Browncast Episode 28: Obesity, Lifestyle, Fat and more..

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In this episode Razib and Omar move away from politics and culture to talk about the science (and non-science) of nutrition, lifestyle, obesity and fatness, especially as it relates to South Asians.  As some readers may know, I am an endocrinologist with a research interest in obesity and insulin resistance and Razib is a geneticist with a personal interest in health, nutrition and lifestyle, so I hope listeners will find it useful. Comments welcome.

PS: a couple of people have asked what my recommendations are for treating obesity. I hope to do a longer post some day, but here is the brief outline of what I advise my (pediatric) patients:

-Increased physical activity (1 hour of moderate to vigorous daily activity that gets your heart rate up; minimum of 30 minutes per day). This can be as simple as taking a brisk walk or using a treadmill or going up and down the stairs or dancing in front of a video or playing activity games on a game console.
-Try to adopt a lifestyle in which most meals are home-cooked and consist primarily of fresh ingredients rather than processed foods. Try to limit overall caloric intake and I especially recommend limiting the intake of carbs (smaller helpings of pasta, rice, bread, potatoes, more of fresh veggies and meats that are not heavily breaded or fried; for significantly obese patients I recommend limiting carbs to 2 servings per meal (30 grams of carbs) and no carbs in snacks). That said, each person can find a lower calorie, lower sugar diet that they are most comfortable with. As long as it is helping them lose weight, it’s good.
-Eat fruit rather than drink fruit juice. Increase your intake of fresh vegetables and eat whole grains rather than highly refined ones. This may not have much impact on weight per se, but will improve cholesterol, cure constipation and may have other health benefits.
-Avoid all chips, Cheetos and other high-calorie snacks. Stop buying these snacks, stop eating them except on rare occasions. 
-Limit foods made with added sugar (cookies, brownies, donuts, cakes, pastries, candy, etc.) to small helpings on special occasions. Limit fast food intake to occasional outings.
-Stop the regular use of soda, gatorade, powerade, iced tea and juice, try to drink more water at meals.
-Avoid all foods that contain trans fats (read labels).
-Most studies indicate that dairy is good for you and drinking 1-2 cups of milk daily is strongly recommended for all children and adolescents. Yogurt is good for you, and cheese (in moderation) is also beneficial rather than harmful. There is evidence that whole fat dairy products may be healthier than low-fat alternatives for most people.
-Nuts, avocados and lentils appear to be healthier than equivalent amounts of other foods and eating them in moderation may have long term health benefits in addition to helping with weight loss.

-Limit screen time. (the official advice is <2 hours daily, but the fact is that most students spend more than that on just work, but limit as much as possible, set up “phone-free time” for physical activity and other social interactions.  

Finally, do NOT make a constant struggle over dieting and weight control the dominant feature of your child’s life. A healthy lifestyle for the whole family is the aim, rather than obsessive control of one child’s food intake.
-Do not be discouraged if weight loss is slow. Your body will always resist weight loss; the aim is to stick to an overall healthier lifestyle (more exercise, less processed foods, few snack items, more fresh foods)

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Brown fat, the bad kind

Unless you have been hiding under a rock you know that people of South Asian are at more risk for metabolic disease than is the norm. More concretely we tend toward “skinny fat.”

My current BMI 24. By normal calculators I’m normal weight (barely), because the cut-off is 25. But for South Asian we should be worried if we’re above 23.

There is the caveat that muscle is heavier, so one shouldn’t take BMI literally, as opposed to seriously. You know if you have too much visceral fat, you don’t need to weight yourself. The phenomenon of brown guys with big bellies due to years of self-indulgence is a thing. And excess weight among South Asians who reach a certain affluence level seems a thing the world over.

So here’s a question: for those of you who have managed to keep the weight off and stay trim, how do you do it? Exercise? Diet? Both?

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