When Yankee Stadium was reopened on April 2, 2009, it had 33,000 fewer seats than the original stadium built in 1923. Each seat was bigger in order to accommodate the "average" fan who had gotten bigger too. Other things that have increased in size over the years are our hamburgers, pizzas, milkshakes and coffins.

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It's not only our drinks that are supersized, it's us! We are the fattest people in the world and the statistics are overwhelming. Two-thirds of Americans are overweight or obese. Obesity is now at epidemic proportions, sadly being the number one cause of death in the nation. The connection between overweight and disease is a given. Heart disease, hypertension, stroke, diabetes, respiratory complications, osteoporosis, joint and arthritic issues and even certain cancers are associated with being overweight.

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Billions are spent each year in an effort to conquer the "Battle of the Bulge." Yet it appears what we are losing is the battle, rather than the bulge! Although we can turn to a vast array of diet books, diet pills, diet shakes, diet programs, prepackaged meals, fat free foods, sugar free desserts, sugar substitutes, diet sodas and diet gurus, we are still in trouble. Even infomercials touting the next torturous exercise machine don't seem to hold the magic bullet solution we are all looking for.

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How did we get here? Are we just a nation of uncontrollable gluttons feeding at the trough? I don't think so! As a clinician for over 35 years, I have seen the despair of those facing the challenge of trying to lose weight. Ironically, we are a nation that celebrates youth and a slim physique. As we stand in line at the super market with our shopping carts filled with foods that sabotage the goal, we are all exposed to the magazine covers picturing exceedingly thin girls as our ideal body type. Since health concerns and psychological wellness are driving forces to our desire to achieve proper weight, why is it that 95% of people who diet end up regaining the weight?

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Americans are facing the "perfect storm" when it comes to getting fat. Every possible factor that can influence weight gain in our society seems to be in place. To begin with, our portion sizes are too big. The French, who are notorious for eating high fat foods, cream sauces and decadent desserts, do not suffer the obesity problem we face. Books have been written pointing out that portion size in France is much smaller than in the U.S. and that the French are not only thinner than we are, they suffer less heart disease. Fast food restaurants in Europe serve smaller portions than their counterparts in America. That is our first problem. We eat too much.

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When Burger King opened in the 1950's, the serving size of French Fries weighed 2.6 ounces. McDonald's was 2.4 ounces and had 210 calories. Today, the typical serving is 6.9 ounces and has 610 calories. Every extra 100 calories we eat daily above what we should be consuming, adds about 10 pounds of weight a year. Some "triple" fast food burgers come in at 1,160 calories per serving and that's without the sides and Big Gulps. We are a culture that celebrates the "endless pasta bowl." The only problem is it's contributing to our "end." Bigger portions mean we eat more at that sitting. It's just human nature. People eat more at buffets than at a regular meal. Studies have shown that when food is served on smaller plates, people eat less. Dinner plates today are about 3 inches larger than in grandma's day.

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Thirty-four percent of meals are consumed away from home. Whether it's from McDonald's kitchen or mama's kitchen, if you take in more calories than your body needs, you will store body fat. There is a science to food and a math to weight loss. If we are simply looking at calorie consumption, it takes about 10 calories for every pound to maintain your present body weight. A female weighing 120 pounds, would need to consume about 1200 calories a day to stay at her present weight, a man weighing 200 pounds, would need approximately 2000 calories. If your desire is to lose weight, you need to lower your calorie intake or increase your expenditure of calories. Nothing new here!

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As far as the science of weight loss goes, in theory it's not complicated. Putting it into action has often proven to be a challenge, but after everything is said and done, there are only three ways to take in a calorie. They are called macronutrients and most of us refer to them as proteins, carbohydrates and fats. Obviously how many calories we consume is paramount to weight loss, but the other major factor is the source of those calories. Proteins come from animals. Soy is the only non animal protein, other than the small amounts found in beans, rice and nuts. Animal protein should always be from lean sources. Fish is a good example. It contains healthy Omega-3 oils that have proven to be heart healthy and a boost to the immune system. Beef, poultry and pork are also examples of protein.

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Carbohydrates have a long history of being misunderstood in America. For years people looked to the no-carb, low-carb diet and as a nation we only got fatter. We need to eat carbs. They are not bad guys. The issue is the kind of carbs. Many people are not even aware that fruits and vegetables are carbohydrates. Unlike bread, grains, pasta, candy and cake, the carbs that Mother Nature has created contain small amounts of sugar and are high in fiber. Scientists call these kinds of carbohydrates "low glycemic." All carbohydrates are comprised of sugar and are broken down in order to be absorbed. The rate at which they enter the bloodstream is very important.

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The carbohydrates from processed foods are rapidly absorbed by the small intestine because they are comprised of simple sugars. The pancreas produces an abundance of the hormone insulin which allows sugar to get into cells and be utilized as fuel for energy. This reaction affects how your body will store fat because when high amounts of insulin are produced, the body retains and stores fat instead of releasing it to be burned as fuel. Low glycemic, high fiber natural carbohydrates do not create the sudden steep rise in blood sugar and do not initiate an abundance of insulin which then drives blood sugar down. Our blood sugar levels are not supposed to look like a flame stitch. Rather, blood sugar should rise and fall subtly throughout the day.

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The last macronutrient, fat, has also been maligned for the past 25 years. "Fat makes you fat," "a moment on the lips, forever on the hips".

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Actually, the body needs fat for energy and proper hormonal balance. Once again, the key is the source of the fat. Healthy fats from avocados, olive oil, nuts, fish and olives are necessary for health. The fats from processed foods that contribute to a high caloric intake cause oxidative stress and harm the cells. Transfats and hydrogenated oils are "bad" fats and contribute to inflammation within the cells as well as the cell membrane. Processed foods containing too many calories, highly sugared carbohydrates and excess fat create the perfect scenario for insulin resistance which is associated with illness and disease. As weight and insulin rise, so do hormone levels. Studies prove that as the reproductive hormone levels of estrogen and testosterone increase, breast and prostate cancer rates go up. Scientists feel that fat, glucose and high levels of insulin affect immune cells and this is what they feel promote certain cancers.

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That is why I often say that we are killing ourselves with our forks.

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If losing weight is simply a matter of taking in fewer calories and making better food choices, why do we now spend an additional $2,800 per person annually on obesity related illnesses? This only adds to our already skyrocketing health care costs. We are now spending $168 billion each year to address America's obesity problem. Now that's a Weighty Problem!

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The Western diet has in large part gotten us to where we are today. Large corporations and food manufacturers have actually studied the science of food addiction and have left us not able "to eat just one." The combination in highly processed foods containing sugar, fat and salt drives us to eat. The brain, not the belly is the organ of diet. Reward centers in the brain motivate us to eat beyond our biological needs. Studies done by the food industry show that the more sugar, fat and salt in a food, the less resistance we have to control. The things that used to influence our food intake no longer count because all those signals are diminished by the brain's desire to activate its reward center.

 

Neither genetics nor metabolic defects can account for our inability to control appetite in today's world. When facing cheese fries, with its abundance of sugar, fat and salt, certain pleasure centers in the brain are activated that keep us wanting more. Because these types of food are so high in calories, it's not difficult to over consume on a daily basis. Cheese fries, as an example, are fried twice; once at the manufacturing plant and then again in preparation before being served. It's sad, because other generations just ate the potato, and did fine.

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We have all experienced craving "something" even though we have recently eaten and are full. Most of the time the body is craving "nutrition, rather than "food." The body requires vitamins and minerals to function Unfortunately, processed foods are deficient or devoid of these necessary nutrients giving us lots of calories but little disease fighting nutrition. A medium sized potato is a great source of potassium. Eating a potato will also supply the body with vitamin C, the B vitamin folate and the minerals iron and magnesium. Natural foods contain lots of healthy fiber that keep blood sugar regulated. Yams, sweet potatoes and red potatoes are even more nutritious than white potatoes. They supply us with antioxidants and phytochemicals including carotenoids and flavonoids.

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We now know that it is not simply hunger that motivates us to eat. If that chocolate milkshake and those M&M's have got a hold on you, it is because these foods generate a sense of pleasure. Sometimes referred to as "comfort food," science has shown that taste is actually hardwired to certain cells in the brain that react and respond to pleasure. Endorphins, brain chemicals that make us feel good, can relieve stress or give us a sense of calm. That is why we often turn to these types of foods when we are under stress. Many people complain they cannot control their appetite when feeling stressed.

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Other approaches to weight management by scientists and pharmaceutical companies have been based on studying how hormones influence appetite. Some hormones, such as leptin, synthesized by adipose tissue have been shown to reduce appetite. Cholecystokinin, known as CCK, is a widely studied hormone involved in the control of satiety. CCK inhibits gastric emptying, resulting in appetite reduction. Another hormone, Ghrelin has been shown to be a vital component in weight control studies. People who are healthy and lean generally have higher ghrelin levels.

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It is no secret that we lead sedentary lifestyles compared to generations that have come before us and it's not news that we should all be exercising. The benefits of exercise are greater than simply looking stylishly slim and burning a few calories. Mitochondria, the little powerhouses of the cell that are responsible for energy, increase with exercise. It is the proper functioning of mitochondria that scientists believe protect us from degenerative diseases like heart disease, cancer and diabetes, linked to being overweight. Clearly, exercise protects us beyond simply working to keep fat cells in check. Mitochondrial production directly increases in proportion to the amount of exercise and physical activity because of the cellular changes that result due to activity.

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Along with a healthy diet that is low in sugar and includes adequate exercise, certain nutrients have proven effective in managing blood sugar levels and increasing metabolic function.

• Chromium enhances the effects of insulin

• B Vitamins are important to carbohydrate metabolism and brain chemistry. This includes Choline

• Vanadium has been found to effect glucose metabolism

• Gymnema reduces cravings and has a positive effect on insulin secretions

• Cinnamon has been shown to have insulin-like activity

• L-Glutamine serves as a source of energy to the brain

• Milk Thistle has been shown to improve fatty liver

• L-Carnitine decreases carbohydrate cravings

• Alpha lipoic acid controls blood sugar levels and prevents peripheral nerve damage

• Co-Enzyme Q-10 stabilizes blood sugar levels

• Gamma linolenic acid (GLA) helps with feelings of satiety and improves energy

• Conjugated linoleic acid (CLA) helps burn off midsection fat by improving insulin sensitivity

• Fish Oils help regulate metabolism

• It seems that so many things influence weight. People who do not eat breakfast usually have more of a weight problem than those who "break" "fast." Even sleep deprivation plays a role in body weight. The association between inadequate sleep and weight gain has been studied for years in the Nurses' Health Study. With over twelve years of data collected, the bottom line is that those who sleep an average of less than seven hours a night were at higher risk of obesity.

• The bad news is that we are fat. The good news is that with knowledge and desire we can reverse this trend that impacts so severely on our ability to attain better health. Behind the storm clouds of illness lies the rainbow of wellness if we just put into practice some of the things that can help restore a more ideal body composition. Proper weight has us living in a body with reduced inflammation, dramatically lower insulin levels, reduced blood pressure, a more functional immune system, a better vascular system, greater energy and less chance of an abbreviated life due to degenerative diseases.

It's worth putting the donut down!