Transcription:
Women's Nutrition

Melanie Cole, MS: Thanks for tuning in to Back to Health, the podcast that brings you up-to-the-minute information on the latest trends and breakthroughs in health, wellness, and medical care. Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Weill Cornell Medicine's top physicians on issues surrounding women's health through the life course. Listen here for the information and insights that will help you make the most informed and best healthcare choices for you.

Host: I'm Melanie Cole. Joining me today is Dr. Sarah Barenbaum. She's an Assistant Professor of Clinical Medicine at Weill Cornell Medical College and an Assistant Attending Physician at New York Presbyterian Hospital Weill Cornell Medicine. And she and I are talking about women's nutrition today.

Dr. Barenbaum, it's a pleasure to have you join us today. This is a topic near and dear to my heart. I love to talk about nutrition and food. You know, I've been in the field for 35 years and it's always so much fun to talk with an expert on these things. So, can we first delve into something that I feel personally is about developing healthy relationships with food and nutrition? We negative self-talk all the time. I'm guilty of it. My mom was guilty of it, my sisters. We all do this and we're so critical of ourselves. I'd like you to start by telling us how we can start this healthy approach to food and nutrition, so we don't pass that on to our children.

Sarah Barenbaum, M.D.: Absolutely. And first of all, Melanie, thank you so much for having me today. I'm really excited to be here and to talk about this. This is, of course one of my big passions as well, something that's very near and dear to my heart. So, thank you. And I think this is a really great question to start with and something that I think about all of the time for myself and for my own family, my children.

Guest: I don't think there is one perfect answer or solution. The approach I try to take at home and with my children is everything in moderation. I don't talk with them about good foods or bad foods, but we talk about making healthy choices. As a family, we really try to focus on eating whole, unprocessed foods as much as possible. We have a lot of fresh fruits and vegetables around for them to pick from if they're hungry or snacking. I try to display healthy eating habits without necessarily pointing it out so that my kids learn to mirror those habits. And we also don't completely restrict treats in our house. We focus on them exactly as that, as a treat, something you have once or twice a week, not every day.

I think something that's also really important in thinking about this is no one is perfect. You can't be perfect with diet every day. I think on those days where you find yourself having a less than ideal day or if your family has a less than ideal day, don't bring a lot of attention to it. And the next day just start over and don't look back.

Host: That's great advice. We have to look at each day as a new opportunity to do those things that we consider that we want, that we think about being better for ourselves. That's really, really great advice. When we think about the snacks you just mentioned, and I keep those things around too, but what does it really mean to eat healthy? And why is it so hard to lose weight, maintain weight loss? My mother, Dr. Barenbaum, she lost 120 pounds through an old-fashioned TOPS, and it was portion control, and she was always looking at the size of her plate and writing everything down, journaling everything, you know. It's not that easy for everybody. I'd like you to speak-- I mean, it wasn't easy for her, she had six kids. But you know, it's a difficult thing for people to do. Tell us what this really means when we're to look at the big picture of weight loss, maintaining weight loss, eating healthy. What does that even mean?

Guest: Sure. I will try to answer all of that and please let me know if I don't get to part of the question. But in terms of eating healthy, there really isn't just one answer. Again, in my opinion, eating healthy really means everything in moderation. Trying to focus on whole, unprocessed foods as much as possible. Limiting simple carbohydrates, starchy carbs and sugars, but not necessarily eliminating anything completely. Trying to become overly restrictive and eliminating anything completely, especially if it's something you really love, can definitely backfire.

So in terms of the question of why it's so hard to lose and maintain weight loss, weight is just incredibly complicated. There are a lot of things that can contribute to weight gain. For example, the availability of highly processed, palatable foods, physical inactivity, even things like prescription or over-the-counter medications can cause weight gain; genetics, hormones, anything that causes stress, anything that disrupts sleep. These things can all lead to weight gain. They can also make it really hard to lose weight. And they can also make it hard to maintain weight loss.

And I really want to stress, I know I've said this a couple of times, but it is really hard to lose weight. It's not just your mother, it's everybody. It's hard for everyone. It's really a struggle. It's a journey. And the reason it's so hard to maintain weight loss after significant weight loss is that anytime anybody tries to lose weight, our bodies think that we're starving. And as humans, we have developed a number of metabolic adaptations that keep us from starving. So when we lose weight, for example, metabolism slows down. It can slow down very dramatically, like you know, it can be about three to 400 calories a day. There's different changes in hormone that lead to more hunger, more cravings, because our bodies really want to get back to the weight that we started at and to keep us from losing weight. These are incredibly frustrating evolutionary tools that are meant to keep us from starving. All of these different factors that I mentioned can lead to weight gain, can make it really hard to lose weight, and it can make it really hard to maintain weight loss after somebody has achieved weight loss.

Host: Well, that was an excellent explanation and it really does put things into perspective for us because people think, "Oh, well, it must be this or that." But really, it's determination and it's willpower, and it's all of these things we're going to put together here today. So, let's put them together. The best diet for weight loss, if you were to say, because there's a lot of them out there. There are fad diets, all of those things. And as I said, my mom did portion control. That way, she didn't feel she was denying herself anything. She would have corned beef, but just a little bit of it. She would have a piece of cake or a piece of pie, but just a small amount. That's not easy to do for everybody. Some people need to see a lot of whatever it is that they want, and they feel like they're denying themselves if they only give themselves a little bit or they deny themselves completely this kind of food, and then that could turn itself around and become a binge eating situation. Tell us a little bit about how you feel the best diet way is, or let's not even call it diet, let's call it healthy eating.

Guest: Sure, of course. I mean, there really isn't one best diet for weight loss. There are a lot of studies that have been done that have compared diets to each other, and what they have found is that there's no specific diet that predicts overall success. But what really predicts success in individuals is being able to stick with a diet long term. So, the best diet is one that you can do and one that you can stick with long term. You were just mentioning, calling it healthy eating. I think of it as a lifestyle change. When people are deciding what changes to make in their life in this journey for weight loss, I really recommend finding something that they can do long term. And it sounds like that's what really worked for your mother, was really focusing on reducing portions, but again, not eliminating anything that she loves.

Typically at our center, what we do recommend as something we know that can be healthy option, is a low glycemic index diet because cutting back on carbs and sugar can really help to reduce hunger and cravings and can reduce your risk of developing type 2 diabetes. However, I'd always tell people don't try to cut out carbs completely because, again, that's not realistic and I want this to be a lifestyle change you can do forever.

Host: I love that you said that because carbs get such a bad rap and, ohh, they're evil and all this, but they're really not because a tomato is a carbohydrate, as is a carrot. And people just don't sort of realize that they're thinking of the starchy breads and sugars and that kind of thing. As we're looking at these types of way that we want to eat. Dr. Barenbaum, how important is reading labels? What are we looking for? Because you mentioned carbohydrates and we see all these things on the label, proteins, sugars, cholesterol, all these things. What are we looking for?

Guest: So, that's a really great question also. I think that looking at the labels are really important. But I think what's also really important to know is that legally they can be off by about 20%. So when you're looking at a food label, it's not always accurate. The calorie count can be off by 20%, which is really significant when you add that up over the course of the day. It also really depends what the goal is. If someone's trying to lose weight or maintain weight, or just focusing on overall health, the things you're looking at on a label will be different. I think it's important to know how to read a food label. It's important to understand, because they can be really complicated. And if you're not used to reading them, it might look like a different language.

So, I think just having comfort with it and knowing what your goals are is just really important. Personally, when I'm looking at a food label, I'm trying to avoid, as I keep saying, like artificial sweeteners. I'm trying to avoid overly processed food. I'm trying to avoid high-fructose corn syrup, but that's me personally. And because of this and because of the fact that food labels can be inaccurate, I really just try to prepare as much of my own food as I can and just avoid anything that is really processed.

Host: I'd like to touch on exercise. As an exercise physiologist, of course, it is one of my favorite topics. However, there's been some talk about whether or not exercise really can help you lose weight, whether it is essential, which I feel that it is in a weight loss goal, as we're looking at the food that we're eating and we're trying to eat healthier and hitting the perimeter of the grocery store instead of the aisles, all the things we hear about, where does exercise fit into that picture? As you're working with people in your clinic, Dr. Barenbaum, and you're helping them to achieve their goals, where do you put exercise into this picture.

Guest: So, I agree with you. I think exercise is essential and it's so important. It's important for overall health. It's important for mental health, it's important for cardiovascular health. It's impact overall on weight loss is relatively modest, however. But we do focus on it really early in a weight loss journey because exercise, aside from having all of these wonderful health benefits that we're sort of touching on, is what helps people maintain weight loss lifelong and make it long term.

As I was mentioning before, when anybody loses weight, metabolism slows down. And as I had mentioned, it can slow down by like 300 to 400 calories a day, which is really significant. Exercise helps to offset that reduction in metabolism and really helps people to maintain their weight loss. When people lose weight, they also lose muscle mass, which is important for a variety of reasons as well. So, adding in some strength training is important also. So, most guidelines recommend at least 150 to 300 minutes a week of moderate intensity exercise, or about 75 to 150 minutes of vigorous intensity aerobic activity with muscle strengthening exercises like twice a week.

Host: Well, thank you for saying that. So when does it get to the part where people need to get help? I mean, there are many weight loss options out there. Tell us a little bit about when you think people should really seek professional help or medically-assisted weight loss.

Guest: This is a really good question, and I think that at any point when someone is considering weight loss, they should definitely consult their doctor to talk about options. Is weight loss appropriate? What should their weight loss goals be? There are specialists like me, I'm an obesity medicine specialist, so I specifically treat patients who have overweight and obesity and medical-related conditions, and we start to think about medications for those who have a BMI greater than 27 and a weight-related medical condition like high blood pressure, high cholesterol, type 2 diabetes, or for anybody who has a BMI over 30.

Typically, when thinking about a medication, it's recommended that people have tried lifestyle changes before, like diet and exercise for at least three months and not had success with it. But there are a lot of physicians out there like me, as I was mentioning, obesity specialists who are specialized in treating overweight and obesity. And we do prescribe medications. We also can talk about. Referrals to bariatric surgery if it's appropriate, if that's something a person is thinking about. Primary care doctors are also starting to do more of this as well, which is really exciting. They're becoming more comfortable with starting medication.

Host: I agree, and sometimes we all need help with those kinds of things. It's very hard to lose weight and to maintain weight loss. Dr. Barenbaum, this is such an interesting episode and I love speaking with you. Can you just wrap it up with your best advice for a healthy relationship with food, for our Women's Nutrition, women's Health Wednesday?

Guest: Sure. And thank you again for having me. This has been such a pleasure. My best advice for a healthy relationship with food is, again, just everything in moderation. Try to focus on eating whole real foods when you can. Don't try to completely eliminate anything you love or that won't work forever. And instead, think of them as treats. Have them once or twice a week instead of every day. Try not to be too hard on yourself too. Like I said before, if you have a bad day, don't look back. Just move forward and it's a new day.

Host: That's great advice. And we have to stop with all that negative self-talk that we do to ourselves as women. We are the caregivers to the world, Dr. Barenbaum, and we have to put our own mask on before we put the mask of our loved ones on. So we have to take care of ourselves, so that we can then take care of all the people that count on us and that we love.

Thank you again for joining us. And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. We're so glad you joined us for Women's Health Wednesday. We hope you'll tune in and become part of a community and fast-growing audience of women looking for knowledge, insight, and real answers to hard questions about our bodies and our health. Please download, subscribe, rate, and review Back to Health on Apple Podcast, Spotify and Google Podcast. And for more health tips, go to weillcornell.org and search podcasts. And parents, definitely don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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