THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 561.6 Guest: Anne Fletcher, author, Eating Thin for Life Topic: Real advice from successful dieters Producer/Host: Steve Girard

NEMA: We talked with Anne Fletcher last year about her book, Thin for Life, where she documented and explored success stories in battling obesity, and as importantly, keeping weight off. She has a new book, Eating Thin for Life , in which she revisits the people in her study, and asks about the techniques they use to stay near their ideal weight. And you may be surprised by what you hear. Anne, one of your goals was to emphasize the positive message of successful weight loss...

FLETCHER: We've gone from one out of four Americans being obese to one out of three, so it's increasing at a very fast rate. And, you know, the problem is we keep hearing about how everybody keeps getting fatter, but in the next breath we keep hearing how nobody can do it. We keep hearing that 95% of all dieters gain the weight back. And I was kind of frustrated with that 'catch-22', and decided to go out and find the people who have done it. And number one, I think there are a lot more successful people out there than we've been led to believe, and even if the number is small... why aren't we paying attention to the successful people, rather than focusing on the failures all the time.

NEMA: There's a tremendous number of packaged foods out there that are low fat, or fat free...and we seem to have latched on to at least the premise of substituting these products for some of the really fattening stuff... but why is America's waistline still getting bigger?

FLETCHER: Well, I don't know that there's a correlation between those two things... a lot of people think that we've been kidding ourselves...saying, "Well, it's low fat, so I can eat twice as much". What I have found in studying people who have lost weight and kept it off for at least three years... and mind you, the people - now, I've got more than 208 people whom I call 'Masters at weight control", who have kept off, on average, 64 pounds. And most of them have kept that weight off for ten or more years...many of them have, the average weight loss is more than ten years in these people. And what I found in looking at their food habits, and you know what I did...the motivation behind Eating Thin for Life was after I finished Thin for Life, which was all about, "How do you take hold of a life long weight problem and do something about it", I was left with a lot of questions about their eating habits. How do you handle it when people push food on you? How do you handle it when you live with a skinny relative? How do you make it through a pregnancy without gaining all your weight back? So, it was these day-to-day questions about eating that I wanted to go back and ask these people. And I did find that quite a few of them do make good use of low-fat and fat-free products, but they've learned something about them...and that's that you can't eat all you want of fat-free foods. One woman, who has ice cream almost every single night, and sometimes it's real ice cream, not low-fat, says that she stays away from the fat-free deserts, because, to her the word 'free' is a signal to eat freely. She says, "In my mind, something clicks and says, 'free means I can eat all I want'". Now that's not true for all these people, because some of them do use the fat free products. But the bottom line is: fat-free and low-fat can be helpful, but you still have to watch portion size. And that's why one of the food secrets of these people is what somebody aptly coined the phrase 'fix your full button'. Lot's of us eat beyond the point of being full, so it's important to take steps not to do that, and one of them is portion control...whether it's fat-free or not fat-free.

NEMA: You believe we can learn from the people who have always been thin, and from our own past successes in dropping weight...

FLETCHER: There was a research study comparing women who had never had a weight problem with women who had lost weight and kept it off, and many of their eating habits were the same. So, sometimes it takes to observe people who are successful at keeping their weight down, who are successful at being fit. You know, most people who have struggled with their weight have made multiple attempts...they've been the yo-yo route, up and down with their weight. They've tried many times to lose weight. The good news is that most of the people in Eating Thin for Life had done that too... but they finally did grab hold and do something about it. But one thing that can be helpful to people is to go back and look at your past weight loss attempts, to see what helped you, and what didn't work for you. So go back and look at the last time you went on a diet, or went to a weight control program. If it helped you to pack your lunch the night before so you weren't faced with tempting choices in restaurant or a cafeteria, go back and do that again. If it didn't help you to eat cabbage soup or eat grapefruit six times a day, well then don't do that, because it's not going to work for you in the long run.

NEMA: Do the 'masters of weight loss' still keep track of everything they take in?

FLETCHER: I sent each of 208 people a five page questionnaire about their eating habits...all kinds of nitty-gritty about, you know, how you eat now compared to the way you used to eat when you were heavy? Describe your eating habits in 25 words or less. Do you keep track of what you eat? Do you consider yourself to be on a low-fat diet? Well, lo and behold, when I looked at how these people eat, they told me things like: I eat a lot of fruits and vegetables...I drink a lot of water...I go easy on meat...I stay away from fried foods. Well, it's kind of like...big surprise! A lot of the things were the things you would expect people to do, the kind of things we all know we should do to lose weight and keep it off. So, the burning question behind eating thin for life for me became not so much 'what do you eat' as... "How do you get yourself to do the things we all know we should do to lose weight and keep it off"? I kind of thought when I started studying these weight loss masters, that I'd find a lot of fanatics, and people who eat like birds. Well, the good news here is that nine out of ten of these people, when I asked them, "Do you feel like you're dieting"? Nine out of ten said 'no'...and the vast majority told me that they enjoy food. And over and over again, I heard the comment, "I eat what I want". Now, again, that's in moderation, but they don't feel that they're living lives of deprivation. I only found 6 out of 208 people who keep track of fat grams. That doesn't mean they're not conscious, but they're not obsessively counting grams of fat and most of them are not counting calories. If they find themselves slipping, if their weight goes up a few pounds, they might go back and do some of the things that helped them lose weight in the first place...like keep a food diary, or go back to weighing and measuring foods...especially foods that tend to be giving them problems.

NEMA: What were some of the strategies that these 'masters' used to get through tough times and keep the weight off...times like divorce, quitting smoking, or another pregnancy?

FLETCHER: People got through pregnancy, there were several people who got through loss of loved ones.... one woman lost a 21 year old son to drowning...how do you keep off a 60 pound weight loss through a tragedy like this? And it really depends on the situation. The kinds of response I would hear to getting through tragedy, would be things like they go to others for support...they realize that if they overeat in response to a stressful or emotional situation, they're going to feel worse in the long run. They do other things to make themselves feel better. One woman, whose husband dropped dead of a heart attack in his late 40's -totally unexpected - this woman has kept off 180 pounds through this tragedy, and I said, "how do you do it"? And she said, "Well, I do other nice things for myself...I exercise, which makes me feel better... sometimes I stay in bed all day...I take a bubble bath...I treat myself to really nice coffee." And she said, "...and then, sometimes I do give into the urge to eat, but if I do, I don't berate myself...I get over it, because that would only lead to more eating".

NEMA: Many of our eating habits stem from the way we were cooked for when we were young... and thus the way we learned to cook. How have the people in your book changed their kitchen habits to reinforce good eating...?

FLETCHER: Well, I describe a story of the woman I call Diane J...I always use first names and a last initial...but Diane J., who I call now, 'the queen of low-fat cooking', describes how she learned to cook all over again. This was a woman who literally used to dip French fries in bleu cheese dressing, real bleu cheese dressing, and eat them. Fat in everything. And she has become, as many of these masters have, experts at low-fat cooking. The masters provide more than 120 recipes in the new book...they're everyday favorites. And they're easy things, like lazy beef stroganoff ... they include everyday foods, most of them are easy things that can be made in an half hour or less. There's lots of recipes for muffins and deserts...because one of the food secrets is not to deprive yourself, if you want it, have it.

NEMA: Have diet drugs played a role in the success of the weight loss masters?

FLETCHER: Well, I asked all these people how they lost weight when they were finally successful after years of struggling...and not one person told me that they used any kind of an appetite suppressant to lose their weight. As I mentioned earlier, many of the masters really do have trouble with knowing when to stop eating, and they've come up with some really nifty ways of stopping themselves from going beyond the point of being full, like "I brush my teeth...that signifies the end of a meal to me". Or, "I only put a set amount on my plate and I don't go back for seconds". I heard things like that over and over. I think that a lot of the new generation of appetite suppressants will make it easier, and do make it easier for some people to control their weight, but the down side is that most people are not experiencing huge weight losses as a result of taking the pill alone, so if you think you're going to lose a hundred pounds by just taking a pill and not changing anything else, it's not going to happen.

NEMA: What about the situation where you're always around people who don't really worry about what they eat... and like the foods you know you'd be better off avoiding?

FLETCHER: You know, I did ask that question...I found that only half of the people eat differently than the people that they live with. The ones who do eat differently handle it in different ways...some of them will do things like - I remember one mom who said, her kids really like to have treats around and need them, because they're thin and there's nothing wrong with them having some treats after they've eaten a well balanced meal. She said she tends to buy them things that are not her favorites. She also told me that she tends to keep things in the freezer, because she's less likely to eat them if they're in the freezer. Another woman told me that when her son still lived at home with her, she asked him to keep his treat foods in his bedroom, so she didn't have to look at them all the time. One woman gave an example, she said in the summertime, when everybody's eating picnic foods, she'll make herself low fat or fat free hot dogs, so that she's making herself a lower calorie, low fat version of what everybody else is eating. But many people told me that they won their families over to a healthier way of eating, because the way the masters eat.... basically eating more fruits and vegetables, cutting back on high fat foods, using low fat and fat free dairy products... are pretty much the recommendations of all the major health organizations are making for all of us to prevent heart disease, to prevent cancer, whether you're heavy or not heavy.

NEMA: Anne Fletcher's new book is Eating Thin for Life, from Chapters Publishing, available everywhere. It's got a foreword by gourmet chef author and TV personality Graham Kerr...that you shouldn't miss. You know, we throw 38 billion dollars each year at diet plans, supplements and books in the hope we'll discover the magic recipe for losing weight and keeping it off. Anne Fletcher's books are two big stepping stones to help readers realize two things: that we first have to be honest with, and depend on ourselves to conquer our problems... and secondly to learn from people who are already successful in the things we're attempting. I'm Steve Girard.

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Tease: Next up...looking into the health claims of herbal teas, with a world renowned expert in the field....Dr. Varro Tyler...on The Heart of the Matter!