Curbing your appetite

It sounds so easy. Just consume fewer calories than you expend, and you’ll lose weight. Eat less, exercise more. The formula is simple, but with a third of the US population obese, obviously it not easy to apply. Anyone who has ever tried to lose weight knows that it’s hard to sustain the resolve to eat less when you feel hungry. How can you curb you appetite so you can make the long-term lifestyle changes required to lose weight and keep it off? What behaviors, diets, pills and products can reduce hunger to help you meet your weight-loss goals?

Behavioral and Dietary Changes • Eat. If you’re hungry, you should eat. Just less, a registered dietitian suggests eating smaller but more frequent meals, or planned snacks between meals. If you’re not starving, you’re less likely to overeat. She points out that the time between lunch and dinner can be especially long, so, to avoid evening bingeing, have a mid-after-noon snack. If you are going out to dinner or to a party, have a snack before you go so you don’t overeat while you’re out. One patient slowly but steadily lost 70 pounds and has kept it off for 2 1/2 years. She did it by reducing portion sizes and becoming more active. Eat everything she used to eat, but less of it. Eating small meals throughout the day helped her feel less hungry. Get into a regular schedule of eating. Make sure you eat breakfast, lunch and dinner. Studies show that skipping breakfast, especially, may result in eating more later.

Select different foods • Publications such as Nutrition and Your Health: Dietary Guidelines for Americans can offer advice on the healthy diet necessary for weight management and good nutrition. However, within the parameters of a healthy diet, how can people choose foods that help them feel full. Dietitian advises clients to include some fat, protein and fiber in their meals because these nutrients slow food absorption and keep you feeling full longer than a meal of mostly carbohydrates. For example, a breakfast of a whole-grain bagel (provides fiber) with peanut butter (provides protein and fat) and an apple (provides fiber) will keep you full longer than pancakes with syrup and apple juice.

While that fat and protein can increase satiety, there are cautions that they should be added only if they are lacking in a person’s diet. While there are exceptions, such as nonfat milk, most protein sources are high in calories and fat, and most people eat too much protein as it is. Director of the Center for Human Nutrition at Washington University of School of Medicine in St. Louis states that the key to feeling full while consuming fewer calories is to eat high volume, low energy-dense food, like fruits and vegetables. If you snack, choose an apple over a candy bar. Points out that water content increases volume to help you feel full. For example, grapes are more filling than raisins.

Avoid fad diets • Many popular diets recommend cutting out specific foods or group, making the diets nutritionally incomplete and hard to stay on. Before her current successful regimen, on many diets, losing and regaining the same 70 pounds she has put on after the birth of her son.

She always felt it was withholding, and couldn’t wait to go back to eating whatever she gave up. Neither professor of medicine nor dietitian recommends the high-protein, low-carbohydrate diets (such as Atkins) that are currently popular. Doctor states that, although there is a great deal of anecdotal evidence that these diets work, there has not really been any date from good, prospective, controlled trials that show these diets are good for weight loss. Many health professionals criticize these diets for their high fat content and nutrient imbalances.

Dietitian agrees that people may not feel hungry on high-protein, low-carbohydrate diets because of the increased fat and protein. But success with these diets is short term. She explains that depriving the body of carbohydrates puts it into a state of ketosis, in which the body metabolizes fats and proteins for energy. Ketosis may lead to weight loss but also may damage organs and muscles, including the heart. Some diets allow enough carbohydrates to prevent ketosis, but eventually the body adjusts to having fewer carbohydrates, metabolism slows, and the diet stops working. Usually, any lost weight is regained. Dietitian also does not recommend very low-fat diets (less than 10 percent of calories from fat) for the average overweight person because the body needs some fat to function properly. She says that people on very low-fat diets tend to feel hungry, so they increase their carbohydrate and, thus, caloric intake. However, a reduced-fat diet (between 10 and 30 percent of calories from fat) can help you lose weight. A recent review of popular diets in the Journal Obesity Research conducted that fat-restricted diets that are high in fiber and water content provide a high degree of satiety.

Be wary of low-fat products • Read the labels before putting these items in your shopping cart. Dietitian points out that low-fat product compensate for their favor loss by adding sugar or other carbohydrates; they are often equal to or higher in calories than their regular counterparts. In addition because the low-fat cookies don’t satisfy, people tend to eat more of them.

Drink water. People often confuse cues for hunger and thirst. You may think you are hungry when you are actually thirsty. Dietitian recommends drinking six to eight glasses of water every day.

Eat from hunger, not habit • The two components of appetite, psychological cues and physiological cues, may become entwined. Dietitian gives the following examples: If you always eat in front of the TV, you will feel hungry when you watch TV. If you eat at noon every day, you will be hungry at noon. Maybe you eat when you are bored. You will have to change the triggering event or your response to it. She suggests, for example, taking a walk if you are bored or only eating at the kitchen table. Reports claim that eating had become more habit than hunger. She credits an environmental change with helping her lose weight: switching jobs from one that was sedentary to one that had her running around all the time. That helped her change her eating habits and burn more calories at the same time.

Stop eating before you are full • Pay attention to situations that keep you eating after you’ve stopped feeling hungry. Suggests that at a buffet, take smaller portions, don’t fill your plate. If you still feel hungry, make yourself get up and go back to get more. At a restaurant, ask for a half portion and have the other half wrapped to go before you start eating.

Cut back on alcohol • Pointing out that alcohol stimulates the appetite and has lots of calories. It also doesn’t provide many nutrients for those calories. In addition, alcohol decreases inhibitions, affecting your willpower to eat moderately.

Get enough sleep • A small study conducted at the University of Chicago’s Department of Medicine showed that sleep deprivation negatively affects carbohydrate metabolism. An ongoing, larger study indicates that people who miss as little as one hour of sleep a night can’t process glucose (blood sugar) as well as those who sleep an additional hour.

Pills and Products • Prescription medications. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), prescription medications can suppress appetite and result in weight loss greater than that expected with non-drug obesity treatments, but weight loss levels off after four to six months. NIDDK advises that these medications cannot take the place of improving one’s diet and becoming more physically active. The major role of medications appears to be to help a person stay on a diet and exercise plan to lose weight and keep it off. One doctor disagrees with the approach of using a prescription weight-loss medication to jump-start a weight-loss program. It’s completely wrong. All it does is decrease appetite; it doesn’t teach people behavioral modifications. It is not effective when used with behavior management because once the medication is stopped, that component will be gone. The only way for the weight not to rebound is for the patient to become more aggressive with other components of the weight loss regiment. No studies have shown that the weight will stay off, even in conjunction with behavioral changes.

Because of possible side effects, NIDDK recommends that weight-loss medications be used only by patients who are at increased medical risk because of their obesity not by mildly overweight people. The effectiveness in decreasing body weight has been shown, but the risk-to-benefit ratio must be evaluated.

Shortly after the birth of her son 22 years ago, took medication for a few months and rapidly lost a lot of weight. On the pills, she didn’t feel hungry, didn’t want to eat, but was whacked out. She could not sleep and had to stop taking the pills. As soon as she went off the pills, she gained the weight right back.

Medications may have changed since then, but regaining the weight is still a problem. Studies show that once patients stop taking drugs, they regain the lost weight. This makes medication only a short-term aid since, with one exception, the Food and Drug Administration (FDA) has approved appetite-suppressing drugs for short-term use only (only a few weeks or months). FDA approved sibutramine for longer use but safety and effectiveness haven’t been established for use exceeding one year.

OTC Drugs • What about bypassing the doctor and buying an over-the-counter (OTC) appetite-suppressing drug to help curb your appetite? OTC weight-loss drugs once contained the active ingredient phenylpropanolamine (PPA) to suppress appetite. On Nov. 6, 2001, FDA asked drug companies to voluntarily stop marketing products containing PPA because a report indicated that taking PPA increased the risk of hemorrhagic stroke (bleeding in the brain). FDA recommends that consumers not use any products containing PPA.

Does this mean that you won’t see the next time you go to the drug store? No, it’s still there. The manufacturers reformulated these drugs, removing PPA and substituting other ingredients. Without PPA, FDA considers these products dietary supplements, which fall under a different regulatory umbrella than do drugs.

Dietary Supplements • Dietary supplements are readily available at drug stores, at health-food stores and on the Internet, and quite a few claims to help with weight loss by suppressing appetite. The FDA defines a dietary supplement as a product taken by mouth that contains a "dietary ingredients" such as vitamins, herbs, enzymes and metabolite. It covers any product intended for ingestion that is not to be used as a conventional food. Unlike drugs, manufacturers do not need to register dietary supplements with the FDA or get its approval before producing or selling them. Nor are manufacturers and distributors of dietary supplements required to record, investigate or forward to the FDA reports they receive of injuries or illnesses that may be related to using their products. Once a product is marketed, the FDA cannot restrict its use or remove it from the marketplace until it can prove that the supplement is unsafe.

The Bottom Line • There’s no way around it: to lose weight, you’ll have to add physical activity and cut calories from your diet. It’s hard to do when feel hungry, which makes controlling hunger a key component in successfully losing weight and keeping it off. The methods that will work best for you depend on a variety of factors. Consider your options, taking into account how much weight you need to lose, your current health status, risks you’re willing to take and environmental factor affect your appetite. Do some self-assessment and discuss your options with your physician. Try some of the behavioral changes suggested above. What have you got to lose?