A Cardiologist’s Advice on Weight Loss (For What It’s Worth)

Every now and again a patient will ask me my recommendations on how to lose weight. Makes sense, right? Your cardiologist is always harping on you to quit smoking, lose weight, exercise more, get healthier—he should be the one with all the answers. Well, here's a little secret. At no point during medical school or postgraduate education (3 years of internal medicine, 3-4 years of cardiology fellowship) do we ever take classes on exercise, nutrition, or weight loss. As a matter of fact, during my entire specialty training I remember only one or two hours' worth of lectures on anything remotely related to health maintenance. Let me just say from the outset that I have no expertise in the field of diets or weight loss, and my understanding of exercise comes only from my own experience as a runner and cyclist. In many ways I am just as much in the dark as my patients are. This is not to say that other cardiologists are as clueless as I am (some are quite knowledgeable—see *shameless ad at end of this post), just that our medical training focuses more on disease management than disease prevention. But don't put all the blame on us. Insurance companies turn a similar blind eye to diet regimens, and will more readily pay for your Viagra than enrollment into a healthy weight loss program.So don't worry, Dr. Oz, I won't be scooping you on Oprah anytime soon. Fear not, Dr. Atkins, I don't plan to author a fad diet book in the near future, and if I did it would undoubtedly languish on the back shelves, gathering dust, until it gets bumped to the bargain book rack with the Complete Encyclopedia of Vintage Automobiles and The Ukrainian Meatball Cookbook.Every since the very first mass marketed diet (purportedly Dr. William Banting's 1863 Letter on Corpulence, Addressed to the Public—you gotta love that title) the industry has ballooned into a bazillion dollar enterprise with new books, fads, programs, DVDs and talk show experts popping up every year. Patients will frequently ask me my opinion on a particular diet plan and, since I'm not a regular fan of The View or Oprah, I have to confess ignorance about most of them. Can you lose weight by eating nothing but celery and jelly beans? Heck if I know (I know I would). Is Atkins better than South Beach? What about the Zone diet? How exactly does one live on cabbage soup?

When it comes to fad diets the best I can offer is anecdotal experience that I glean from my own patients. Weight Watchers seems pretty good since it lets you eat what you want, just in small portions. No human I've ever heard of has been able to stay on the Atkins diet for longer than a few weeks (I'll take a little bacon with that half-pound bun-less cheeseburger and a side order of pork rinds, please). The Zone diet seems pretty sensible to me, as does the South Beach, although I don't know more than the rudimentary basics about each. Dean Ornish's approach of a low-fat vegetarian diet, regular exercise and yoga seems like a good way to trim down but it may be a bit too "new age" for the average Husker fan.

But, despite my confession of utter ignorance, some patients continue to press me for my opinion. Thus, for them I've compiled all the common sense recommendations my limited intellect has to offer:

1. It's simple math. To lose weight you need to take in fewer calories than you expend. All successful diets come down to the same straightforward principle—you must either exercise more, or eat less, or both.
2. Set reasonable goals. Don't try one-up The Biggest Loser by dropping 50 pounds in a season. Focus on losing one or two pounds a month. Stick to that goal for two years and you'll be 25-50 pounds lighter.
3. Start by cutting out things you know are bad for you. Fried foods, sugary treats, greasy sauces, and fatty meats are pretty obvious targets if you want to cut back on calories that go straight to your hips.
4. Stay away from sugary drinks. If you absolutely have to consume liquids that are full of calories try skim milk. It'll give you protein, calcium, and vitamin D. Beer, when it's more than a can or two a week, has got to go, too.
5. Don't eat after 6 p.m. Many people consume half their daily calories in a late meal and late, late snacks. Don't worry—eat a healthy, early dinner and you won't go to bed hungry.
6. Don't eat out so much. A diet of restaurant food will fatten you up faster than you can say two-all-beef-patties-special-sauce-lettuce-cheese-pickles . . .
7. Inject more fruits and vegetables into your diet. It'll fill up your stomach and provide much needed nutrients.
8. Fix and bring your own lunch from home. Stay away from the dreaded Workplace Grazing Syndrome (no, it's not a real medical syndrome, but it should be). To quote Nancy Reagan: just say no.
9. Exercise daily. You don't need join a gym, or hire a trainer, or invest in a $3,000 elliptical machine (unless you need a new clothes hanger). Just find a route by your house where you can go for a 30 to 45 minute walk. You've got to make it as much of your daily routine as brushing your teeth or using the toilet—it's got to be habit. Forty-five minutes of brisk walking every day and I can guarantee you'll be a different person in a few months.
10. Park out in the corner of the parking lot, take the stairs, spend less time in front of the TV or computer, get your spouse involved in your exercise, take the dog for more walks—anything to increase your activity.
11. Stay off the scale for 3 months. Do all the things I describe above and then stop worrying about how much you weigh. After three months of cutting back portions and increasing your activity you won't need a scale to tell you how much better you feel, how much less your knees, hips and back are screaming, and how your exercise capacity has improved. Even if you don't lose a pound (which I doubt) you'll be better off for your efforts and your heart will be much healthier.
12. Finally, take one night a week, go out to your favorite restaurant and just go crazy. Call it a reward for a week of good habits. Order a steak, a bloomin' onion, cheesecake for desert, whatever. Just enjoy yourself (and take some Maalox when you get home). It's impossible to be perfect all the time, but it's reasonable to be good most of the time.

There you have it. All the knowledge I possess in twelve short bullet points. Maybe if I beef up the prose, throw in a few extra adjectives, and put a recipe section at the end I could turn it into a book. Who knows? Just remember to look for it at your friendly neighborhood bookseller in the bargain section right behind the meatball cookbooks.