Monday, July 20, 2009

My top 3 "hidden" causes of weight

Over the years I've seen literally thousands of patients. While certainly many come to my office with a clear understanding of where their weight's come from, a significant percentage come in and truly can't understand why they're having difficulty losing weight or why they gained weight in the first place.

Indeed there are a myriad of sources of struggle, but here are my top 3 (in order):

1. Meal skipping

These folks often come in and tell me they barely eat. Looking at their weight and lifestyle inventory (WALI) these are the folks that skip breakfast, generally avoid daytime snacks, have soups or salads for lunch and then eat a large dinner and often struggle with cravings and impulse control in the evening. I can understand why they feel they barely eat as the vast majority of the day, they're not eating at all. Of course by the time they do eat, they're hungry. And of course when we're hungry our bodies crave calories. So what happens? While it's true they might only eating one substantial meal per day, during that one meal, due to the influence of hunger, they're eating more calories than their bodies burn the whole day and hence, gaining - not losing.

Simple try at home solution: To lose weight you can't be hungry. Eat every 2-3 hours and include protein with all meals and snacks.

2. Eating out

These folks often come in and tell me they only eat healthy. Looking at their WALI you'll see them eating out anywhere from 4-10 times per week. When I point out their frequent meals out these folks will often tell me that they're great at choosing healthy options at restaurants. Unfortunately for them, even healthy options at restaurants can contain ridiculous numbers of calories.

Simple try at home solution: Here's an easy way to think about meals out. Assume that every meal out you eat will result in a day you don't lose. If you eat out 4-5x per week and then add in a few days of normal life stress struggle you might well not lose a pound. Eat out more than that and you're likely to gain. It's important to point out that while I think zero is certainly too few meals out in the context of a realistic and enjoyable lifestyle, to lose weight you'll have to lose the convenience meals out and keep only the truly celebratory ones and occasional social ones.

3. Liquid calories

These folks are often the most confused by their weight. They may be eating regular meals and snacks, eating in and watching their portions. Looking at their WALI you might see them having 2 glasses of milk, one glass of juice and one glass of wine a day. Put together that's roughly 40lbs of liquid, non-filling calories per year.

Simple try at home solution: Don't drink your calories. If you're drinking any beverage for health reasons (milk for calcium, juice for vitamins, wine for heart health, V8 for vegetables, etc.), stop. If you're looking for calcium - take supplements. If you're looking for vitamins - take a multi. If you're looking for heart health - take a 10 minute walk a day and if you're looking for vegetables - eat them. At roughly 10lbs per glass per beverage/day per year none of these so called health benefits are worth their weight.

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  1. #3 was definitely a big one for me. I was drinking probably 300 calories of milk a day plus a glass of OJ maybe once or twice a week. I cut out liquid calories completely, and I think it's made a huge difference (I also tracked my calories and practiced strict portion-controlling by weighing and measuring). Now that I'm at a maintenance stage and upping my calories a bit, I've started drinking milk again - but only one glass a day instead of three!

  2. Anonymous9:10 am

    Excellent points about hidden causes of weight gain. Only suggestion is that two cups of milk per day is recommended by the food guide for calcium and vitamin D. There are only 88 calories per cup of skim milk, and there is some promising research that calcium from milk may help with weight loss. Vitamin D deficiency is common among Canadians, even those drinking milk should be taking between 400-1000 IU vitamin D supplement per day if over 50.

  3. Anonymous,

    Most of the research linking dairy with weight loss has been funded and spun by the dairy industry and does not represent solid science.
    Therefore to suggest the research surrounding weight loss and dairy is "promising" would be tantamount to suggesting that dairy is a magic food group to which the laws of thermodynamics don't apply.

    The "only" 88 calories per day per glass of skim milk, when consumed in 2 glass per day quantities would provide you with just over 18lbs of calories per year.

    Dairy is not magic and milk calories do count.

  4. Anonymous9:44 am

    So, why eat at all if you can just have supplements?

  5. I don't think there is anything wrong with drinking some of your calories. You just have to be honest about it and not act like liquids don't have calories.

    I have a protein shake every morning for breakfast and it really sets me up well for the rest of the day. When I don't have it, I get behind in my protein requirements and my fluid intake.

    However, I also log all my food so I know exactly what I am and am not eating.

    I also think it's a lot healthier to drink a glass of milk than to pop calcium pills. For one thing, a lot of the calcium supplements are not particularly bioavailable the way calcium in milk is.

  6. Anonymous11:37 am

    Counselling clients to avoid milk to save the calories removes a food group (yogurt and cheese are not nutritionally comparable to milk). Calories aren't the only factor in a healthy diet, nutrition matters too. I have heard Dr. Tremblay speak at several conferences about calcium in milk and weight loss. Reader can read this link and make their own decision.

  7. Really?

    You're posting a link to a Dairy Farmer's of Canada document?

    So people can make up their own minds?

    Gee thanks.

    By the way. The post was about problems with weight - not about nutrition. Milk calories are not magical and are certainly well worth cutting if weight's a concern.

  8. Anonymous11:55 am

    Foods that are nutrient dense for relatively few calories such as vegetables, fruit, and low fat dairy are recommended for people to manage their weight. That document includes information from NHANES III - the dairy board did not have a role in that data. I would be surprised if the dietitian on your team is suggesting to people to cut out one or two glasses of skim milk a day to save the calories. People often do not reliably consume calcium and vitamin D supplements, therefore these nutrients need to come from the diet.

  9. Anonymous,

    Liquids are non-satiating.

    Low fat dairy is not a liquid.

    You might also be surprised to learn that Dr. Walter Willett, Chairman of Nutrition at Harvard since 1991, discourages the consumption of milk for health benefits as well and in fact has stated that given our current evidence base there is more evidence for risk than benefit from high dairy consumption.

  10. Anonymous12:40 pm

    What would low fat dairy be without milk, that is what the other milk products are made from. I am not suggesting encouraging high dairy intake, especially not of cheese, but two cups of reduced fat milk provides a lot of nutrition that is difficult to make up elsewhere. I do hope that for anyone who cuts all milk out of their diet at your suggestion that you provide clear information on what supplements they will need to take for life. Especially for your clients under thirty who are still gaining bone density.

  11. Oh really?

    You're concerned about bone density?

    I guess you haven't read the multiple meta-analyses that suggest that high milk intake doesn't in fact protect against osteoporotic fractures.

    I guess too that you're not aware of means to obtain dietary calcium aside from drinking milk.

    I'm done with this line of commentary. For more information, links and background for my views and concerns regarding milk please feel free to click here to read all my posts on the subject.

  12. Anonymous12:48 pm

    I eat quite a good diet. My extra calories do come from alcohol. I know I should cut down, but damn I like a nice martini or two at the end of a long day. When are they gonna make low calorie vodka?? :)

  13. Anonymous1:12 pm

    Daily calcium needs for adults 19-50 is 1000 mg, for adults 51-70 it's 1200 mg. Skim milk offers the most calcium for the fewest calories.

    Here are the options for calcium (in mg):
    -1 cup skim milk 300 mg, 88 kcal
    -2 oz cheese 390 mg, 202 kcal
    -1/2 cup low fat yogurt 236 mg calcium, 137 kcal
    -1 cup broccoli, 50 mg, 92 kcal
    -1/2 cup almonds 150 mg, 408 kcal

    The Ontario Food Report 2003 showed that mean calcium intake of both men and women did not meet the recommendations(for example, women aged 50 to 64 in Ontario had a mean intake of 714 mg per day).

  14. Oh, you're killing me Anonymous.

    How many calories in calcium carbonate tablets? How many in vitamin D tablets?

    Less than skim.

    Do you really think for a person with weight to lose who's in fact trying to losing weight, that getting dietary calcium from milk is worth the 18lbs of non-satiating milk that person's going to have to drink a year to get it?

    I don't.

  15. Thanks for the reminders! I am slowly working off years of bad habits, all wrapped up in good intentions. I have been using a skim milk latte as a treat- I find that the mix of caffeine and a bit of protein in the milk make it a good pick me up - I do have it with fruit or veggies. Is there something else that might be a better choice. I like the latte because I can get one nearly anywhere.

  16. Hi Lucy,

    Nothing "wrong" with a skim milk latte so long as you're drinking it because you enjoy it and not because you think it's "healthy".

    For liquid calories as I note in the blog, for me the goal is the smallest number you need to be happy and if a skim milk latte makes you happy and you feel the calories are worth it - nothing wrong with that at all.

  17. Theresa1:27 am

    This post was EXCELLENT for me to open my daughter's eyes as to why she can't lose that extra little bit she has gained. Black and white, these are problem areas. My sincere thanks for this short, to the point accurate post.

  18. Anonymous4:19 pm

    Very good post; milk is a very satiating drink for me though.One glass of milk in breakfast helps fill me up a great deal.

    Of course,I know my calories...I don't omit counting milk because it's 'liquid',there's no logic behind that.

    Sometimes it's hard to inspire thoughtfullness in people.

  19. IMO it's healthier to drink milk than take supplements. Skim milk and yoghurt are way high in protein and will keep you full, which helps with weight loss! Pair some fresh fruit (not juice, skin on) with a cup of skim milk in a smoothie or in a bowl with skim yoghurt - so much better than a pill!

  20. I drink milk because I like it, but I count it as a food instead of a drink.

    I also drink cokes on occasion ("on occasion" meaning "I've had the same six-pack of Dr. Pepper in my fridge since last September) but I count them as desserts. So, I'd drink one after dinner, maybe with some pretzel sticks, but not to wash down a meal. Water is for thirst.