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Focus on behavior, not scale

April 30, 2006 1:45 am

R ACHAEL CUBBAGE is a 61-year- old retiree with multiple health problems who is trying to lose weight.

She lost 32 pounds not long ago and hopes to lose 10 more. But she recently started needing an oxygen tank to help her breathe. Walking--much less losing weight--has become difficult.

Cubbage, who lives by herself in Stafford County, stands 5-foot-6 and weighs 210 pounds. She has diabetes, high cholesterol and blood pressure. She suffered a heart attack last year, and also battles depression, arthritis and fibromyalgia.

Although she loves old-fashioned Southern cooking, Cubbage has taken diabetes management classes and made a huge effort to eat less salt and lard. She also quit smoking years ago.

Cubbage should be proud of the changes she's made, while also considering other changes she can make to feel better.

On the day she kept a food diary for me, Cubbage started off well, with cereal, soy milk and water.

At lunch at the International House of Pancakes, though, she ate quite a few eggs, pancakes and sausage patties, and neglected to balance her meal with fruit or veggies.

Cubbage had a modest, healthy dinner. And the rest of the day, she snacked--often healthfully, but in a way that made it a challenge to keep her blood sugar balanced.

Small, frequent meals such as the snacks Cubbage ate can be a good thing, but it's important that they have some structure. That's because spreading carbohydrate foods throughout the day helps balance blood sugar. Cubbage ate most of her carbohydrates at midday, and then grazed until 1 a.m.

Overall, Cubbage kept calories around 1,700, which is good for most women. But it's possibly a bit high for her because she has difficulty being active. It might help her to stay closer to 1,500 calories.

Rather than counting calories, though, it may be easier to concentrate on what to eat. She got plenty of protein but fell short of the 1.5 cups of fruit and 2.5 cups of veggies recommended for her height.

Eating more fruits and veggies would not affect calories much but would boost her fiber intake. (She took in 17 grams, short of the minimum of 25 grams recommended to reduce cholesterol and regulate digestion.) Many fruits and veggies have vitamin C, of which she also fell short.

Cubbage did an excellent job of getting enough B vitamins, iron, selenium and zinc. But she fell short of meeting the recommendations for calcium, vitamin D and magnesium. She could meet those goals by having another cup of soy milk or yogurt, or through supplements.

The turkey sausage patties Cubbage ate, even though they are lower in fat than beef, are still fairly high in artery-clogging saturated fat and sodium. She took in about 30 grams of saturated fat, and it would be safer to stick to 20. She might accomplish that by eating one less turkey sausage and switching from half-and-half to low-fat milk in her coffee.

Cubbage has tools to help herself: She has a meter to check her blood sugar, which is critical to controlling her diabetes, and she has a Cardio Cruiser exercise machine. Using these tools more often every day would be a great step.

The better Cubbage knows her blood sugar numbers, the easier it is to work with her doctor to control her diabetes and prevent complications such as heart attacks, strokes and kidney failure. If Cubbage is eating well and her blood sugar runs high, it may mean she needs her physician to adjust her medications.

Using the Cardio Cruiser more often also would help control her blood sugar levels and burn calories for weight loss.

Keeping track of exercise time, rather than what she weighs, could help Cubbage. Especially since she's somewhat disabled, I think it would be better for her to focus on her behavior rather than on pounds on a scale.

Cubbage can control what she eats and to some extent how active she is, but she cannot control exactly how this affects her weight. She may end up losing more than 10 pounds or she might not reach her goal. What matters more is that she makes good choices most of the time.

Choosing to exercise at least five days a week, even if she starts out at only two minutes on the Cardio Cruiser, would be a big jump.

For Cubbage and others with serious health concerns, it's generally best to ease into an exercise routine and add to it over time.

Cubbage describes herself as "a late-night person" who snacks in front of the TV till the wee hours and sleeps only five to six hours nightly.

Going to bed earlier and sleeping for seven to eight hours, if possible given her pain and breathing problems, may help Cubbage control her blood sugar and weight loss, studies suggest.

It's hard to adjust sleep schedules, and she may need to ratchet back her bedtime by 15 to 30 minutes a day until she gets to 10 p.m. or so.

Mindful eating also may help. It's easy to eat past the point of fullness while distracted by TV.

I recommend people set certain rules around eating, the type of polite rules you might follow if you had a guest over for a formal dinner, even when you're really dining alone. Turn off the TV while eating. Don't read the paper, write bills or otherwise distract yourself from your delicious food.

Set a nice table for yourself--eat off plates, not packages. When you eat, eat with your whole mind and body. Pay attention to your food, how it tastes, looks, smells. How does it feel in your mouth? You miss most of the pleasure of eating if you do it while distracted by the TV.

When I interviewed Cubbage to get a better sense of her health, lifestyle and food preferences, she told me she hates cooking.

"I would love to have someone come out with a list of prepared foods that I can eat without fear of too much sugar or salt--something like the books on what you can make from Bisquick or Campbell Soups," Cubbage said.

The American Diabetes Association's "Month of Meals" cookbook series might be fun for Cubbage. Menu themes include "Meals in Minutes," "Soul Food" and "Vegetarian Pleasures."

Also, since Cubbage requested Campbell's Soup, the company has a diet plan called "Soup for Life," which you can see free online at campbellwellness.com. They have 1,600-calorie menus that keep sodium below 2,400 milligrams.

Diabetic Gourmet magazine has free menus online, as well, and they are easy to prepare for one person. Cubbage might like the 1400- and 1600-calorie Southern, American and Hispanic menus at diabeticgourmet.com/Food_and_Dining/Meal_Plan ning/index.shtml.

Knowing Cubbage struggles with pain, I'd also suggest she ask her doctor to test her blood for 25-hydroxy-vitamin D.

Many people with fibromyalgia have vitamin D deficiency, which this test can reveal. If that is the case, taking vitamin D supplements for several months could help ease the pain.

Because Cubbage has several medical problems, it's a good idea for her to talk about any changes she makes with her doctor first.

Spicing up Cubbage's food also may be helpful.

Studies show that certain spices can calm inflammation from arthritis by blocking a chemical called transcription factor kappa-B.

Turmeric, the spice that makes curry powder yellow, is powerful. I'd also recommend red pepper, cloves, ginger, cumin, anise, fennel, rosemary, basil, garlic and pomegranate.

Even people who buy a lot of already prepared foods can add some spices.

Homemade or takeout chicken salad is delicious with a bit of curry stirred in. Red pepper spices up spaghetti and other tomato sauces. Rosemary and garlic are tasty in grilled or mashed potatoes or mixed with olive oil and spread on fresh bread. Pomegranate juice can be purchased year-round, and it's delicious, though pricey.

Seasonings won't cure Cubbage's fibromyalgia arthritis, but any relief might be helpful, especially if it makes meals more delicious.

If I could give Cubbage just one piece of advice, it would be to focus on what she can control--her exercise and diet--instead of on how many pounds she loses. It's advice that I think can help lots of people feel and live better.

JENNIFER MOTL, a registered dietitian, welcomes reader questions via her Web site, brighteating.com, or mailed to Nutrition, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401.