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GENERAL DIET AND NUTRITION Are all doctors knowledgeable about all diets? In a perfect world, yes, but we do not live in a perfect world. Many excellent, caring, well educated doctors have, unfortunately, little experience with the many possible diets out there. If your doctor does not approve of your diet choice, listen to his concerns. Do your own study for : info by reading the books, etc. And do the blood work your doctor may suggest before starting the diet and then three months into the diet to access the diet's impact on your health. While it is important to listen to your doctor, you are the one who must live in your body. there fore it is necessary for you to be as informed and knowledgeable about your chosen diet as possible. Therefore, you can make an informed decision, based on all the info about the diet. Discuss this with your doctor and explain to him why you are choosing this diet and that you want your doctor to monitor your health while you are on the diet. This way his concerns will be addressed and dealt with while you are dieting. This will also allow you to examine the efficacy and safety of the diet on an on going basis and educate your doctor about a diet he may not be familiar with. This is in no way a recommendation that you should not listen and follow your doctors advice, just an alternative method, should you wish to follow a diet against your doctors advice. -I keep hearing that a low-fat diet is supposed to be good for me. Why should I eat a low-fat diet, and how low is "low"?- There is strong evidence that the high levels of fat consumed by most Americans (and members of other westernized cultures) cause, or are a contributing factor in, diseases such as gallbladder disease, cancer, and diabetes. High levels of saturated fats, which are found in animal fats, high-fat dairy foods, tropical oils, and hydrogenated (solidified) vegetable oils, raise your cholesterol level and promote heart disease and strokes. The "typical" American diet gets more than 40% of its calories from fat, with the remaining calories coming from protein and carbohydrates. The American Heart Association, the National Academy of Science, the American Cancer Society, and many other groups and nutrition boards across the country recommend a diet in which a maximum of 30% of calories come from fat (no more than 10% of total calories from saturated fats), 55-65% calories come from carbohydrates, and 10-15% of calories are provided by proteins. A growing body of authorities (Pritikin, McDougall, Ornish, et al.) suggest that even lower levels of fat (10-20% of total calories) are much better than 30%, and can actually reverse existing heart disease. Dr. Dean Ornish, for example, recommends a 10% fat vegetarian diet of fresh fruits and vegetables, whole grains, and legumes (peas and beans); nonfat dairy products and egg whites are also allowed. Alcohol (which suppresses the body's ability to burn fat) and processed sugars (which can trigger food cravings in many people) are discouraged. From a weight loss standpoint, a low-fat diet is ideal because it minimizes the amount of fat that your body has to store in the first place. Excess dietary fat can be directly stored by your body, no conversion needed (so perhaps there's some truth in the adage, "Cheesecake goes straight to my hips"). Proteins and carbohydrates, on the other hand, are usually burned up immediately rather than being stored. They can be converted to fat if they're present in sufficient quantities, but that's quite a bit of work for your body. -Should I eliminate all fat from my diet?- You couldn't even if you wanted to, and you really don't want to. Even "fat-free" foods such as raw vegetables and dried beans contain trace amounts of fat, so there's no way you can totally escape the stuff. Besides, your body does require small amounts of fat for lubrication, essential fatty acids, and fat-soluble vitamins. However, you could eliminate all pure fats (e.g., butter/margarine, cooking oils, etc.) and high-fat foods (non-skim dairy products, red meats, nuts, etc.) from your diet and still get all the fat that your body requires from those trace amounts. -How can I tell how much fat is in the foods I eat?- For processed foods, check the nutrition information panel on the package, which should indicate how many grams of fat one serving contains; each gram of fat contributes about 9 calories towards the total number of calories per serving. For example, one serving of crackers might break down as follows: 60 calories, 1 gram of protein, 10 grams of carbohydrate, and 2 grams of fat. In order to determine what percentage of the calories in this food come from fat, multiply the weight of the fat (in grams) by 9, then divide this figure by the total number of calories in a serving. In our example, 18 calories (2 g fat * 9 cal/g), or 30% of the total calories (18 cal/60 cal = 0.30), come from fat. The remaining calories come from the protein and carbohydrate, which each provide only about 4 calories per gram. (If the weight of a serving of food is more than the combined weight of its fat, protein, and carbohydrate weights, the "missing" weight is probably due mostly to water, which has no calories.) NOTE: Take a closer look at those food products that proudly proclaim that they're "85% fat-free!". Such statements can be misleading, since they usually mean that the productis 15% fat by weight, not that the product gets only 15% of its calories from fat. (Gram for gram, fat contains more than twice as many calories as protein and carbohydrates.) For example, a serving of a brand-name turkey breakfast sausage which is allegedly "85% fat-free" has 6 grams of fat in each 80-calorie serving, and therefore gets more than 67% (6 * 9/80 = 0.675) of its calories from fat. You may wish to purchase an inexpensive book on nutrition information to look up foods which are not labeled with nutrition information. (Or, try the Nutrition Analysis Tool at http://www.ag.uiuc.edu/~food-lab/nat/. It works best with browsers capable of displaying tables.) Fruits, vegetables, berries, grains, legumes (peas and beans), and egg whites generally have little fat. (Avocados, olives, nuts, soybeans, and seeds--such as sunflower seeds, and even seeds from low-fat vegetables such as pumpkins--are exceptions.) Any food which looks oily or leaves greasy stains on a paper napkin is probably high in fat. This doesn't mean that you should never eat high-fat foods, only that you should balance them with lower fat foods such as grains, vegetables, and fruits. Keep the broad picture in mind; evaluate your diet over a period of a day (or a couple of days) and aim to keep your total fat intake under 30% at most (10-20% if possible). -How do the new nutrition labels on processed foods differ from the old labels?- The new nutrition labels, which debuted in May 1994, may make evaluating the nutritional values of processed foods a little easier for most people. The new labels list not only the amounts (weights) of fat (total and saturated), cholesterol, sodium, carbohydrates (total, fiber, and sugars), and protein in the food, but also the percentage of the "Daily Value" that most of these provide. (The term "Daily Value" replaces the old term "Recommended Daily Allowance," although the actual nutrition recommendations have not changed.) Daily Value percentages are also listed for vitamin A, vitamin C, calcium, and iron; depending on the food, percentages for other vitamins and minerals may be given. A Daily Value percentage is not given for protein. (FDA pamphlet #932260, "How to Read the New Food Label," states that "most Americans get more protein than they need"; presumably this is why no value is listed.) The Daily Value percentages are based on a 2,000-calorie-per-day diet in which no more than 30% of the calories come from fat, so if your needs are different, you'll need to keep this in mind when reading the labels. The U.S. Food and Drug Administration offers a simple rule of thumb: If the percentage of Daily Value for a given nutrient is less than 5%, the food is considered low in that nutrient. Therefore, you should look for foods that have low Daily Value percentages for fat, cholesterol, and sodium, and high percentages of carbohydrates (including fiber), vitamins, and minerals. Other provisions of the new food labeling standards: *All packaged, processed foods must now carry nutrition labels. Previously, nutrition labels were voluntary, and many foods were unlabeled. * Terms such as "fat-free," "low-fat," "lean," "light" (or "lite"), etc. are now defined by the government. Previously, food manufacturers were free to describe their foods in any way they liked. * The serving sizes used to determine the Daily Value percentages are now more realistic (read "larger") and are expressed in terms that are easier for consumers to deal with. For example, serving sizes for chips and crackers are now expressed as "x pieces" rather than "x ounces." -What is fiber? Is it important?- Fiber (also known as "roughage") is simply the non-digestible portion of the foods that we eat. (There are actually several different types of fiber, such as cellulose, hemicellulose, lignin, pectin, and guar.) Fiber is found chiefly in non-processed foods such as whole grains, legumes (beans and peas), fruits, and vegetables, especially in the outer layers of such foods. Fiber may be added to processed foods in the form of bran, which is the outer coating from a grain such as wheat or oats. A high-fiber diet has a number of benefits: * It speeds the elimination of fecal material from the body. This can reduce or cure constipation and intestinal polyps, alleviate hemorrhoids which often result from straining during bowel movements), and may greatly reduce the risk of colon cancer. It may also prevent or alleviate diverticulosis, a condition in which the intestinal lining develops small pockets in which fecal material can be trapped. * It fills out the stomach and intestinal cavity. This produces a sense of fullness which is a real boon in weight control. * It can alleviate conditions such as spastic colon and diarrhea because fiber absorbs excess water and produces a bulkier stool. *Some types of fibers, particularly those found in whole fruits and legumes, tie up sugar molecules so that the levels of insulin normally produced after eating are reduced, a big advantage for diabetics. (This effect is most pronounced when fruits and legumes are eaten whole, rather than as fruit juice or ground beans.) The typical American diet is high in processed foods, most of which contain little or no fiber. Most people get only around 10-12 grams of fiber per day, but you need 25 grams or more to get the real benefits. If your current diet is low in fiber, it's important that you increase fiber gradually over a period of weeks or months; sudden increases can cause bloating, cramping, and gas. Try having a small serving of a high-fiber, low-fat cereal with your breakfast; as your system becomes used to the higher fiber levels, start substituting whole-grain breads, cereals and pastas for the refined (white flour, low-fiber) varieties you've been eating. Increase your consumption of fresh fruits and vegetables, and consume edible peels and skins (e.g., on apples and potatoes) rather than trimming them. -Is sugar a no-no?- Sugar has gained a nasty reputation over the years largely because it is so often found in combination with high levels of fat in foods such as ice cream and pastries. Sugar is also a major source of "empty calories": calories which are not accompanied by any appreciable nutrient value. In terms of weight loss or maintenance, sugar is not necessarily objectionable, provided that you can keep your intake of it down to moderate levels. Since it is a carbohydrate, it is normally metabolized (burned) by the body immediately, and is converted to fat only if present in quantities too large to be used at once. Some people do find that even moderate amounts of sugar stimulate cravings for yet more sweets, often of the high-fat variety. If you are one of these people, you may wish to eliminate processed sugars from your diet, relying instead on the natural sweetness of fruits, vegetables, and grains. -What about artificial sweeteners?- Artificial sweeteners may be an effective aid for those who have occasional cravings for sweets, but probably work against those of us who have an active sweet tooth. The taste of artificial sweeteners can trigger sugar cravings about as well as real sugar can. Some long-term users of artificial sweeteners use sweeteners in addition to all the foods they normally eat, rather than as a substitute for part of the foods. -What is the new "Food Pyramid" I've heard about? Is it similar to the "Four Basic Food Groups"?- It replaces the "Four Basic Food Groups" plan, which was heavily influenced by the meat and dairy industries. It's quite possible to eat a healthy diet without using any meat or dairy products, which can be high in fats anyway. The new "Food Pyramid" is a step in the right direction, since it emphasizes fruits, vegetable, and grains, and suggests smaller amounts of protein sources (meats, legumes, dairy products, etc.) than did the Four Basic Food groups. /\ / \ /Fats \ / oils \ /sweets \ / go eassy \ /=========\ / | \ / Dairy | Protein \ / (23 | (23 \ /servings)| servings)\ / | \ /================\ / Veggies | Fruits \ / | \ / (35 | (24 \ / servings) | servings) \ /======================\ / Grains \ / \ / (breads, cereals, rice, pasta) \ / (611 servings) \ /............................................................\ (See http://www.nalusda.gov/fnic/Fpyr/pyramid.gif for a large color GIF of the Food Pyramid.) If the quantities of food suggested here seem excessive (eleven servings of bread and cereal a day?!), remember that the USDA's idea of a serving is often much smaller than the portion that a typical consumer actually eats. For example, a serving of vegetables is only 1/2 cup of cooked or raw, chopped vegetables, or 3/4 cup vegetable juice, or one cup of raw, leafy vegetables like spinach or lettuce. A serving of fruit is 1/2 cup of bite-sized fruit pieces, 1/4 cup dried fruit (e.g. raisins), 3/4 cup of fruit juice, or one medium piece of fruit (e.g., a medium orange, apple, or banana, or one half of a grapefruit). A serving of dairy products such as milk or yogurt (look for skim or low-fat varieties) is one cup; a serving of cheese (which should be used in moderation or replaced with low-fat varieties) is 1-1/2 ounces of natural cheese or 2 ounces of processed cheese. When it comes to proteins, many Americans far exceed the recommended servings per day: a serving of meat is only 2 to 3 ounces of cooked meat, a portion about the size of a deck of cards. One ounce of meat can be replaced by 1/2 cup of cooked beans, 1 egg, or 2 tablespoons of peanut butter (remember that whole eggs and peanut butter are high in fat and should be using sparingly). For grains, a serving is considered to be one ounce of bread (about one slice) or dry cereal (most of us consume at least 1-1/2 to 2 ounces of breakfast cereal at a time), or 1/2 cup of cooked grains or pasta. Since a typical serving of rice is 3/4 to 1 cup, and a plateful of pasta contains around 2 cups of the stuff, most of us have no problems meeting the suggested servings per day. -Is Promise Ultra Fat-free Margarine really fat-free?- According to its label, one serving (one tablespoon) of Promise Ultra margarine contains 5 calories, 0 g. protein, 0 g. carbohydrates, 0 g. fat, 0 g. cholesterol, and 90 mg. sodium. The ingredient list includes water, vegetable mono and diglycerides, gelatin, salt, rice starch, lactose, vegetable diacetyl tartaric acid ester of mono and diglycerides (Datem), potassium sorbate and lactic acid (added as preservatives), artificial flavor and color added including beta carotene, and vitamin A palmitate. Because of its high water content, Promise Ultra cannot be used to fry foods, and should not be substituted for regular margarine or butter in baked goods because the texture of the final product would probably be adversely affected. However, Promise Ultra could be used to sauté vegetables or to add flavor to moist recipes. Informal taste-tests by a.s.d'ers have produced mixed results, to say the least; some people find the taste acceptable on toast, hot vegetables, etc., while others find the taste repugnant. YMMV. WEIGHT LOSS PHASE -Are there any computer programs that will help me plan my diet or keep track of the foods I eat?- The following programs are used and recommended by various a.s.d members: * Nutritionist IV (for DOS and Windows), published by N-Squared computing phone#: 800-289-1701). Analyzes the fat, carbohydrate, protein, fiber, sodium, vitamin, and mineral content of your diet; comes with a database of 8,500 foods (database values can be edited, and new foods and recipes can be added). Nutritionist IV is intended more for professional dietitians and physicians than for end-users, and therefore is rather too expensive (US$495) for most casualusers. * Diet Analyst [for PC-compatibles, I assume?--kbc], from Parsons Technology; about US$20 Diet Balancer for PC-compatibles, from Nutridata Software Corp. phone#: 800-922-2988); about US$60. Analyzes your food intake for fat, carbohydrate, protein, fiber, sodium, vitamin and mineral content. * Michael Traub (firstname.lastname@example.org) writes: "I have a freeware program that relies on data from the USDA. That data is available at http://www.nal.usda.gov/fnic/foodcomp/Data/SR11/. The program is available directly from me. The user will require a C compiler and an MS-DOS or Unix platform." * DINE for the Macintosh, available from Nutrition Action Healthletter for around US$80-90. (Note: The January/February 1995 Nutrition Action Healthletter lists a program called "Dine Healthy" for Windows or Macintosh; US$99 + US$5.50 shipping/handling. Call 800-237-4874 to order.--kbc) * DietLog for the Newton MessagePad, available from Mac Warehouse (800-255-6227) * Digital Gourmet for Macintosh, US$69.95, available from Mac Warehouse (800-255-6227) * Shareware/freeware available via anonymous ftp and national online services: ^ Diet Tracker for Win 3.1, tracks weight changes: available from America Online as DTK21.ZIP ^ From Scratch recipe program for Win 3.1: ftp://ftp.coast.net/pub/coast/win3/food/ ^ Gut-buster for Newton MessagePad, tracks intake for exchange diets: ftp://ftp.uiowa.edu/pub/newton/medical-health/ ^ Heart Rate Zone Calculator for Mac (Hypercard): available from America Online ^ Heart Smart for Windows, tracks calories, fat, cholesterol: available from America Online as HSMART40.ZIP (for Win 3.1) or SMT4095.ZIP (for Win 95). ^ NutriGenie publishes a wide variety of nutrition- and health-related shareware for Win 3.1, including "Fat to Fit," "Compleate Nutritionist," "Eat Well, Weigh Less," "Pregnancy Nutrition," "Diabetic Nutrition," and *Carbohydrate-Restricted (Atkins) Diet Meal Planner." The software is available through their Web sites at http://users.aol.com/nutrisoft/ and http://pages.prodigy.com/CA/nutrigenie/. The programs are also available by ftp at ftp://ftp.coast.net/pub/coast/win3/food/ (check the file .00_index.txt for descriptions and exact filenames) ^ Nutri-Base Jr. for Win 3.1, nutrition analysis: available through America Online as NUTRBSJR.ZIP ^ Weight Commander for Win 3.1, weight tracking program: ftp://ftp.interaccess.com/weightcmdr/dload.exe ^ Wellness Inventory for Mac (HyperCard): available from America Online as WELLNESS INVENTORY -How many calories per day do I need?- Your body needs a certain number of calories per day just to keep you alive and to maintain yourbodily functions (breathing , digestion, etc.); this figure is referred toas your Basal Metabolic Rate(BMR). You can estimate your BMR by multiplying your current weight (inpounds) by 10 for women,11 for men. For example, a woman who weighs 120 pounds would require about1,200 calories perday just to maintain her bodily functions. You'll also need some percentage of calories above your BMR to provide energy for your daily activities (using your hands and arms,walking, exercising, etc.); the percentage will vary widely based on your metabolism and activity level. A moderately fit and active person might need 30-50% calories above her BMR to maintain her current weight; our hypothetical 120-pound woman would need approximately 1,680 calories per day (1,200 + (1,200 * .40) = 1,680) assuming that she is somewhat active. A person who is very fit and exercises frequently might burn as much as 100-200% more than his/her BMR. If your goal is to lose weight, you'll need to take in fewer calories than you use up, or burn off additional calories through exercise, or both. If you choose to decrease calories, aim for the amount needed daily to maintain your ideal (not current) weight. Most health care professionals recommend that women take in at least 1,200 calories per day (1,400 for adolescent girls, 1,600 for men); at lower calorie levels, you're likely to be cheating yourself of essential nutrients. -Can I lose weight faster by consuming fewer calories?- Sounds like good math, but your body doesn't work like that. If you make a habit of consuming fewer calories than your body requires, your body will automatically go into "starvation mode." In effect, your body says, "If (s)he ain't gonna feed me, then I'd better slow things down until (s)he decides to eat again." There are some awfully compelling reasons to lose weight slowly. If you lose more than a pound or two per week, you're almost certainly losing muscle, not just fat tissue, and that's exactly what you don't want to do. (It's your muscles, after all, that work to burn off the calories you take in!) Also, weight lost quickly is far more likely to be regained than weight lost very gradually. -Is it really necessary to drink 8 glasses of water per day while dieting?- Many physicians, dietitians, diet plans, etc. recommend that you drink 6-8 glasses (8 oz./glass) of water per day, quoting one or more of the following reasons: * Most people already drink far less fluids than they should, and dieters in particular should avoid the physical stress that dehydration can cause. * You can be dehydrated without being thirsty; drinking this amount of water ensures adequate levels of hydration. *Fluids temporarily distend your stomach, relieving the hunger pangs that some dieters experience. Well, maybe. You should definitely drink whenever thirsty, and if you exercise regularly (as you certainly should), then it's an excellent idea to drink an extra glass of water both before and after you exercise. (Sipping cool water during exercise is also great, but may be impractical.) An easy way to tell if you're getting enough fluids is to check the color of your urine in the toilet bowl: if it's colorless or light yellow then you're adequately hydrated; if it's medium or dark yellow, you need to drink more. There's also a lot of controversy about whether you must drink only water, or if other fluids (Gatorade, fruit juices, diet pop, etc.) are acceptable. Gatorade and other "exercise drinks" are expensive ways to get sugar and minerals that you probably don't need unless you exercise for long periods (at least 90 minutes at a time); the calories from fruit juices can add up quickly, especially when ingested in large amounts; some varieties of soda pop (and coffee and tea) contain caffeine that you really don't need, and the carbonation can cause cramping in some people. Your best (and cheapest!) bet is plain water. -Is skipping a meal a day an effective way to lose weight?- All else being equal, it would probably work better to have more meals, not fewer. A large meal causes your body to release a lot of insulin, which promotes the conversion of food into stored fat. If you haven't eaten in several hours, your metabolism decreases and you actually burn fewer calories than if you "graze" (eat 4-6 small meals throughout the day). -I'm afraid that I'll have to give up all my favorite foods in order to lose weight. Is this true?- There are no "bad" foods; it's just that most of us tend to eat too much of foods that are high in fat and low in other nutritive values. If you can teach yourself to eat and enjoy fatty/sugary foods only occasionally, there's no reason that you can't indulge yourself every once in a while. Be warned, though: once your stomach has gotten used to a low-fat diet, you may find that greasy foods produce unpleasant gastric effects (bloating, nausea, diarrhea). Interestingly, dieters have traditionally listed starchy foods, such as bread, pasta, and potatoes as foods that they most missed while on a diet. Of course, we know now that these foods (preferably whole-grain varieties and without fatty sauces and toppings) are an important part of a balanced diet, and should in fact make up the bulk (at least 60-65%) of your diet. -Can I lose weight without dieting?- If by "dieting" you mean a temporary regimen of eating measured portions of raw veggies and expensive, funny-tasting "dietetic" foods, then the answer is yes. Your goal should be to adopt healthy eating and exercise plans that you can live with for the rest of your life; these two factors can be enough to cause gradual weight loss in most overweight people, without the need for regimented diets. And these plans will serve you well after you've lost the weight, too--most of us who have successfully maintained our weight losses find that we can eat whatever amounts of low-fat, nutritious foods (whole grains, fresh fruits and vegetables, low-fat dairy products, legumes, etc.) we need to satisfy our hunger, without regaining the weight. There's no need to deny real hunger pangs, so long as you satisfy them with healthy foods. Note that it is possible to lose weight (without changing your eating habits) by increasing youractivity levels dramatically, although this approach won't necessarily makeyou healthier. -Are surgical procedures like liposuction or stomach stapling a good way to lose weight?- Liposuction (also known as lipolysis or suction lipectomy) is a surgical procedure in which localized deposits of fat tissue are suctioned out of the body through a long, thin metal tube known as a cannula in order to improve body proportions (e.g., to reduce "saddlebag thighs," oversized buttocks, or double chins). Liposuction is not appropriate as a weight loss method; because of the large amounts of blood and body fluids that are suctioned out along with the fat, only about 2-5 pounds of tissue can be removed during the procedure. Most reputable plastic surgeons recommend that liposuction be used only on patients who are already at or near their ideal body weights and whose unsightly bulges fail to respond tosensible diet and exercise plans. [Since liposuction is not a weight loss procedure, it will not be described in detail here. For those interested inthe details of the surgery, check your local library or bookstore for references on plastic surgery, such as Dr. Paula Moynahan's Cosmetic Surgery for Women by Paula A. Moynahan, M.D., or The Complete Book of Cosmetic Surgery by Elizabeth Morgan.--kbc] Surgical procedures that are used to treat obesity include gastric bypass and gastric reduction or partitioning (a.k.a. stomach stapling). These are both drastic measures that are normally used only when more conventional weight loss methods have failed and the patient's health is compromised by his/her weight. The gastric bypass procedure involves stitching or stapling across the entire width of the stomach, closing off the bottom portion of the stomach and leaving only a fraction of the upper part of the stomach open to receive food. A small opening is made in this remaining "pouch" of stomach; the jejunum (a part of the small intestine) is brought up and ttached to this small opening. As a result, all food and fluids ingested by the patient must now pass through this small opening in the top of the stomach and then directly to the attached small intestine. The stomach stapling surgery also uses staples or stitches to close off part of the stomach, but in this procedure, the staples or stitches are not placed across the entire width of the stomach. A small opening, about 1/8 to 1/4 inch (.3-.7 cm) in diameter, is left through which food can pass into the lower portion of the stomach and then into the small intestine as usual. Both of these procedures reduce the size of the stomach so that only very small amounts of food can be stored in it at any given time; the patient feels full after eating tiny portions of food. Because the opening into the remainder of the digestive tract is also reduced in size, food must be chewed very thoroughly (or pureed) so that it will pass through the opening. Attempting to eat too much at one sitting, or failure to chew food slowly and thoroughly can result in upset stomach and vomiting. Weight loss following surgery is dramatic: 26-44 lb. (12-20 kg.) in the first month, with total weight losses of 50 lb. (23 kg.) or more being quite common. However, neither of these surgical procedures should be viewed as a quick or easy fix to a lifetime of obesity. Because the surgery drastically decreases the amount of food that the patient can eat, special care must be taken following the surgery to ensure that the patient consumes a nutritious diet which is low in fat and has adequate amounts of vitamins, minerals, and fiber. The patient must also accept the necessity of eating small meals and chewing food completely to prevent regurgitation. Some patients find themselves unable to tolerate the discomfort created by gas-producing foods such as carbonated beverages. Neither procedure is without risks. As in any major surgery, bleeding, infection, and anesthesia-related complications are possible. Increased occurrence of gallstones, vitamin deficiencies, and occasional stomach ulcers have also been reported, although patients who have undergone the stomach stapling procedure seem to be affected by these complications less often than are gastric bypass patients. Neither operation is foolproof, either--the size of the upper "pouch" of stomach can increase with time, as can the size of the opening left following stomach stapling. Either of these occurrences can allow the patient to eat more without feeling bloated or experiencing vomiting, and can result in gradual weight regain. It is also possible for patients to regain weight by consuming high-calorie foods such as milkshakes which will pass through the opening. The long-term success rate of these procedures is estimated to be around70-80%. -How many pounds a week should I lose?- Although it's tempting (and motivating) to lose a lot of weight quickly, this really hurts you in the long run, since you'll be losing muscle mass long with the fat. A rough rule of thumb is that you should lose no more than 2 pounds per week, with 1/2 to 1 pound being better. A more precise rule is that you should lose no more than 1 percent of your current body weight per week, so if you weigh 250 lb. (113 kg.), you could safely lose 2.5 lb. (1.13 kg.) per week. Again, this is a maximum weekly rate; to be safer still, aim for .5 percent of your current weight. Study after study indicates that the slower you lose weight, the more likely you are to actually lose fat, rather than muscle tissue, and that the slower you lose weight, the more likely you are to keep that weight off permanently. -Why do men seem to lose weight faster/more easily than women?- Sorry, ladies, this is just one of life's inequities. Men tend to have more muscle tissue than women, and muscle tissue is what does the work that burns calories. Women also have a genetic tendency to retain fat more efficiently than men, since adequate stores of fat are vital during pregnancy. Women may take some comfort in the fact that men tend to accumulate their fat deposits around the belly, which puts them at higher risk of heart disease than women, who tend to put on fat below the waist (hips and thighs). -Some weeks into my diet, my weight loss just stopped, even though I followed the diet plan to the letter. What did I do wrong?- Not a thing! You've encountered a "plateau," a normal (and temporary) pause in weight loss. Your body has learned to adapt to your lowered caloric intake and has slowed down your metabolism in order to conserve energy. The solution to getting past a plateau is not to lower your caloric intake even further, but to continue with your current eating plan, and perhaps to increase your exercise somewhat. Reducing your food intake will only reinforce our body's perception that it is caught in a starvation situation. Plateaus seem to be more common in persons who have dieted repeatedly in the past; their bodies have learned all too well to hang onto the few calories that do come in. -Once I've lost the weight, how can I keep from regaining it?- Continue whatever you did to lose it. Phrasing it another way, don't do anything to lose it that you aren't willing to continue as long as you want to keep the weight off (e.g., forever). For the overwhelming majority of people, weight lost on fad or crash diets is regained within a matter of months or years, leading to yet another fad diet, weight loss, weight regain, etc. (a pattern commonly known as "yo-yo dieting"). There is anecdotal evidence that repeated weight loss/regain make it more difficult to lose weight each time--presumably because your body comes to believe that it is encountering famine situations and becomes more and more adept at hanging on to whatever calories are present--and that the stress of repeated dieting may have other adverse affects. A 1988 study of over 11,000 Harvard alumni found markedly higher death rates from cardiovascular disease among male alumni whose weights had changed significantly (up or down) between the early 60's and 1977.