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The RangelMD Diet.

By Chris Rangel MD ⋅ December 1, 2005 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Losing weight and other manageable tasks.

I hate diets. I hate the fact that so many charlatans have made $$Billion$$ selling “special” diets that are nothing more than books full of complicated recipes and pop psychology crap designed to make you feel better about yourself (and about the fact that you were suckered out of $20 for a pile of crap in print form) without a shred of scientific proof of effectiveness behind them. But enough about my pathologic feelings of envy! A reader recently sent me the following;

“I’ve just found out this year that I have hypothyroidism. I currently take synthroid (.1 mg), watch what I eat, yet still am having so much trouble losing weight. I’m really concerned about my weight (I need to lose 70 pounds). Do you have any suggestions as to what sort of diet I need to be on and what kind of exercise would be good?”

First off, don’t buy a diet book! Save that $20 and rent a movie (no workout videos!). Second, forget about hypothyroidism being a significant cause for your inability to lose weight. Other than the huge appetite and obesity seen in patients the genetic abnormality known as Prader-Willi syndrome, there are few if any “diseases” that directly lead to significant obesity.

Acceptance. An amazing number of my patients who tip the scales at 300 + lbs will tell me (with a straight face) that they really don’t eat that much (the same goes for my diabetic patients who have persistently high blood sugar levels)! It’s not politically correct to say this but fat people eat a large amount of food every day. There is no other way to become obese. In addition, the larger a person becomes, the more energy they expend to maintain all that extra weight and so the more they need to eat in order to remain large.

Why the denial? Many obese patients honestly have no idea that they overeat. Studies have found that obese patients underestimate the amount of food they actually eat by 30% or more! Part of this is psychological and part is conditioning. The more people eat as children and as teens the more likely that they will become accustomed to large meal portions and high calorie meals. As an example try the following experiment. Go out to eat with a friend who is very thin compared to yourself. Pay careful attention to how much they eat and I guarantee that you will be astonished at how little they consume before they declare themselves to be full and ask for a “doggie bag”.

Don’t underestimate the influence that “loved ones” have in being enablers for your eating habits. Many family members of my patients have the misconception that eating and gaining weight is akin to healthiness even if this is taken to the extreme of obesity. If everyone in the family has diets of large caloric meals then how are you to know what is healthy when everyone in your family is doing it?

Goals! If you are morbidly obese (BMI of 35-40 or more) then you need to realize that improving your health via moderate weight loss is a much more realistic goal than expecting to lose 100-300 lbs. The bad news is that if you are already morbidly obese, you are unlikely to be able to lose a significant amount of weight (at least in the near term) with diet. However, the good news is that losing only 5-10% of your weight can have significant benefits for your health including better blood sugar control (for diabetics or the avoidance of diabetes), better blood pressure control, and better cholesterol levels to reduce your risk of serious medical conditions. The first goal of weight loss should be in improving one’s health and not the absolute amount of weight lost itself (i.e. 70 lbs is probably excessive and not realistic in the near term).

How? Excessive caloric consumption in excess of energy expenditures leads to weight gain. While fatty foods may lead to more caloric consumption (by virtue of being yummy), it is the carbohydrates (breads, cereals, rice, anything made from wheat) that are stored as fat when diet exceeds energy requirements. Try to substitute other foods (meats, vegetables, fruits) in place of carbohydrates wherever possible. This is not to say avoid ALL carbs! Just cut back on your carbs as you cut back on your calories.

Pointers. KISS; Keep It Simple Stupid! Don’t make your “diet” complicated. If you have to follow complicated recipes, schedules, and calorie counters then you are more likely to quickly lose focus and resort back to your old ways. Find out what you like to eat that is low in carbohydrates and low in calories and STICK TO IT! You are not going to adhere to a diet where you have to eat something you can’t pronounce and that makes you gag. Don’t torture yourself. Your new lifestyle modification should be enjoyable.

This is NOT A DIET! This is a lifestyle modification! A diet implies something that is temporary (thus I hate the term “diet” but I use it here for simplicity). If you are serious about improving your health then this should be something that you should be prepared to do for the rest of your life! It makes no sense to quit smoking for a few weeks only to go back to that pack a day habit. Why then would you “diet” for only a few weeks only to resume your prior eating habits and gain all that weight back?

Avoid “Diet pills”! Currently there is no pill on the market that will effectively make you lose weight and improve your overall health. Diet and exercise are superior in improving your overall health even if it means only modest weight loss. Avoid amphetamines, laxatives, and health food store con jobs like “fat burners” pills. Some of these can be dangerous and the only thing they make lighter in the long run is your wallet. Your diet should actually SAVE you money! If you have to pay to lose weight (other than for excerise) then you are doing something wrong. Trust me. If and when a medication does come out that leads to effective weight loss, improved health, and is safe then you’ll know it. It’ll make the commotion over Viagra look like a minor sideshow in comparison.

Exercise. A sedentary lifestyle certainly contributes to obesity however, exercise alone has not been shown to be an effective part of a weight loss lifestyle. However, exercise has been shown to be effective in maintaining a healthy lifestyle and weight loss of patients who DO lose weight! And exercise has shown health benefits in almost every study and in almost every age group. In short, exercise alone will not help you lose weight but it will help you keep it off once you lose it and will benefit your health in almost every single way! Exercise PLUS diet. *

Other. Stop smoking. Even though you may gain weight in the short term the combination of obesity and smoking is a surefire guarantee of a much shorter lifespan. Drinking in moderation. Excessive alcohol intake actually decreases energy expenditure (hence the famous beer gut). Get a good night sleep. Insomnia is often a sign of what I call the “modern American lifestyle syndrome” where job and family demands put enormous stresses on your ability to lead a healthy lifestyle. If you suspect that you have depression then seek help. Don’t overeat out of boredom, loneliness, or depression.

*I should add this about exercise. Your initial goal should be to do something that increases your heart rate above 140-150 (generally) and makes you sweat for 15-30 mins three times a week. But find something that you enjoy doing or (as with a nasty diet you don’t like) you won’t stick to it for long.

Well, there it is. The Rangel diet. It’s not pretty. It’s not step-by-step instructions on how to become an SI swimsuit model and it doesn’t spoon feed you pop psychology crap about how great a person you are (i.e. I won’t make a mint off this). What I try to do is to avoid all the myths and pit falls that make up 90% of any diet book or diet program. Take it or leave it. After all, it’s free.