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Losing is Winning 

Dieting is a multi-million-dollar industry, but successfully losing pounds and inches and maintaining a healthy weight still comes down to the basic equation of more calories burned than consumed

A defining moment for Noelie Burke was having to sit down every five minutes when she was trying to prepare dinner to alleviate the pain in her joints. At 38, she weighed more than 400 pounds and was a virtual shut-in — ironic for a woman who makes her living planning trips for people as co-owner of Serenity Travel in Westwego. Although she has been overweight since she was a child and had failed in various efforts to lose weight since she was 8 years old, Burke decided to try one more time.

  "I fought my weight my whole life," she says. "I think until this time, I never really understood that there was such an emotional and mental component to this whole thing. I would go on a diet and lose 30 or 40 pounds, then I would gradually fall into old habits.

  "I think I had finally reached a level of physical misery that I had to do something. When you weigh over 400 pounds, I was in a whole lot of physical pain. I couldn't walk to the bathroom without getting winded; I couldn't stand for more than five minutes without intense pain in my joints. I was crippled from being so heavy. Then comes the mental part, where physically I couldn't fit in the seats at the movies; I couldn't walk for more than a few minutes, so I couldn't go to the grocery. I felt like I was a prisoner in my own body."

  Burke rejected the option of gastric bypass surgery in favor of Medifast, a 59-year-old weight-control program that has been recommended by 50,000 physicians. It calls for five meal replacements and one meal of lean meat and green vegetables every day. In a year and a half, she lost 219 pounds and went from wearing size 7X clothing to size 14, a success she attributes in no small part to her online support community.

  "I didn't work with a doctor," Burke says. "I hadn't been to a doctor in a while; they never have an answer to how I am supposed to [get rid of the weight and keep it off]. What I found [in Medifast's online community] far exceeded my expectations. ... Over the course of a year and a half, you really get to know people. There were days when it would have been so easy to just say, 'Forget it. This is too hard.' Instead of eating a doughnut, you go to a forum and tell them, 'I'm having a very, very bad day.' They rally around you, and it's nonjudgmental support."

  Medifast and sheer tenacity worked wonders for Burke, but there is no single weight-loss program that works for everyone. The factors for success are as varied as the reasons people become obese in the first place. There are, however, lots of facts that ring true for almost every overweight person: The more body fat you carry around, the higher your risks for developing heart disease, high blood pressure, Type 2 diabetes, gallstones, breathing problems and some cancers. To lose weight, you must expend more calories than you take in, which normally means you need to exercise in addition to eating nutritious foods that aren't immediately stored as fat, and you need to eat smaller portions.

  Dr. George Bray, a researcher at Pennington Biomedical Research Center in Baton Rouge and an expert in obesity and metabolism, contends the type of diet you choose — high-fat, low-fat, protein or carbohydrate — is less important than finding a heart-healthy program with reduced calorie intake and sticking to it over time. In "Pounds Lost," a study published in the New England Journal of Medicine in February, Bray and researchers at Havard's School of Public Health followed volunteers who each went on one of four different diets over two years. Researchers found that participants who stuck with their diet lost an average of 13 pounds in the first six months, maintained a 9-pound loss after two years and lost between 1 and 3 inches in their waists. The four diet programs differed in proportions of three major nutrients: low- or high-fat (20 percent to 40 percent of calories), average- or high-protein (15 percent to 25 percent of calories), and high- or low-carbohydrate (35 percent to 65 percent of calories). All the diets were high in fiber and low in saturated fats and cholesterol. At least 90 minutes of moderate-intensity exercise a week and both group diet counseling and individual sessions every few weeks were also part of the program.

  The most important decision, Bray says, is to find a healthy diet you can stick with over time, a fact backed up by other physicians, researchers and dieters. Analyses and studies of major weight-loss programs by ConsumerSearch.com, the BBC, Consumer Reports and the Journal of the American Medical Association consistently place Weight Watchers in one of the top two spots in their rankings. Other plans that scored high include Slim-Fast and Jenny Craig. Consumer Reports alone included The Volumetrics Eating Plan, which garnered its top spot. Weight Watchers' success often is attributed to the fact that it teaches you how to eat healthily, providing recipes for tasty dishes and a point system for counting calories as well as incorporating in-person support at meetings. Jenny Craig provides prepared meals as well as recipes you can cook at home. Both of these programs focus on lifestyle changes that will keep off the weight. Slim-Fast uses meal-replacement products such as shakes, snack bars, soups and more. Volumetrics, developed by nutritionist Barbara Rolls, focuses on filling up with foods that are low in calories instead of reducing portions, so dieters always feel full.

There are factors other than food intake that lead to weight gain and obesity.

  Nikhil Dhurandhar, associate professor of infection and obesity at Pennington Biomedical, believes the adenovirus (a virus with DNA) Ad36 leads to obesity in humans. "There are 10 (viruses) that have been shown to cause obesity in animal models by various groups," he says. "For ethical reasons we can't infect humans (to observe the pathology of these viruses) ... but we looked for a presence of antibodies to Ad36. It turned out that on average, about 15 to 17 percent of the people we surveyed have antibodies to Ad36, which means that at some time in the past, they were infected with the virus.

  "Some 30 percent of obese people have been infected with the virus and only 11 percent of nonobese people are infected. If you look at the 11 percent nonobese people infected, they were heavier than those (nonobese people who were) not infected." Interestingly, he says, while the virus makes them obese, it actually lowers their cholesterol and triglyceride levels, findings that mirror what researchers see in animal models. In addition, the virus appears to improve the body's ability to handle glucose, at least in animals and in vitro experiments using human fat and muscle cells, including those of diabetics. His research team now is trying to identify the viral protein that makes cells more insulin sensitive because they may be helpful in identifying drugs for diabetes.

  Dhurandhar says researchers are not focusing on a cure for the virus. "By the time they become obsese, it could take six months or two years," he says. "You're not going to remember you had [the virus] and it may have left your body. If there's no virus in the body, what are we trying to kill? Instead, our goal is to come up with a vaccine that can prevent this type of obesity. It's better than finding a cure."

  Another researcher at Pennington Biomedical, Leslie Kozak, believes some people's brains are programmed for obesity before they are even born, based on their mother's nutrition while she's pregnant.

  "It does this through hormones it secretes," he says of the body programming the brain. "We're beginning to have a pretty good idea of the kinds of hormones that affect [calorie intake and energy expenditure]. The location of neurons in the brain that control food intake are pretty well known."

  Using mice whose body functions are similar to humans, researchers are studying what impact the hormone leptin, which is produced by fat, has on the brain, especially in regard to how the body programs the brain to store fat in offspring.

  "The kind of experiments we can do is restrict the amount of food the mother mouse is given," Kozak says. "If you underfeed this animal, you severely depress leptin. Excess leptin would inhibit food intake and stimulate energy expenditure." Conversely, depressing leptin would cause the body to store fat for future use.

  "Our studies show what happens in this early stage will affect molecular mechanisms associated with the mouse accumulating fat," he says. "It's a lifetime quest to understand what controls our body composition in response to the environment. It's genetic, dealing with survival mechanisms that evolved prehistorically to enable humans and animals to survive. How do you control the ability to maximize caloric intake to survive for some time in the future when you're not going to have any food at all?"

  He cites studies of the Dutch population in which children of mothers who were starved by the Germans during World War II were followed over a period of time and found to be susceptible to chronic diseases like obesity and diabetes. "It has a profound impact on how you as an adult will respond to your nutritional environment," Kozak says. "It's remarkable how people who have been through these experiences (starvation) and survive ... develop chronic diseases as an adult."

Regardless of why she ultimately became obese, Burke found a weight-loss program that has had a profound impact on her life.

  "Physically I feel amazing," she says. "I'm able to do things that it never occurred to me to do. I'm completely addicted to walking, and I'm looking to walk in a marathon, a 5k to 10k walk. I feel emotionally healthy for the first time ever. I've learned to deal with my emotions instead of trying to stuff them down with food. I'm a work in progress, but I feel good, really good."

  One of the best parts about being able to get out, walk, shop and other activities that most people take for granted is "seeing people and feeling like you fit in," Burke says. "That was a stunning experience for me. I was in a grocery store and I looked around and discovered that I look like everyone else. I'm no longer the biggest one in the room."

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