into the green. Who’s with me?

Resolve to Improve the Health of our Region

January is a time of resolution, and often our New Year resolutions focus on diet and exercise. My friends, we need a city, county, and region resolution to lose weight!

In July, 2016, Sabrina Perry wrote an article for HealthGrove.com – a health data analysis and visualization site – titled, The County with the Highest Obesity Rate in Every State. She repeated the American Medical Association’s contention that obesity is a disease and noted that the World Health Organization considers obesity a global epidemic. I perused the article with interest, looking for the county in Texas that got the dubious honor of being the fattest. Unfortunately, it was our very own Angelina County.

Look around and it is evident. Angelina County has the highest obesity rate in Texas, coming in at 37.5%. That means nearly 4 out of 10 of us aren’t just overweight; we are downright fat. To achieve the dubious distinction of being fat, you have to get to a body mass index (BMI) of over 30. To give you an idea what it takes to qualify as obese, consider a 5’11” male such as myself. My appropriate weight is less than 180 pounds (and probably more like 160 pounds). Any more than that and I am considered overweight. But to be considered obese – which is what 37.5% of Angelina County residents are – I would need to weigh 215 pounds or more. For me, that would be at least 35 pounds overweight, if not more. I routinely see patients with a BMI of 40 or more, which is considered extreme (or morbid) obesity. That would be a whopping 100 pounds overweight for me.

What can we do?

Dan Buettner, author and founder of bluezones.com, has been writing for years about particular geographic pockets around the world where people live longer. According to the website, “Residents of the Blue Zones live in very different parts of the world. Yet they have nine commonalities that lead to longer, healthier, happier lives.” So much of this is what has been preached to us for decades: don’t smoke, eat your vegetables and legumes, exercise, don’t overeat, and drink wine in moderation. On top of this are stress-related factors, having strong family and friend relationships, and spirituality.

It’s not just that we are obese. Our overall health is terrible. The Robert Wood Johnson Foundation ranks population health by county. In Texas, many of the lowest ranked counties are in deep East Texas. Wouldn’t it be great if Lufkin could be known not just for pump jacks and forests, but also for the health of our citizens? This can only work for communities if each of us individually works at it. We have family, friends, and lots of churches. Strengthen those relationships. And, let’s stop smoking, exercise, and eat right!

I recently participated in a set of strategic planning sessions hosted by the Texas Forest Country Partnership called Stronger Economies Together, or SET. The purpose was to set goals for growth across a broad spectrum of our regional economy, from forestry and tourism to manufacturing and healthcare. Our SET healthcare workgroup noted that we have significant work to do if we are going to impact the poor healthcare factors and outcomes the Robert Wood Johnson Foundation identified in the deep East Texas region. We set an ambitious goal simply to raise our overall health ranking from the lowest 20% to the next lowest; in other words, from poor to still below average. But we have to start somewhere.

This will require a multi-year effort working with all aspects of the healthcare and social service community to start to move the dial toward a healthier region. We can do it, but we all need to make – and keep – that that resolution for better health!