- The Washington Times - Tuesday, February 25, 2003

Umberto Neri of Silver Spring knows the common wisdom regarding weight loss: Eat less. Work out more. Beware fried and fatty foods. That hasn't made it easier for the 63-year-old retiree to maintain a healthy weight. Mr. Neri, who stands 5-foot-7 and weighs about 200 pounds, has type 2 diabetes and underwent triple bypass surgery in 1993, a procedure that has limited how much strenuous exercise he can perform.
"Some people can just eat less and get by controlling their weight," Mr. Neri says. For him, it takes far more discipline to shed unwanted pounds.
"I have to also keep a strict low-fat [diet], with no fried foods, no sugars and little or no carbohydrates like pasta and rice," Mr. Neri says with a sigh. The Italian immigrant arrived in this country at 17 and still loves his native country's cuisine, food that now is off limits.
For too many, losing weight can be far more complicated than following an exercise guru's well-intentioned advice. Some, like Mr. Neri, have medical conditions that make working out, and thereby losing weight, more difficult. He can't exert himself with the zeal others might, given his heart history.
Moreover, Mr. Neri is battling against what some experts describe as an evolved predisposition to survive by eating.
Dr. Richard Atkinson, director of the MedStar Obesity Institute in the District and president of the American Obesity Association, says our bodies evolved over time to protect us from starvation. Only in the modern era have Americans had so much food that an excess has proved problematic.
"We've got this physiology … that's geared for the jungle," Dr. Atkinson says. "It says if there's food available and we're hungry, eat it. It's a very powerful drive."
"Two hundred and fifty genes are thought to be involved with regulating food intake," Dr. Atkinson adds, explaining, in part, our craving for food and how we digest it.
Some individuals' genetic makeup may make weight gain hard to avoid. Others may find it relatively easier to maintain a comfortable weight for their height and build.
Dr. Atkinson says very few people are born with inherently slow metabolism. Endocrine disorders such as hypothyroidism can slow the metabolism, however. If a person with a hypothyroid condition gains weight, losing those pounds will be more difficult than for someone without the condition, he says.

For Mr. Neri, a combination of age, heart troubles and an increasingly sedentary lifestyle let the weight pile on.
"Not until my forties or so was weight a factor," says Mr. Neri, whose weight peaked at 220 pounds a few months ago.
The former University of Maryland mathematics professor began working with Chevy Chase nutritionist Tracy Gensler in November and since then has dropped about 20 pounds.
He says the diet is getting easier with time.
"For the first month or so, it's a question of willpower and changing your habits," says Mr. Neri, who uses a treadmill twice a week in addition to performing tai chi, a graceful exercise that originated in China. His exercise regimen can be broad, but given his heart history, he cannot work out too vigorously and must make sure he doesn't get overly fatigued.
"After a month or so, you get used to getting by with less food. Your appetite goes down, but it's tricky when you eat out at restaurants," says Mr. Neri, whose doctors would like to see him lose about 25 to 30 more pounds.
Ms. Gensler says the majority of those grappling with weight loss can make major gains with an improved diet and increase in exercise. A few people follow all the rules, though, and still can't lose enough weight.
"They're sincerely doing everything they can. They're eating set amounts [of food]. They're recording what they're eating. They're doing strength training," Ms. Gensler says, but it's not enough.
It could be they are coping with depression, she says. Research on weight gain with depressed people is weak, she says, because the widespread use of anti-depressant medication is a fairly new phenomenon, but she has fielded calls from clients who have complained that their anti-depressant medication has made losing weight more difficult.
Other medications may have side effects that inhibit weight loss, she adds.
Or, she says, it could be that a person is at a "good weight" for his or her body, but that weight doesn't allow that person to wear the trendiest, tightest clothes. It doesn't mean that weight is unhealthy, she says.
For clients still struggling with weight gain, Ms. Gensler will lower their caloric intake and shape their diets to "surprise the body," she says.
One morning, a client will have a larger breakfast; the next day lunch will bring the most calories. She compares the approach to how bodybuilders adjust their workouts to surprise their muscles to perform beyond their capabilities.
She also might dial down a client's carbohydrate intake from about 60 percent to 70 percent of their diet to about 50 percent, citing studies claiming such reductions help weight loss.

Many grappling with excess weight hit the gym. The best way to maximize a workout routine is to judiciously combine cardiovascular exercise and weight training, says Germantown exercise physiologist John Wetherill.
Aerobic activity such as running on a treadmill pumps up the body's cells, making them manufacture more energy. At the same time, resistance training increases the number of muscle cells that thrive on that energy.
Combining, say, treadmill work and muscle-building push-ups will increase the amount of energy produced and the need for that energy, an efficient one-two punch to burn calories.
Also, if someone has a limited amount of time for weight training, that person should focus on the larger muscle groups, including the quadriceps, hamstrings and back muscles, he says. Larger muscle groups need a higher amount of energy to work, which burns more calories.
That said, an ideal weight-resistance program would hit all the key muscles, from calves to biceps, he says.

Denise Feeley, a nutritionist with the MedStar Obesity Institute, says losing weight requires a comprehensive look at who we are and what our bodies do.
Ms. Feeley's center brings nutritionists, doctors and even social workers together to address the whole patient and his or her weight gain.
"You have to identify the emotional triggers that prompt you to eat," Ms. Feeley says, ticking off stress, boredom and depression as three likely factors.
The elation caused by eating prompted by those feelings is a "short-term fix. Then, after, they feel worse, they feel guilty about the fact that they just overate," she says.
"It's not hard to lose weight," she continues. "It's hard to keep the weight loss. I could hand out 1,500-calorie weight plans, and there's no question you'll lose weight. It's a question of being able to maintain that weight loss. They revert back to their bad habits."
Katherine Tallmadge, spokeswoman for the American Dietetic Association and author of "Diet Simple," knows how an unfriendly genetic hand can deal someone a lifetime of weight issues.
"I gain weight very easily … my mother has battled weight problems all her life," Ms. Tallmadge says. "I have these things against me, but I've been able to conquer it."
She agrees that physical problems plague a small percentage of those trying to lose weight. More troublesome are diets that ask people to adhere to an unrealistic schedule.
"They fall back into old habits," she says. "They may have been on such a punishing diet that it's impossible to continue. They didn't allow themselves any treats or any carbs or fats."
She says poor planning can doom the best-intentioned dieter.
"Sixty-six percent of Americans are overweight or obese," she says. "We're not talking about that lonely poor soul who's unique or different. We're talking about the majority of the population."
Mr. Neri offers the same type of advice a financial planner might counsel regarding weight loss: "Start young," he says with a laugh.
"Don't wait until you're obese … or you've had a heart bypass."


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