As fitness wearables become more commonplace, many people may assume that if I wear my new gear and take my steps, I will instantly begin to look just like (insert your favorite fitness model’s name here).  I mean, it sounds simple.  Take 10,000 steps per day, burn an extra 500 calories per day, or 3,500 per week (the amount in a pound of fat), and then you’ll just walk any extra weight right off.  Unfortunately, as many people have discovered, that’s not exactly the case, and here’s a few reasons for these fitness setbacks:

1. Your actual body composition differs from the weight used in this calculation:  These metrics are for a 180 lb person who travels 5 miles in 10,000 steps and burns roughly 100 calories per mile.  So, if you only weight 120 lbs, then you’d really only burn about 300 calories over the same 5 miles.  Also, if your stride is too short to travel 5 miles in your 10,000 steps (ie perhaps you’re a bit more petite than allows for long enough strides to reach your 5 miles), then you may also miss out on hitting your burned calories goal.  Also, even at rest body composition can play a role in your metabolism with muscle burning 7-10 calories per pound per day whereas a pound of fat may only burn 2-3 calories per day.  Thus, even if you hit the 500 calories from the 10,000 steps, you may still not see results if you have a higher fat to muscle ratio as your baseline metabolic rate (calories burned at rest) is slower.  Also, as you lose weight, the amount of effort to burn the same calories in exercise increases while your basal metabolic rate decreases. 
2. Say you weigh exactly 180 lbs and your body composition exactly matches that of the test subjects.  Intensity in your travel may also affect the number of calories burned.  Walking at a 4mph pace (or a mile every 15 minutes) would put you on track for 500 calories burned.   So, it takes roughly an hour and fifteen minutes of walking to burn those 500 calories.  Say you increased your pace to 6mph (a mile every 10 minutes).  You could look to burn 444 of those 500 calories in just 30 minutes, or with only 3 miles of effort instead of 5 miles.  Add another 4 minutes of running, and you’d match the 500 calorie output in just 34 minutes instead of an hour and fifteen.  Alternatively, if you walked more slowly than 4mph, then it would take a longer time to burn 500 calories, so you’d need to extend your walking time to reach your goal.
3. Gender also plays a role in metabolism.  For instance, following puberty, most men began to increase their lean body mass as testosterone levels increase, whereas for women, we don’t see such a surge in lean muscle as testosterone levels are naturally lower than for men.  That being said, participation in activities, such as weight lifting, that increase lean body mass may cause a slight increase in metabolism
4. Age can also play a role.  As we age, we may begin to see a decrease in muscle mass over time.  This can be due to participating in less weight-bearing and strength-training activity, dietary changes and also that maintaining lean mass may become a little more difficult due to simply being older.  In addition to the loss of muscle mass from the changes listed above, the parts of the body responsible for metabolism begin to wear down.  While staying active and paying attention to diet can help offset these changes, the bottom line is that the whole pizza you could eat without gaining an ounce at 20 will make you gain weight at 40.
5. Speaking of diet, one of the biggest misconceptions about exercise is that once done, you can now eat whatever you want.  You know the extra 500 calories you burned?  Check out the number you’re putting back in your post-workout smoothie.  Or in your post-workout splurge at whatever fastfood you might be treating yourself with.  It’s so easy to “treat” yourself with more calories than you burned exercising, not too mention more vigorous exercise often makes us hungry, so we tend to eat more than when not exercising anyway.

The bottom line is that there’s no easy way to lose weight and stay fit.  Those who tend to have the most success make changes that they can live with long term.  Results from a crash diet and daily intense workouts will only last as long as your motivation.  Ultimately, you will gain the weight back.  If you hate running, then you won’t keep doing it.  If you find that you love hot yoga and long walks with your dog, then do that.  If you’re eating 500 calories a day and are always hungry, then you can’t do that forever, and the weight will come back.  It's the same with diet pills you take for a few months and then have to stop for heart health.  Switching out healthier recipes for foods you already love to eat can be something you can allows for not feeling deprived while making positive progress.  The bottom line is that more calories have to be expended than consumed for weight loss to happen.  Gradually eating more healthily and learning to be active in a fun way are changes can allow for lifelong success.
Dr. Nick

Looking for a little more motivation to keep up with your New Year’s health goals?  New data from the American Cancer Society suggests that being overweight or obese increases your risk of both developing and dying from cancer.  As many as 8% of all cancers and 7% of all cancer deaths are thought to be caused by excess body weight, even if you’re otherwise healthy.

There is a clear association between obesity/being overweight and endometrial cancer, (menopausal) breast cancer, colon cancer, esophageal, renal (kidney) and pancreatic cancer.  There may also be a link to ovarian, cervical, gallbladder, liver, multiple myeloma, and non-Hodgkin lymphoma as well as aggressive prostate cancer (while prostate cancer is not a concern for women, it may affect your partner).  Even for normal weight women, having increased belly fat is associated with the development of cancer. 

Why do researchers think this happens?  It seems like “healthy” and “obese” may not go together after all, as obesity can have negative effects on immune function, inflammation, and hormone.  These changes can impact not only overall health but may play a role in the development of certain cancers.  For instance, excess estrogen production from adipose (fat) tissue can change the flow and length of the menstrual cycle, and this unopposed estrogen is associated with the development of endometrial cancer.  This same mechanism may contribute to some types of breast cancer as well.

Even a small amount of weight loss may be helpful for decreasing cancer risk, and, of course, there is a reduction in heart disease and diabetes.  Weight loss can also be helpful in bringing some predictability back to the menstrual cycle without the need for hormonal birth control to regulate bleeding. 

Given all of the benefits above, not to mention an improved sense of overall wellbeing, now is the perfect time to start making and working toward your own health goals for 2019.  Whether that’s to take an exercise class, run an 5K or just lose those pesky (fill in the blank) pounds, we hope that this information can help provide some motivation.  Good luck living your best 2019!
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Dr. Nick

I get this question a lot: “Ever since I had my babies, my trouble spots have only gotten worse. I have tried everything- diet, exercise, more crunches than I ever thought I could do. Doctor, what do you think about CoolSculpting? “

Fat is such a complicated thing to get rid of. Of course, there is liposuction, tummy tucks and lifts for everywhere. Most of these procedures require surgical intervention in the operating room by a plastic surgeon (unless, of course, you want to end up on the latest reality tv show that specializes in botched outcomes). These procedures unfortunately require time to perform, down time from work and are rather expensive.  Who has time for that? Recently we have seen the advent of non-invasive fat reducing procedures such as CoolSculpting and Sculpsure. The purpose of these procedures is to get rid of those trouble spots that the crunches aren’t touching. 

First- what is CoolSculpting? Coolsculpting is an FDA-approved treatment that involves freezing fat cells. There is an applicator that applies suction to the area that you want to target and the applicator brings the temperature of the fat cells down to the point where they are irreversibly damaged. These cells eventually die and are then eliminated by the body, which is why it takes a few weeks to see the final effects of the procedure. This technology is really for specific trouble spots that are large enough to adhere to the applicator- tummy fat, love handles, thighs, bra fat, banana roll (fat underneath your butt).

Instead of freezing fat cells, Sculpsure uses heat to kill fat cells and then the body eliminates those cells within a couple of weeks. Because it is using heat to kill fat cells, this can be a more painful procedure especially for people with sensitive skin.

The biggest advantage of these minimally invasive fat reducing procedures is that there is very little down time and the risks are minimal compared to more comprehensive surgical procedures like liposuction and tummy tucks. The biggest disadvantage is that they only target specific areas, the results take weeks to appreciate, and can be very variable: up to 15% of participants did not see any improvement after treatments. At $1500 per trouble spot, that can be pretty frustrating.

If you are considering a fat reducing procedure, of course we always recommend that you give that cheap, old-fashioned option a try first- diet and exercise.  If that doesn’t work, we recommend that you consult with a board-certified plastic surgeon to discuss your options before making a decision.  While Coolsculpting may be the perfect remedy to eliminating fat in certain areas, there may be certain instances in which a more traditional surgical approach would help you achieve your desired goals.  While this is not a service we offer, we hope this information is helpful!

Dr.  Pam

​We’ve talked about the recommended amount of exercise in the past, so I’ll just take a moment or two to review the guidelines.  You should generally get 150 minutes of moderate aerobic exercise (swimming, brisk walking, push mowing, etc.) or 75 minutes of vigorous aerobic exercise (i.e. running) each week in addition strength training at least twice per week.  In order to see significant weight loss, this amount should increase to closer to 300 minutes per week, or about an hour a day for 5 days per week.  We often get really excited about our workout goals in the beginning, but sometimes, those workouts can begin to feel like even more “work” than usual.  Here are a few signs that you may benefit from a day off:

1. Ever feel so exhausted that you just can’t fall asleep?  That means your sympathetic nervous system may be working overtime.   Pushing too hard for too long can sometimes cause constant release of stress hormone that keep you wired for “flight or fight,” and that imbalance can totally throw off your sleep.  Another sign may be the disappearance of your menstrual cycles.
2. Constantly sick?  Either you have a toddler, or your immune response could be lowered due to inflammation and stress from overtraining.  Make sure you’re getting adequate breaks between hard workouts.
3. Reached a plateau in your workouts that no amount of training can push past?  Sometimes a short break for either a rest day or simply changing your preferred workout activity can help you resume making gains in your 5K pace or your weightlifting one-rep max.
4. Are you so tired that every day feels like a blur?  After sleep and dietary change, constant stress, either from workouts or even daily life, can really wreck your body.  We’re made to undergo cycles of work and rest, so being constantly “ramped up” can keep you from reaping some of those down-time benefits and even make it harder for you to rest when you finally have a chance.
5. Does that walk from your car to the gym make you tired just thinking about it?  The reason that people often begin to look forward to their daily workout involves the brain’s own reward system.  Dopamine, the body’s feel-good hormone that provides positive feedback for everything from workouts to intercourse, and endorphins, the body’s natural painkillers, are both released during and after exercise.  That being said, excessive training can blunt that response, and thus, blunt your satisfaction with your workout routine.

The bottom line:  working out and exercise are good, but be sure not to overdo it.  This is especially common when just beginning more intense exercise.  If you notice any of the symptoms of burnout listed above, it may be time for a little break or a change in your routine.  If those symptoms persist, then it may be wise to check in with your doctor to see if these symptoms are a sign of something else.  Before you do that, though, you might consider one last try for some fun exercise outside where you can really enjoy this lovely spring weather 😉
Dr. Nick