Losing Weight with Arthritis

8 Ways to Lose Weight Without Dieting

• 8 Ways to Lose Weight Without DietingLosing extra weight may help you look better, but more importantly, it can take pressure off painful joints and improve overall health. Research shows overweight people with arthritis who lose 10% of their weight have better mobility and 50% less pain. Try these small steps to drop excess pounds and get big health results.
• Plate PicksUse smaller dishes to reduce how much you eat by as much as 20%. Plate and portion sizes have increased over time, so you may be eating more than you realize – most people eat and drink more when served larger portions. And make sure dish color contrasts with the food on it; research shows people eat more when food is the same color as the plate.
• Water WiseAmericans get more than a fifth of their daily calories just from beverages, so switching to water is a smart weight-loss move. Research shows that drinking water before meals can make you feel fuller, which can help shed pounds, too.
• Slumber to SlimPoor sleep triggers a part of the brain that controls urges to eat and staying up late increases cravings for unhealthy foods, so people tend to eat more after a bad night and make poor food choices later at night. What’s more, sleep deprivation can slow the body’s production of leptin, which makes you feel full, and amps up the hunger hormone ghrelin.
• Group ActivityTeam up with friends or join a group that’s also working to lose weight. Doing so can provide encouragement and motivation. One study shows people who teamed up with successful dieters were 20% more likely to succeed.
• On the Other HandIf you’re right-handed, use your left hand to eat (and vice versa). Research suggests that people eat less when they use their non-dominant hand, partly because they’re less likely to munch mindlessly. It’s likely you will also eat more slowly. Scientists say eating slowly will allow time for your stomach to transmit a feeling of fullness to your brain, which can ultimately help you eat less.
• Slow is GoodEat mindfully, focusing on and savoring each bite without distractions like watcing TV. People can cut their daily consumption by 300 calories by eating more slowly and giving their brain time to register how full they feel, according to one study.
• Move to LoseCutting calories can help you lose weight, but it also can slow down your metabolism. It’s better to combine physical activity with a nutritious diet to achieve or maintain a healthy weight. Walking and water aerobics are great, low-impact exercises, but talk to your doctor before you get started.
• Tools You Can UseNeed tips and resources to help you maintain a healthy, balanced diet and weight? Check out more ways to eat well at arthritis.org/eatingwell and to stay active at arthritis.org/stayingactive.

Benefits of Weight Loss

Learn how you can reduce joint pain and other health risks by losing weight.
| By Teresa T. Gentry

Although most people know that maintaining a healthy weight is important for their overall health, actually achieving weight loss and being at a healthy weight are different issues. This is evident in a study from the American Psychological Association, which noted that being overweight or obese is the number one health challenge facing the United States today.

Despite the fact that 68 percent of Americans are currently considered overweight or obese, according to study data published in the Journal of the American Medical Association, this health problem can be reversed. Even a modest weight loss of 5 or 10 pounds can provide immediate and long-term health benefits.

It’s important to keep in mind that losing weight is not a race – whether you need to lose 20, 50 or even 100 pounds – and that the benefits of losing weight and being physically active go far beyond how you look in the mirror. It’s a lifelong process to become a healthier you – for yourself and your family.

As always, consult your health care provider before beginning any weight loss program.

Benefits

Reduces pressure on your joints.  A 2005 study in Arthritis & Rheumatism of overweight and obese adults with knee osteoarthritis found that losing one pound of weight resulted in four pounds of pressure being removed from the knees. In other words, losing just 10 pounds would relieve 40 pounds of pressure from your knees.

Eases pain and inflammation. The results of a 2010 study from the University of Paris published in the Annals of Rheumatic Disease indicated that weight loss can lessen pain, improve function and lower inflammation levels in the body. Fat itself is an active tissue that creates and releases pro-inflammatory chemicals. The authors of another study titled Effects of Exercise and Physical Activity on Knee Osteoarthritis noted that exercise, which aids in weight loss, can help manage and lessen the pain and symptoms of arthritis.

Cuts risk of chronic diseases. Data from the CDC-led Diabetes Prevention Program show that a moderate weight loss – around 14 pounds – can lower the risk of developing type 2 diabetes by 58 percent. Weight loss can also reduce the risk of developing diseases such as cancer and can help prevent and treat arthritis and related diseases.

Makes breathing easier. Rena Wing, PhD, professor of psychiatry and human behavior at Brown University’s Alpert Medical School and director of the Weight Control and Diabetes Research Center at The Miriam Hospital in Providence, R.I., says that “Weight losses of just 10 percent of a person’s body weight (or about 20 pounds in those who weigh 200 pounds) have also been shown to have a long-term impact on sleep apnea …” Findings in a report from the American Heart Association noted that reducing obesity is the single, most changeable action that can be taken to prevent sleep apnea.

Lowers the risk of heart disease and stroke. Studies have shown that losing weight can lower your blood pressure into the healthy range. In addition, eating right and engaging in physical activity that leads to weight loss can also lower your cholesterol. Data suggest that even a moderate weight loss of 5 to 10 pounds can help to reduce your blood pressure and your risk of heart disease and stroke.

Overall

Weight loss is a tough endeavor, but no single action can provide as many positive effects on the body as weight loss. Its benefits for your body – helping you live longer, and pain and disease free – far outnumber the challenges you’ll meet as you work toward your weight loss goal. Talk to your health care provider about starting your weight loss program to gain lasting, better overall physical and mental health.

Beyond the Bathroom Scale

These techniques can help accurately gauge your weight-loss success.
| By Judy DiEdwardo

The bathroom scale may not be the most reliable means of determining how much weight you may need to lose, say experts. That’s because body weight doesn't take into account the proportion of fat in the body, or where that fat is deposited. Other measuring devices may deliver a more accurate assessment of body fat versus muscle mass, though they aren’t all easy to find.

Most experts agree that each method has its limitations, and sometimes the “mirror test” is the best one all.  

BMI

Body mass index (BMI) has largely replaced the number on the scale alone to determine overweight or obesity. Although it is relatively simple to calculate, it has its drawbacks.  For one, it does not identify fat content, saysRobert Davidson, PhD, the program director of the Nutrition and Human Performance Program at Logan University in St. Louis.

“A person could have a normal BMI but still need to lose weight,” says exercise physiologist, Lauren McDonald, at Duke Health & Fitness Center in Durham, N.C.  “It's one of the inaccuracies of BMI measurements. It depends on where the weight is being carried. Carrying excess weight in the abdomen is riskier to your health than excess weight around the hips and thighs. Bottom line: BMI is a good screening tool but not a diagnostic tool."   

Skin-fold Measurement

The skin-fold technique is commonly used to determine body fat percentage. It involves pinching your skin at specific locations, pulling the fold away from the underlying muscle, and using a skin-fold caliper to measure its thickness.  A formula is used to translate the skin fold thickness into a percentage of body fat.

While you can buy skin fold calipers for as little as $15, the ones used by professionals can run up to $500, and you will need a trained professional to take the measurement.

Although the technique is reliable if performed accurately, it is technically challenging to do accurately, says Davidson.

Underwater Hydrostatic Weighing

This method of determining the ratio of body fat to lean mass is based on the principle that muscle sinks and fat floats, so a leaner person will weigh more under water than someone with a lot of body fat.

For this method, you are weighed on dry land and then three additional times while sitting on a special scale in a tank of water. Your underwater weights are averaged and your lean-to-fat ratio is calculated.

The technique is considered the gold standard for determining body fat percentage, says Davidson. The drawback: It may be difficult to find a facility that performs it.

Dual-energy X-ray Absorptiometry (DXA)

The same X-ray technique used to measure bone density can also be used to accurately evaluate body composition and determine the amount of lean and fat tissue. The procedure is available at many hospitals and clinics and costs around $100.

Waist circumference

One of the simplest ways to know you are gaining weight is to feel your waist band getting tighter. Seeing the numbers increase when you measure your waist is another. “The simpler the better,” says Missouri State University professor and exercise physiologist Barbara Bushman, PhD.  Another benefit of measuring waist circumference is that it is a good indicator of cardiovascular risk.  Weight gain around the midsection is typically fat and abdominal fat is associated with increased risk of cardiovascular disease.

Bottom Line

“Some people are encouraged and motivated by numbers and measurements, while others get discouraged and fail to realize the progress that isn't reflected on a scale, chart or measuring tape. I encourage my clients to shy away from obsessing over the scale and continuous measuring, and have them focus on how they feel, how they look, how their clothes feel. If you increase activity, eat a balanced diet, over time, you will see results.”

Diet Beats Exercise for Weight Loss

After decades of weight loss research, experts conclude that exercise alone won't win the battle of the bulge.
| By Brenda Goodman

Exercise can be a powerful balm for many of the things that ail us, including depression, bone loss, fatigue, heart disease, diabetes and arthritis. But the reason many of us pound the pavement is because we want to lose weight, and that, experts say, is a goal for which exercise alone may not be especially helpful. 

Monitoring your diet – specifically portion control – is more effective than exercise for weight loss. The reason boils down to simple math. It is far easier to eat 100 calories – the amount in a piece of bread – than it is to burn them off, which, for most of us, would require walking one mile. And while exercise helps us burn more calories, it also increases appetite, making it excruciatingly easy to undo all that hard work.

In the position paper “Physical Activity and Public Health: Updated Recommendations for Adults from the American College of Sports Medicine and the American Heart Association” which was published in 2007, a blue ribbon panel of experts reviewed all available scientific evidence on the connections between exercise and health and conceded that while exercise is critical for many aspects of health, it doesn’t seem to help with weight loss.

“Despite the intuitive appeal of the idea that physical activity helps in losing weight,” the panel wrote, “it appears to produce only modest increments of weight loss beyond those achieved by dietary measures and its effects no doubt vary among people.”

Amy Luke, PhD, a nutritional epidemiologist at Loyola University, Stritch School of Medicine, in Chicago, has seen this phenomenon for herself. 

Luke compared two populations of black women: One group was from rural Nigeria, while the other was from downtown Chicago. All body size measurements were lower in the Nigerian women, and Luke and her team set out to understand why.

“Our hypothesis going in was not particularly brilliant,” Luke says. “It was that women who were heavier, particularly in the U.S., would have lower calorie expenditure than women who had a lower body mass index (BMI).” (To calculate your BMI, click here.)

In other words, she thought thin women would be more physically active than obese women. That turned out not to be the case. “The differences in physical activity were minimal,” Luke says.

Luke believes the Chicago women weigh more than their Nigerian counterparts because of differences in diet. The Chicago diet is 40 to 45 percent fat and high in processed foods, while the Nigerian diet is high in fiber and carbohydrates, and low in fat and animal protein.

“For us, the take-home message is that a lot of public health policy on increasing physical activity for weight control may not be as productive as focusing on the dietary intake side of things,” says Luke, whose study was published in the journal Obesity.

In the real world, people who have lost significant amounts of weight and kept it off say they have used a combination of exercise and diet to achieve their goals. Ninety-eight percent of people enrolled in the National Weight Control Registry, a group of 5,000 individuals who have lost at least 30 pounds and kept it off for at least one year, report modifying their food intake in some way to lose weight, while 94 percent say they increased their physical activity.

The trick, experts say, is to carefully monitor how much you’re eating, by counting calories, watching portion sizes or keeping a food journal, while increasing your physical activity. While you’re fighting flab by cutting calories, you can still appreciate exercise for all the things it does to well, such as relieving joint pain, fatigue, boosting mood and helping to keep your heart and bones strong.

“It’s critically important for those things,” Luke says, “but for weight loss per se, it may not be as critically important as we’ve stressed.”

Don't hang up your walking shoes quite yet though – physical activity  is a proven effective way to treat the aches and pains that come with arthritis.

How to Wisely Choose a Weight-Loss Program

There’s no shortage of weight-loss programs from which to choose. Here, diet experts share their advice on making good choices.
| By Emily Delzell

Deciding the time has come to lose weight – whether it’s for your joints, cardiovascular health or your 25th high school reunion – presents yet another choice: How are you going to do it? Structured weight-loss programs may be the best means to achieve your goals.

According to the National Weight Control Registry, a database of 10,000-plus individuals who have lost 30 pounds or more and kept the weight off for at least a year, about half of these weight-loss winners did it on their own and about half participated in a structured program.

“Often, people can accomplish great things on their own,” says Howard Eisenson, MD, director of Duke University’s Diet and Fitness Center, Durham, NC. Some people, however – particularly those with more than 25 pounds to lose or those who feel “stuck” after a few diet failures – may more easily reach their goals with the extra accountability and support that comes with a structured weight-loss program, Eisenson says. 

There are hundreds of options when it comes to selecting a program, from doctor-supervised regimens to group-oriented settings to meal replacement plans, and few of these are cheap. Here, Dr. Eisenson and Adrienne Youdim, MD, medical director of Cedars-Sinai Weight Loss Center, Los Angeles, offer some insight into what to look for – and what to void – when choosing a weight-loss program.  

Look for:

• A balanced approach. The program should address and emphasize healthier eating habits, increased physical activity and behavioral strategies and modifications to promote lasting change.
• A professional staff. Look for program leaders who have appropriate professional education, credentials and experience. This includes registered dietitians, certified personal trainers, and health professionals with specialized training in bariatric medicine or weight management.
• An individualized plan. A tailored weight-loss approach, Dr. Eisenson says, requires a thorough assessment of your current health status as well as a thoughtful evaluation of your needs, goals, resources and physical and emotional challenges. 
• Flexibility. Extreme plans that severely restrict, eliminate or demonize food groups can sometimes help you lose weight quickly, but are difficult to maintain and can lead to regaining the weight, says Dr. Youdim.
• Professional follow up and long-term support. Staff should also be able and willing to answer all your questions before you enroll and provide you with opportunities to talk with people who have gone through the program.

Avoid:

• Programs that over-promise. “While ALL weight-loss programs can provide some extraordinary success stories, it is important to understand what kind of results are typical. If a behaviorally based weight-loss program can consistently help people lose approximately 10 percent of body weight, they are doing well,” says Dr. Eisenson.
• Programs dependent on “gimmicks.” This includes, Dr. Eisenson says, an emphasis on dietary supplements or weight-loss agents or medications. “These are often expensive, of very limited or unproven value and sometimes of questionable safety.” He notes that these caveats don’t include programs that feature balanced meal replacements, such as shakes and bars, which studies have shown are helpful weight-loss tools.
• Plans that promote expensive testing. Extensive lab studies and other diagnostic testing, such as full body imaging scans to measure body fat, are rarely necessary. Body composition can be estimated adequately with simple, inexpensive methods, such as measuring waist circumference or calculating body mass index. If you’re not sure whether a test is appropriate, ask your doctor is there is scientific evidence to support its use outside of research studies.
• Programs that promise rapid weight loss. Without supervision by a health care professional who understands the potential health and safety concerns, rapid weight loss can be dangerous. “A person may need to change the type or dosage of their medications, for example,” says Dr. Youdim. “You need to know that someone is evaluating these issues and is qualified to manage them.”

A Look at What's In Weight Loss Supplements

Are these products helpful or harmful?
| By Mary Anne Dunkin

Turn on the TV or radio, browse the Internet or flip through a newspaper or magazine, and you’ll undoubtedly come across advertisements for weight-loss supplements. Their ads often lure you with promises of quick loss without dieting or exercising. However, often their claims are just that – claims – and are not supported by research.

Furthermore, because dietary supplements are not regulated the way medications are, they may have health risks that are not recognized until they are in common use. Ephedra, which used to be a common ingredient in weight-loss supplements, illustrates that all too well. The herb, also known as ma huang, is related to the hormone adrenaline and revs up the body’s systems. In doing so, it increases heart rate and blood pressure and can stress the heart and blood vessels, which has led to heart attacks and sudden death.

Because of the turmoil, ephedra products have been banned in the U.S. and other ingredients have taken ephedra’s place on the shelves.

Here are some commonly found ingredients in weight-loss supplements and what you should know about them. 

Bitter Orange

This ingredient contains synephrine. Because it is similar to ephedra both in chemical make-up and possible side effects, bitter orange should be taken with caution.

Chitosan

Processed from a protein found in the shells of insects and shellfish, chitosan packagers claim it keeps fat from being absorbed in the intestine. However, there is little research to demonstrate its effectiveness for weight loss. In one analysis of 15 studies with a total of 1,219 participants, researchers concluded that “chitosan may have a small effect on body weight but results from high quality trials indicate that this effect is likely to be minimal.”

Chromium

A mineral claimed by some manufacturers to decrease blood sugar and help with weight loss, chromium has not been proven to have any positive effects. In one clinical trial comparing 1,000 micrograms of chromium picolinate daily to placebo in 80 overweight adults, there were no differences in weight loss between the two groups after 24 weeks.

Cider Vinegar

Thought to interfere with the digestion of carbohydrates, vinegar held down after-meal sugar spikes and was associated with moderate weight loss in two separate studies. But don’t run out for vinegar pills or capsules; it’s the active acetic acid in fresh vinegar that’s thought to have an effect on metabolism. Instead, have vinaigrette dressing or pickles with your lunch or dinner.

Guarana

This tropical berry is loaded with caffeine – about 30 percent more than coffee. Some studies show caffeine increases metabolism, but not necessarily fat burning, and it tends to raise blood pressure. The safety of guarana is not well known.

Gymnema sylvestre

An extract from the leaves of this woody tropical plant from India is supposed to work as a “sugar destroyer.” But for weight loss, the evidence isn’t clear. In one study, people lost weight after eight weeks of taking a product containing Gymnema sylvestre, but the product also contained chromium and hydroxycitric acid. In addition, the subjects’ diets were limited to 2,000 calories per day and they participated in a walking program, so it’s not possible to say what caused their weight loss.

Hoodia gordonii Cactus

The flesh of this cactus-like plant is thought to suppress appetite. Interest in Hoodia skyrocketed following a 2004 “60 Minutes” report on the plant’s effects and continues to be a popular weight-loss ingredient. However, there is no reliable scientific evidence to support Hoodia’s use; and its potential risks, side effects, and interactions with medicines and other supplements have not been studied, according to the National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH). Furthermore, the quality of hoodia products varies widely, NCCIH reports.