You have heard it referred to as "middle-aged spread" or "carrying a spare tire" but those extra pounds around the middle of the body are getting more attention from researchers. Health care providers have always measured weight and height on routine check-ups and more recently may have calculated a patient's BMI or body mass index. Studies have linked the risk for heart disease and diabetes to excess fat stored in the abdominal area. A waist measurement of greater than 40 inches for men and 35 inches for women is linked to higher risk of common chronic illnesses such as type 2 diabetes and heart disease. (To measure your waist, place the tape measure at your belly button or just slightly above and then keep the tape in a horizontal position all the way around your body. Pull the tape snug but not too tight.) A new American Heart Association study compared waist circumference with another indicator called the waist-to-hip ratio. The waist and hip measurements are taken and the waist measurement is divided by the hip measurement to yield the "waist-to-hip ratio." A ratio of more than 1.0 for men and .85 for women is considered high risk for health problems. Example: A man's waist is 36 inches and his hips measure only 32 inches- divide 36 by 32 and the answer is 1.13 or greater than 1.0 which implies an increased risk for heart disease, diabetes and high blood pressure. The men with the highest waist-to-hip ratio had a 55 percent higher risk of heart disease than the men with the lowest waist-to-hip ratios. Women with the highest ratios were 91 percent more likely to develop heart disease than those with smaller waists and bigger hips. Regular walking of about 30 minutes 5 times a week is one of the best ways to reduce the abdominal fat stores. Combine this physical activity with some smaller portions and moderation in eating habits and it might save your life.

Those of us in the health care field are trained to give instructions or advice to clients about healthy eating, exercise and lifestyle changes for improved health. Most of the people that I see for diet counseling have been referred by their doctor or nurse practitioner for help with better control of diabetes or for weight loss. When the client shows up for an appointment, I might make the assumption they are interested in my advice and they are ready to make changes. This is not always the case. Some clients come to an appointment only because their health care provider asked them to do so. They are not ready to make any lifestyle changes and the visit can end in frustration for both of us if this fact goes unrecognized. In order for people to adopt new behaviors, they must move through several stages of change. Patients must move from a stage where they are not thinking about or not interested in making a change (called precontemplation) to a stage where they are considering a change in behavior (called contemplation) before any of our sage advice will be useful. Motivation to change must come from within, but we can support a client's efforts to change and help them understand that behavior change takes time. In the contemplation stage, clients will explore the pros and cons associated with trying to change behavior. You might hear, "I know I should exercise for my health, but I just don't have the money for a gym membership." We can help guide the patient in setting some realistic short-term goals. When clients enter the preparation stage of change, they have taken some small steps and are intending to do more. Guide clients through a brainstorming session on practical ways to plan for and monitor further changes in behavior. A calendar, a diary or daily log can be useful in this stage. In the action and maintenance stages of change, the client has reached a behavior change goal and now must work to stay on track. Expect some lapses in behaviors, but never label these slips a "failure." Focus on the positive changes that have been made and ask what you can do to help them move forward.

Most men in our society are raised to be tough and macho and taught never to admit weakness in any form. This approach to life probably serves men well in business or in competitive sports, but it leads to big problems when it comes to health issues. A mindset of invincibility often results in men ignoring preventative health advice. They will engage in unhealthy eating, smoking, and excessive drinking because they believe nothing bad will happen. When they have a heart attack or a diagnosis of diabetes, they are shocked. June is Men's Health Month and the American Dietetic Association offers these tips for men: • Eat a moderate amount of a variety of foods. If you need to lose a few pounds, limit second helpings and choose more fruits and vegetables to round out the meal. • Choose a diet lower in saturated fat and cholesterol. Cut saturated fat intake by choosing more lean meats and low-fat or fat-free dairy products. Bake, broil and grill more often than frying. Limit the margarine, butter, gravy, salad dressing, regular cheese and ice cream. • Include more whole grains, vegetables and fruit. Men tend to be "meat and potato" fans. The average American male consumes only half of the daily recommended dietary fiber. • Shake the salt habit. Most restaurant meals and convenience products contain plenty of sodium already. Grabbing the salt shaker and adding more at the table is usually unnecessary and may lead to higher blood pressure readings. Try adding hot pepper sauce, lemon juice, herbs and salt-free seasoning mixtures to boost flavor. • Drink alcohol in moderation. A maximum of two drinks a day is recommended. One drink is defined as 1.5 ounces of distilled spirits, 12 ounces of beer, or one 5 ounce glass of wine. • Get active. Physical inactivity is a risk factor for heart disease and diabetes.

We are moving into the real heat of summer now and the risk of overheating and dehydration rises with the mercury. New science-based guidelines for fluid intake were published in 2004 by the Institute of Medicine, part of the National Academy of Sciences. Adult women need eleven and one-half cups of fluid per day from a combination of food and drink. That's a total of about 92 ounces or almost three quarts per day. Adult men need 16 cups a day or 4 quarts per day.

Children ages 1–3 need approximately five and one-half cups, and children ages 4–8 require seven and one-half cups of fluid daily. Teenagers need somewhere between 10 and 16 cups per day, depending on growth and activity.

If your usual diet contains several servings of fruits and vegetables daily, you can get at least 4 to 5 cups of fluid from foods that you eat. For example, watermelon and cucumbers are 97% water, while tomatoes and squash contain 95% water. Anything that melts, like a popsicle, contributes water as well. Foods that soak up water when they cook, such as dry beans, pasta, or rice, are a source of fluid, too. Chicken and fish contain about 65% water while cheeses are around 40% water.

New research shows that carbonated beverages ARE hydrating and that caffeine has only a minimal brief diuretic effect so diet sodas and tea can be counted as part of your total daily fluid intake.

Thirst is not a good indication of the body's need for hydration. If you feel thirsty, you are already dehydrated. It is important to drink at least 12 to 16 oz. of fluid BEFORE engaging in any activity which causes perspiration and then drink additional fluids every thirty minutes during activity. Water is always a great choice and studies show that children and adults will drink 50% more if the water is flavored Sports drinks help replace fluids and the sodium and potassium lost with perspiration. If you are exercising with a goal of weight loss, try one of the new low-calorie sports drinks. Even mild dehydration (a loss of 1% or 2% of body weight) can impair your ability to concentrate and your short-term memory.

The latest round of product recalls is certainly a good example of the adage "let the buyer beware." In April, the U.S. Food and Drug Administration identified more than seventy over-the-counter weight loss products that contained undeclared, active drug ingredients. These products are marketed to the public as supplements that can make you slim, increase fat-burning, improve appetite control and speed up weight loss. Many carry labels with the descriptors "herbal" or "natural" which may be interpreted by the general public as "safe" to use. These products are sold on the internet, on television, in beauty salons and some retail stores across the country.

Weight loss aids and supplements are regulated by the FDA, but are treated as food rather than prescription medication. Companies who produce these products must follow certain guidelines for health claims on the product label, but the FDA does not test the products before they are sold. The public assumes these products are safe to consume because they are easily obtained without a prescription.

The recalled weight loss products contained active prescription drugs which were not listed on the ingredients. Some of the drugs found in these products were present in amounts that exceed the maximum daily dosage for that prescription medication. Prescription drugs found include:

• Sibutramine – an appetite suppressant and a controlled substance
• Fenproporex- a controlled substance not approved for use in the U.S.
• Fluoxetine- an antidepressant (trade name Prozac)
• Bumetanide- potent diuretic or fluid pill (trade name Bumex)
• Furosemide- potent diuretic or fluid pill (trade name Lasix)
• Rimonabant- drug for weight loss not approved for use in the U.S.
• Cetilistat- experimental obesity drug not approved in the U.S.
• Phenytoin- anti-seizure medication (trade name Dilantin)
• Phenolphthalein- a solution used in chemical experiments and suspected cancer-causing agent not approved for use in the U.S.

For a full list of the product names go to the official FDA website at this address: www.fda.gov/bbs/topics/NEWS/2009/NEW01977.html

I often have clients say, "I never sit down. I'm always on the move. I don't understand why I can't lose weight." Our perception of how physically active we are may be off the mark if we have no way to measure our activity. We tend to underestimate how many calories we eat and overestimate how much we move. Randomized, controlled trials have shown that individuals who used pedometers to measure the number of steps they took daily, increased their total steps by 2,400 each day when compared with control subjects. Weight loss was significantly improved if patients had a step goal or a plan to increase steps by a certain increment each week. On average, using the pedometer lowered systolic blood pressure by 4 mm Hg which translates into a 20 percent reduction in stroke risk. Obese participants with diabetes who took 19,000 steps per day or 11,400 steps combined with resistance training had significant blood sugar reductions with improved insulin sensitivity. Neither sex, race, ethnicity or starting BMI were predictors of success. In fact, the most sedentary individuals had the greatest increase in activity. The key to success is setting a minimum step goal with the patient and then a goal for adding steps at regular intervals. Keeping a diary of steps taken and food eaten can improve weight loss. Empower patients to track and improve fitness with a simple inexpensive tool- the pedometer.

You can stop wondering which fad diet is the most effective thanks to a two-year study at the Harvard School of Public Health. Researchers assigned four different diets to 811 overweight adult volunteers: low-fat with higher carbohydrate levels, low-fat with more protein, low-carbohydrate with higher fat and protein content, or very low-carbohydrate combined with more protein and fat. All participants lost about 13 pounds over the first 6 months and many regained some of the weight at the one-year mark. At two years, 80 percent had maintained an average 8 pound loss. When asked about hunger or satiety (the feeling of being full after a meal) the answers for each diet category were similar. The men in the study ate just over 2,000 calories and the women ate 1,250 calories per day. The study group met with dietitians and had the opportunity for group support sessions. Interestingly, the most successful losers were those who attended the most education and support group sessions. As long as they were aware of the calorie intake, they lost weight regardless of the type of diet they followed. This study points out the importance of behavior change support for those trying to lose weight successfully. The authors recommend choosing a balanced, heart-healthy diet with foods that appeal to you so you can stick with it and not feel deprived. Crash diets and fad diets don't work if you can't follow them for the long haul.

February is Heart Month and the message is that lifestyle changes can make a difference in our risk for heart disease and stroke. We can't change our genetics or family history, but there are lots of risk factors we can change. In 2009, it is estimated that 785,000 Americans will have their first coronary event and 470,000 will have a recurrent attack. One person every minute will die from the resulting injury to the heart. Good advice for reducing our risk: Eat more fruits and veggies, low-fat dairy, and high fiber whole grains. Even a weight loss of 10 pounds can be significant. Bake, broil, or grill instead of frying foods. Reduce intake of saturated fats and trans fats. These fats will always be solid or stiff at room temperature. Examples are bacon grease, butter, stick margarine, shortening,and the fats found in cheese and ice cream. See your health care provider for clearance to begin a physical activity program. Seek help for stopping smoking and all other tobacco products. Limit sodium intake and begin reading labels for hidden sodium. Small reductions in blood pressure result in big risk reduction. If you have diabetes, strive for good control of blood sugars. Stress can be a major factor in the development of heart disease. Acknowledge the stress and get help with constructive ways to deal with your daily stress.

It is an annual ritual. We like to think about the New Year as a time of renewal and a chance to turn over a new leaf. Most of us make resolutions with good intentions only to be frustrated or disappointed in ourselves within a few weeks. Usually this is because our list of goals is unrealistic not because we lack enthusiasm or will power. For instance, clients will list: • stop smoking • lose 50 pounds • walk an hour every day Each one of these items is a worthy goal, but consider the energy and attention it will take to accomplish only one of these. It would be extremely difficult to give all four goals your best effort. Life can be unpredictable and other obligations come up. So this year why not take a different approach? Set small goals that will add up to big results. For example: • use a smaller plate and limit second helpings when eating at home • drink more water and fewer high calorie beverages • take the stairs whenever you have a choice • park farther from the store and always walk instead of ride when you can • when you feel stressed, take a 10 minute walk instead of eating a snack for comfort • when eating out, eat half the food on the plate and put the rest in a container for another meal • eat slowly, making each meal or snack last at least 20 minutes- this gives your stomach a chance to send the message to your brain that you are no longer hungry • get 7 to 8 hours of sleep each night- sleeping fewer hours is associated with weight gain and increased risk of diabetes and heart disease • floss your teeth – bacteria in your mouth cause inflammation that can increase the risk of heart disease • include more fruits and veggies daily- use fruit for a snack and check out frozen microwave-in-the-bag veggies • curb late night eating and eating in front of the television- this leads to many extra calories you don't even realize you have eaten Choose just one or two of these goals you can reasonably do each day. Limiting second helpings and using a smaller plate could save 100 to 300 calories per meal. If you only did this at supper, you could lose a pound in two weeks. That adds up to 2 pounds per month or 24 pounds before next New Year's celebrations.

Favorite family recipes and seasonal foods are among the best memories of holidays for many people. In fact, most of us would agree that it wouldn't be the same celebration without these classic menu items. On the other hand, people who struggle with weight control or have special dietary guidelines to follow may dread these holiday food temptations. The constant availability of food at work, parties, church, and family events makes it difficult to choose wisely and eat in moderation. Here are some tips that may be helpful: At Work: • Take a brisk walk during your breaks to avoid the food in the break room. Exercise helps reduce stress and burns calories. • Plan ahead and tell yourself you will pick one day a week to snack on the goodies in the lounge. • Bring a healthy snack alternative such as nuts, popcorn, fruit, or raw veggies with low-fat dip for nibbling during the day. At Parties: • Plan to eat something before you go to the party. Starving yourself all day because you're planning to attend a party will only lead to eating much more of the high calorie foods offered there. • Tell yourself before the party that you will choose a small plate with a sample of your favorite items and then move away from the food table and find someone to socialize with. Standing near the food table usually leads to loading your plate several times. • Alcoholic beverages can add quite a few calories- One ounce of liquor has about 110 calories in addition to the calories in your mixer. One 4 ounce glass of wine has about 150 calories and a beer has 95 to 175 calories. • Take something low-fat or lower calorie to contribute to the offerings. At Family Dinners: • Make one pass through the buffet line and get one small spoonful of everything on the table and then don't go back for seconds. • Sit with someone you would like to catch up with and remember to eat slowly and enjoy the conversation. When you eat your meal in less than twenty minutes, you still feel hungry and may be tempted to go back for seconds. • Ask family members to go for a walk after the meal instead of sitting in front of the television. • Decide to have one small serving of your favorite dessert item or split a couple of the desserts with someone else. • Prepare one of the traditional meal items such as cornbread dressing and use a lower-fat version of the recipe. Last but not least, keep up with your physical activity during the holidays. Exercise can help reduce stress and weight gain.