Doc wants to end dieting as we know it

By Ilene Nechamkin

If you don't know that Americans are alarmingly overweight, you haven't been reading the newspaper, watching TV, or listening to the radio. Nor, for that matter, have you looked around at the people standing next to you in line lately. A recent "call to action" by the Surgeon General David Satcher warned that overweight and obesity may soon cause as much preventable disease and death as cigarette smoking.

In 2001, about 3,000 deaths a year were associated with obesity and overweight; over 400,000 deaths a year were associated with cigarette smoking, he said. And the total direct and indirect costs attributed to overweight and obesity amounted to $117 billion in 2000.

In 1999, an estimated 61 percent of U.S. adults were overweight, along with 13 percent of children and adolescents. Obesity among adults has doubled since 1980, while overweight among adolescents has tripled. Satcher noted "dramatic increases" in asthma and in Type 2 diabetes among children. "Failure to address overweight and obesity could wipe out some of the gains we've made in areas such as heart disease, several forms of cancer, and other chronic health problems."

Enter Dr. Dennis Gage. a Manhattan endocrinologist and author of "The Thinderella Syndrome," released this summer by Vantage Press.

If you're overweight, or have been battling the bulge for years, you probably won't like what this Quaker Ridge father of four has to say. Gage doesn't present an effortless menu or promise unlimited quantities of certain foods. And if you define diet as a temporary regimen, you're dead wrong. "You live a diet, you don't do a diet," Gage told the Inquirer. "There is very little difference in dieting and maintaining a healthy weight." The success of a diet, he continued, is not whether you lose weight, but whether you maintain the loss for two years.

In other words, Gage's crusade is to end dieting as we know it, as a torturous adventure with clearly delineated stop and go points. But he also promises an end to dangerous yoyo dieting, a phenomenon of periodic gains and losses - and wardrobes of variously sized slacks to show for it.

One other caveat: If you're attributing a widening girth to a decreasing, older metabolism, Gage will have nothing of it. "The metabolic rate stays pretty constant until about 70, " he said, "and this may be due to a decrease in muscle mass." The reality is that people become more sedentary as they age. "When we were younger," he said, "we were running around all the time, with children and families. Now we've slowed down."

Gage actually looks like a diet doctor, without any of the upholstery of middle age. He's 5 foot 10 and weighs in at or below 160, exercises daily and scrupulously watches his caloric intake, lunching on fruit and raw cashews on workdays and "banking" his calories -deliberately creating a temporary deficit-for the occasional splurge. He knows exactly how many calories he needs to maintain an ideal weight, and doesn't let up.

But does the world really need another diet book? The bestseller lists bulge with diet manuals and how-tos, some promising a lifetime of pleasurable dining. Gage doesn't aspire to the pantheon of miracle workers. The impetus for his book, he explained, was more practical. He used to provide his patients with copies of Dr. Henry Jordan's "Eating is Okay," which outlined behavioral modification techniques. When the book became out of print, he decided to write a guide to permanent weight loss for his patients, devoting his vacations over 10 years to the project.

Americans are now more obese than any other time in history, he said, despite the availability of diet foods and nutritional information, and despite the popular wisdom about the benefits of exercise and the proliferation of gyms and fitness centers. Gage seeks a thinner, fitter nation.

The title, "The Thinderella Syndrome" refers to the fantasy world of dieting. There is no magic pill for being thin. Most "mass market" diets, he said, use strict avoidance techniques, eliminating, say, carbohydrates. "They work for the moment, he said. Even formula diets, consuming a liquid balanced "meal," can work, reductionwise. "But there's no conscientious effort to change your habits," he explained, an absolute requirement.

You probably know if you need to lose weight, but how do you select a goal or ideal weight? Gage offers a practical approach. The idea is not to be a fashion magazine model, but healthy, and the weight you set has a lot to do with the limits you're willing to set on your own eating. The promulgated ideal weights, he said, were developed by insurance companies in the 50s and 60s, and based upon what weights men and women of different heights lived the longest at.

Gage said that most fad diets require "an enforced lifestyle. The weight loss may occur, but there is no structure supporting this weight loss. Think of it as being on top of a building with a shaky infrastructure." Behavioral modification, he said, will secure and strengthen the building, floor by floor. The process may be slower, but ultimately more permanent. The ideal weight loss is generally about 1 percent of body weight per week, he added. More rapid losses can be dangerous; sudden death and cardiac irregularities plagued 500-calorie and water fast dieters.

Gage recommends keeping an accurate food diary, religiously charting what you eat, citing research that shows a correlation with success with a precise record, greater than working with a doctor. To shape healthy eating patterns, though - the diet's goal -- suggests noting the speed and place of eating, the position and any associated activity or mood, and estimating the number of calories.

He also advocates a number of techniques, many of which seem commonsense. He suggests eating more slowly, for example, eating smaller pieces and chewing more thoroughly, sipping water between bites, and occasionally getting up from the table.

Gage also provides a few nutritional techniques, the three cardinal rules: If you must eat animal products, the lighter the better. Choose light meat chicken over dark, veal over steak, egg whites over yolks. The second rule: choose unrefined vegetable products over refined; choose refined animal products over unrefined. Corn, for example, is better than corn oil, an apple is better than apple juice. Apropos of animal products, a lean beef burger is better than the natural fatty burger, and sugar-free, fat-free yogurt tops whole yogurt.

The final rule is to always choose vegetable products over animal products because they are generally lower in fat and calories, free of cholesterol and, have more vitamins, minerals and nutrients.

The book also provides behavioral and cognitive techniques, and a wealth of motivators. Keeping weight off and maintaining a new weight is, he admitted, a boring business. American lifestyles, everything from TV remote controls to the automobile, discourage physical activity, which goes hand in hand with sensible weight loss and maintenance. He offers a down to earth technique to increase activity, getting off the elevator a few floors below your destination, parking the car in a distant space, or simply walking your dog.

Gage's biggest contribution to dieters is a "red alert system," a simple enough concept to understand, but one that's difficult to enforce. First, there's a set of early warning signals, like pants that feel a bit tight or having to loosen a belt a notch. Bin he recommends setting a defensive weight, and pulling out all the stops if it's exceeded. The diet doctor himself hits his red alert four or five times a year, and considers it a test of lifestyle and conviction.

Gage, a graduate of NYU School of Medicine, completed a subspecialty fellowship in endocrinology, metabolism, and nutrition at St. Luke's Medical Center, where he oversaw the weight control unit. That's where he acquired his research-based approach to weight loss. His book, although not a quick fix, offers relief to the frustrated dieter, with a hard dash of reality.

But Gage has not always been thin. Twenty-five years ago he was taken to the emergency room after an automobile accident, and noticed that he was described as "mildly obese" on the intake form. The embarrassment was an "aha" moment for the intern, providing the impetus for him to devise what became his "live a diet" routine, with a bit of trial and error along the way.

 

 

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