We often talk of exercise programs, gym memberships and exercise classes of all kinds, but it starts with… we just don’t move as much as we used to. Most of us are not living on farms and ranches, not hauling hay or planting, foraging and picking our food, not hauling and chopping our firewood, and not building our shelters. Most of us aren’t even playing outside anymore. Too many of us have acquired the thought that all our needs can be met by a flip of a switch or an indoor environment. Again, too many of us press the garage door opener, put our clothes in the washing machine and our dishes in the dishwasher, watch TV and play/work on the computer, take an elevator or escalator to our destination and park right in front of the store.

In addition to this lack of physical activity in our daily life, most individuals in modern America have sedentary jobs where we sit most of the work week– talking on the telephone, typing, writing, working on the computer, talking with clients or patients or working at the check out counter.

Our bodies are made to move and actually can do it quite well, but sadly, most us do not have any kind of routine exercise and have a bevy of excuses to support our choice—not enough time, too cold, too wet, too dark, too tired, too many aches and pains, and on and on. I’ve had them myself at times.

In working with patients, I take a gentle yet tough love approach full of support and empathy and education… it is useful to ask questions, find the limitations and obstacles, try to find out what they might like, try to strategize the practicalities, set goals, motivate and inspire and never give up on the potential for change. The tough love part is trying to find ways to make them realize that moving/exercising should be considered a mandatory part of their life. I even say some times… “You have got to get religion about exercise”. Some helpful keys to the process can be: 1) Focus on the fact that you can do it– you can become someone who regularly exercises. 2) Make a schedule for when it is going to happen. Each day… I plan for when I am going to get my 60 minutes of exercise in for that day and even the next. “Oh… on my lunch hour I can walk to the hardware store, shop for light bulbs, walk back to the office (that’s 30), and then I have another 30 minute walk after work— either to the grocery store after work, or on a forest trail next to my house once I get home. 3) Maybe find an exercise partner or a personal trainer or a class or a team of some kind– even for those who are not athletically inclined— paddling on a “dragon boat” team might be just the ticket. 4) Set goals and make them a priority– and set goals that are realistic. 5) Know your limits and don’t injure yourself or make a chronic health problem worse.

According to the American Heart Association and to reduce the risk of chronic disease we need to have 30 minutes of moderately intense physical activity per day most days of the week. For those women who need to lose significant weight… it will probably take more than that to overcome the physiological forces that are now in play– insulin resistance, slowed metabolism, loss of muscle mass and aging. In my women patients who desire weight loss… our goal is 60+ minutes per day of aerobic exercise (walking, treadmill, elliptical, bicycle, running) for 6-7 days per week and ideally, some kind of strength training (yoga, weight training) 2 days per week.

With education, desire, and a plan…. You can succeed!! You can make a change! You can improve the quality of your life!

A study conducted at Fred Hutchinson Cancer research center in Seattle, Washington evaluated the effect of dietary and supplemental calcium on 10-year weight change in 5250 men and 5341 women from the Vitamins and Lifestyle (VITAL) study. The participants ranged in age from 53 to 57, and completed questionnaires about their supplement use for the 10 years prior to the study and their dietary calcium intake for the immediately preceding year. The subjects’ height, current and previous weights, exercise, smoking history, and demographic characteristics were recorded.

Most individuals in the study were Caucasian and well educated, and all except 8% were nonsmokers. Women in the study had an average dietary calcium intake of 811 mg/day in the year preceding the study, and the average dietary calcium and supplemented calcium totaled 1094 mg/day.

Women who took 500 mg or more of supplemental daily calcium either during the study or during the previous 10 years had a significantly smaller weight gain over those 10 years than women who did not take supplemental calcium. The difference was about 4 lb. Dietary calcium alone was not associated with a smaller weight gain, and calcium intake in men had no effect on weight gain.

Commentary

Previous research has elucidated an inverse relationship between calcium intake and weight gain. This study seems to support that observation. However, the study is limited by the reliability of self-reported body weights and supplement dosing over the 10 year pre-study period. We cannot feel confident that this study provides adequate evidence for recommending either calcium supplements or dairy products to middle aged women as means for achieving weight stability. On the other hand, there are compelling reasons for women to have an adequate calcium and vitamin D intake as they age. Perhaps this will also give them the small benefit of less weight gain during aging.

Among overweight or obese participants, long-term use of a multiple vitamin/mineral, vitamins B6 and B12, and chromium were significantly associated with smaller weight gains. Obese men who took chromium at < 150 mcg/day for the 10 years preceding the study had a weight gain of 6.1 pounds, versus 11.7 pounds for nonusers of chromium, while those who took > 150 mcg/day for the previous 10 years had a weight loss of 3.1 lb. Among obese women, women who used chromium at < 150 mcg/day had a weight gain of 7.9 lb, versus 14.1 for nonusers, and those taking > 150 mcg/day had a weight loss of 3.2 lb.

Other supplemental nutrients, in addition to the multiple vitamin/mineral supplements, were associated with smaller weight gains at higher doses among obese women were coenzyme Q10, ginkgo, ginseng, garlic, omega 3 fatty acids and melatonin.

Nachtigal M, Patterson R, Stratton K, et al. Dietary supplements and weight control in a middle-age population. J Alternative and Complementary Medicine 2005;11(5): 909-915

Commentary

The findings in this study are encouraging for overweight and obese women (and men). It is not surprising to see chromium on the list of nutritional supplements associated with weight loss. Chromium has been previously tested in randomized trials, and a meta-analysis reported a small but statistically significantly greater weight loss in subjects taking chromium than in controls.

Several of the supplements associated with smaller weight gains, and even small weight losses, such as vitamins B1 and B12 and coenzyme Q10,probably exert this effect through their roles as important cofactors in metabolism. The effect of chromium on weight may be due to its enhancement of blood glucose utilization and insulin sensitivity.

The main weakness of this study was its observational format, with a dependence on subjects’ recall of their actions during the 10-year period preceding the study. It is also possible that subjects who showed smaller weight gains or who lost weight had made efforts toward these goals independent of their use of supplements, but the study design did not control for caloric intake or exercise. Nevertheless, limited research suggests that other supplements may be efficacious in limiting or preventing weight gain. These would include CLA, as well as green tea and other herbs containing caffeine.

Before nutritional supplements can be validated as useful and reliable means toward weight maintenance and loss, longitudinal studies and randomized trials of their effects on these goals are sorely needed. And even if supplements are shown to have bariatric efficacy, physical activity and sensible eating are likely to remain the best keys to weight control

A randomized, double-blind. placebo-controlled trial examined the use of conjugated linoleic acid (CLA) in 118 overweight subjects with a body mass index (BMI of 28-32 kg/m2 . The study subjects were mainly women, and were given 3.4 g/day of CLA or placebo for 6 months. Measurements included total body weight, body fat mass (BFM), and waist size. Women assigned in the CLA group lost 3.4% BFM, while those in the placebo group lost 0.1%. Subjects who complied well with the study protocol had a loss of 5.6% BFM. In women who were obese at the start of the study (BMI > 30 kg/m2 ), most fat loss was from the legs. Waist size in the treatment group decreased by more than 1 inch, or 2.7%, but did not change in the placebo group.

Commentary

The results of this study aren’t surprising in view of previous reports that CLA reduces body weight. The primary mechanism of the effects of CLA on weight loss has not been spelled out in detail, but a reduction in the accumulation of fatty acids in fat cells as the result of inhibition of lipoprotein lipase and promotion of carnitine palmitoyltransferase is the most probable mechanism for this. The legs aren’t a critical area for weight loss, but the waist is. Abdominal fat and abdominal weight gain are highly associated with an increased risk of cardiovascular disease. As CLA is used for one to two years, Other reports suggest that use of CLA for 1-2 years can be accompanied by a decline of 9% in BFM.