You Ask, I Answer: Friend's Weight Loss

I have a question concerning my friend's health.

He is an obese 34 year-old man with a thyroid problem (which slows down his metabolism).

As far as I know, he eats very little throughout the day, and what he eats consists mainly of hamburgers, beef, pizza, etc. He does not -- and will not -- eat vegetables, and his taste for fruits is very limited.

He does not eat chicken or seafood either. He also skips breakfast every morning, and does not take vitamin supplements.

I'm really concerned about his healthy but can't seem to sway him to eat better.

What are the risks he's up against with his health if he continues to eat like this?

What kind of eating plan would you advise he go on? Should he be eating more food in a day, but with fewer calories and in smaller quantities?

I feel like the food he is eating isn't getting properly broken down because of the lack of other foods in his diet. Is that true?

-- Kara (last name withheld)
St, Louis, MO

There are many things worth covering here, so let's take everything in order.

Your friend is certainly in a fragile situation.

The few statistics you provide (thyroid issues, obesity) as well as your observations of his eating habits (a diet lacking fruits, vegetables, and, I'm assuming, whole grains) paint quite a bleak picture.

I do find it interesting that you are curious to know what negative health effects this may have on him, because I have a feeling he is already experiencing some of them.

I am sure he feels short of breath when exerting the slightest bit of physical activity, experiences pain in his knees, and may even have sleep apnea (a potentially fatal condition in which people stop breathing for short periods of time in their sleep.)

The examples mentioned above give us a clue of what is happening to some of your friend's organs (i.e.: the heart may be working overtime, and joints can have too much pressure put on them.)

Although the human body is very resistant, years and decades of these conditions really run it ragged, and "system malfunctions" (or meltdowns) can begin to happen.

A heart that is put through the wringer every day for 10 or 15 years is not a healthy heart. Although your friend may be 34 years old chronologically, his organs very likely resemble that of an older person (depending on how long he has been obese.)

You mention not being able to sway him to eat better, and it appears you aren't too sure why.

I'd like you to go back and re-read the questions you sent me. Pay attention to the feelings they conjure up.

Perhaps you feel overwhelmed, not knowing where to start with your friend. Or hopeless that it will be hard to break this behavioral mold. You might even feel like whatever the "solution" is, it will be one that will take a lot of time, effort, and patience.

I ask you to think about this because the thoughts and feelings that come to your mind will very likely reflect what your friend is feeling about all of this.

A lot of tweaking needs to happen here -- eating more small frequent meals, consuming more fruits and vegetables, cutting back on calories, increasing physical activity... I could go on.

Believe it or not, though, that isn't really the issue right now.

Why? Because, most likely, your friend is already aware that some changes need to happen.

The issue here is what is keeping your friend repeating behavioral eating patterns that keep him at an unhealthy weight.

I am willing to bet that he either doesn't know where to start, or the entire concept of eating healthy and losing weight is so overwhelming that the mere thought of it makes him want to forget the whole thing.

It isn't uncommon to contemplate a "can of worms" scenario like this one and be at a complete loss as to which particular worm to untangle first.

All change, no matter how small, is difficult.

I can't provide an eating plan without knowing his medical history, food preferences, and bloodwork numbers, but here is what I suggest you do:

Once, and only once, sit down with your friend and thoroughly explain your concerns to him.

Let him know you are concerned about his weight from a health perspective, and ask him what his feelings and thoughts are on the matter.

Be mindful, though, to stay away from tips, suggestions, or recommendations about what he should or should not eat. The point of this conversation is not to tell him what saturated fat does to the body or which diet book he should read.

Simply recommend to him that, if his insurance covers it, he has the option of meeting with a Registered Dietitian, a trained professional who will work WITH him one-on-one to achieve whatever his goal may be.

Once this conversation is done, you have to make a promise to yourself to let the issue go.

That, my dear Kara, is really all you can do. Until your friend is ready to make a change, there is very little you can do.

Lastly, your question about whether the food he is eating is being broken down properly even though his diet isn't balanced? The answer is yes.

The human digestive system breaks down all foods, regardless of how healthy -- or unhealthy -- they are.

You Ask, I Answer: Iodine

The only salt I have at home (and use for everything) is sea salt.

The packaging states that it is not a source of iodine.

Do I need to use regular table salt in order to get iodine in my diet?

How would I know if I had an iodine deficiency?

How much should I get each day?

-- Crystal Fales
Philadelphia, PA

Iodine has a very specific function in the body -- without it, our thyroid gland is unable to produce an important hormone called thyroxine.

Consequently, an iodine deficiency results in the enlargement of the thyroid gland (a condition known as goiter, pictured at left) as well as hypothyroidism (some of the main consequences of this include a slowed down metabolism and increased total blood cholesterol.)

Thyroxine is also crucial for brain growth and development in babies (both inside and outside the womb) and children.

Although table salt contains iodine (a direct result of fortification), so do many other foods.

Ironically, although iodine is not in sea salt, anything that lives in the sea (whether it's fish or plants) is a great source of the mineral.

Dairy and eggs are also fairly good sources of iodine, as a result of food processing techniques.

Vegetables are a little tricky because their iodine content varies on the amount of the mineral found in the specific soil in which they grow.

Adults should aim for approximately 150 micrograms a day. This figure is not too helpful, though, since most foods that contain iodine do not contain nutrition fact labels, and those that do do not list it.

A three-ounce serving of fish (the size of a human palm and as thick as the average adult's pinky finger) provides approximately 150 to 300 percent of a day's worth of iodine.

Vegans can sometimes be low in iodine (again, depending on the specific content of iodine in the vegetables they are eating,) so supplementation is always an option.

Be careful with over-supplementation, though. An excess of iodine results in hyperthyroidism, which can lead to insomnia, restlessness, and rapid heartbeat.

Lastly, allow me to point out that the sodium in processed foods is not fortified with iodine. So, a frozen meal containing sky-high levels of sodium provides absolutely no iodine.

You Ask, I Answer: Low Calorie Diets

What would you say is the minimum substantial amount of total calories you should eat to lose weight?

Are 800 calorie diets really that bad?

I was told that if you eat below 600 calories, your body goes into starvation mode.

But if you stay from 600-1000, then you're guaranteed weight loss?

I just want to figure out what I'm doing wrong and fix it.

I recall you saying that's the wrong way to go but then why do so many dietitians and weight management centers recommend this ?

-- Janie (last name unknown)

New York, NY

Low calorie diets (those going below the minimum daily recommended intake of 1,200 calories) are a terrible idea.

I take issue with the entire concept of a "diet."

If you go on one, you will inevitably go off it. And then what?

Most likely, old habits return -- along with the weight you initially set out to lose.

What I recommend is a metamorphosis towards improved dietary patterns and relationships with food.

I want to point out that this should always be looked at as a work in progress, and a process that isn't consistently moving in one direction.

An emotional setback or particularly stressful time, for instance, might have you reverting to old dietary patterns or seeking out high-calorie, sugar-laden comfort foods.

Not surprisingly, in a society where we are basically told that if we do not get what we want in 7 days or less we might as well resign ourselves to the fact that we are failures, this thinking doesn't exactly dominate the mainstream media.

Instead, people are told that in order to lose weight, they must:

Believe that food does not make them fat (The Secret)
Not eat brown rice and chicken in the same meal (Suzanne Somers)
Get a colonic every 2 days (Kevin Trudeau)
Drink a hideous mix of maple syrup, lemon juice, and cayenne pepper (Hollywood fast).

And so on and so forth.

If any dietitian, weight center, or book recommends that you eat less than 1,200 calories a day, RUN – do not walk – away.

Going below this figure poses several problems.

From a weight loss perspective, metabolism slows down (especially since the thyroid gland slows down production of thyroxine, a hormone that plays a major role in metabolism), lean mass is lost, and muscle tissue is broken down in order to create glucose.

So, when you return to your normal caloric intake, you will undoubtedly gain weight because your body is no longer as efficient at burning calories.

Going below 1,200 calories is also problematic from a health perspective.

With such low caloric intakes, it is extremely difficult to obtain necessary nutrients from food, including fiber, calcium, iron, and potassium.

Sure, there are always supplements, but healthy compounds like polyphenols, lignans, and certain antioxidants are exclusively found in foods, not pills.

What always strikes me as odd is that many times I see people who normally consume 2,500 calories start a 1,200 calorie diet overnight.

Completely unnecessary.

If that person were to simply slash 500 calories each day, they can enjoy 2,000 calories on a daily basis and kick-start weight loss.

You mention not knowing "what you are doing wrong."

I am assuming you are having a difficult time losing weight.

I do not know your individual circumstances, but by reducing your caloric intake (say, by 300 calories each day) and increasing your physical activity, you should begin seeing slow, steady results.

If this is not the case, I recommend having your thyroid checked by an endocrinologist.

You Ask, I Answer: Basal Metabolic Rate/Daily Caloric Intake

How can one correctly find their BMR and the calories intake needed for the day?

I have messed up my BMR with my undereating and am in almost malnourished state.

I want to increase my BMR and lose some fat.

From what I understand, maintenance and weight loss is figuring out the equation between calories intake and daily activity.

I just want to know how to estimate a calorie range I should go for and amount of exercise I need to do daily.

I am small - medium frame woman, 130 pounds, and 5' 4", with almost no muscle tone.

-- Mandy (last name unknown)
Halifax, Canada

I’m confused.

You claim to have messed up your basal metabolic rate due to undereating to the point where you are in a “malnourished state”, yet are looking to lose fat?

In any case, to answer your question – yes, weight loss and maintenance comes down to figuring out the net result of calories in (food) minus calories out (metabolism).

Our basal metabolic rate -- the amount of calories we burn off simply by existing -- is ultimately determined by a variety of factors, among them age, genetics, physical activity, dietary paterns, body composition, and hormonal activity.

This last point is especially important. Thyroxin, produced by the thyroid gland, plays a crucial role in metabolism.

In hypothyroidism, very little thyroxin in produced, and BMR is significantly lowered.

If you are cutting calories appropriately and upping physical activity for several weeks and see absolutely no changes, pay a visit to an endocrinologist and have your thyroid gland checked.

Thyroid issues apart, many people appear to forget that some of these factors change with time, age being the most obvious.

This is one reason why, as people age, they find that weight “creeps up on them.”

The 2,500 calories once needed to maintain weight can be too many -- and cause weight gain -- ten years later.

This is where knowing TDEE (total daily energy expenditure) also comes in handy.

TDEE lets you know how many calories you approximately burn each day on top of what your body uses up as a result of standard bodily processes.

So how do you determine all these numbers?

First, calculate your BMR.

You can easily find that out by plugging some basic numbers into Discovery Health’s BMR Calculator.

If you want to get slightly more technical, you can also use the Mifflin-St Jeor formula, developed in 1990, which goes something like this:

Male BMR = 10* (weight in kg) + 6.25* (height in cm) - 5* (Age)+ 5
Female BMR = 10* (weight in kg)+ 6.25* (height in cm) - 5* (Age) -161

NOTE: To convert pounds to kilograms, divide by 2.2 To convert inches to centimeters, multiply times 2.54.

Prior to this, the Harris-Benedict formula (created in 1919) was used. While useful, Mifflin-St.Jeor results in more accurate numbers.

Ok, now: to calculate TDEE multiply your BMR by:

1.2 if you perform little to no physical activity
1.38 if you perform light physical activity a few times a week
1.55 if you perform moderate physical activity at least 3 times a week
1.725 if you perform intense physical activity on a daily basis
1.9 if you perform intense physical activity several times a day or have a very physically demanding job.

Whatever number you get is how many calories you need to maintain your desired body weight.

If you wish to lose -- or gain -- weight, simply subtract – or add – fifteen percent to that figure.

By consuming fifteen percent less calories and increasing your physical activity, you will certainly shed weight.

The fact that you mention having “no muscle tone” is significant, since increasing lean muscle mass is a sure-fire way to speed up metabolism.

This is why weight-bearing exercises are highly recommended -- they help with bone density and metabolism.

Alas, weight loss comes back to the tried and true advice of “eat less, move more.”