Exercise and your health
Uniontown physician Dr. Paul Hartley said brisk walking for about an hour five days a week is probably enough exercise for most people. Hartley, president of the Uniontown Hospital’s medical staff and a general internist, answered questions about new dietary guidelines released recently by a panel of scientists that urged Americans to get more exercise.
“If you want to follow the government’s guidelines, you don’t have to do a lot of strenuous exercise,” Hartley said. “It can just be brisk walking. You don’t have to go to the YMCA and lift weights or play basketball to get the amount of exercise that the government is talking about. The only thing you need to do is to put on some comfortable shoes and walk for about an hour.”
Hartley was responding to a recent Associated Press story, which reported that the Institute of Medicine released a two-volume study updating its guidelines for a healthy diet. For the first time, the Institute added an exercise recommendation, urging that Americans get at least an hour of physical activity daily – twice the amount that had been recommended by the Surgeon General.
The report also proposed recommended ranges for the amounts of fat, protein and carbohydrates in the diet. It calls for limiting added sugars, but says everyone needs at least 130 grams of carbohydrates daily to maintain brain function.
Hartley said diet and exercise are just “common sense” based on what our mothers and grandmothers told us to do when we were children.
“They told us to eat a well-balanced diet and not to eat too much fast food,” he said. “They also told us that we needed to exercise. If we would have listened to the common sense advice of our mothers and grandmothers, we would be doing all right.”
By walking for an hour each day, Hartley said, people can burn as many as 100 to 200 calories.
But even with an exercise program, he explained that it’s extremely difficult for women to lose weight because they only have about half the muscle mass that men have.
Muscle burns more calories than fat. But women can build more muscle mass by lifting weights and doing other resistance training.
“Hopefully, you will burn about 200 calories a day if you’re moving pretty quickly when you’re walking,” Hartley said. “It’s really hard for women to lose weight because they have to restrict their diets to 800 or 1,000 calories a day. But if a woman eats 1,200 or 1,300 calories a day and then gets some exercise, she will start to gradually lose weight. The best way to lose weight is to lose about one-half pound to one pound per week.”
The Institute, an arm of the National Academy of Sciences, said that because fats, carbohydrates and protein can all serve as sources of energy they can, to some extent, substitute for one another in providing calories.
The newly recommended guidelines call for getting 45 to 65 percent of calories from carbohydrates, 20 to 35 percent from fat and 10 to 35 percent from protein. The protein recommendation is the same as in the past.
The Associated Press reported that studies have shown that when people eat very low levels of fat and very high levels of carbohydrates their so-called good cholesterol declines. Good cholesterol, or high-density lipoprotein, can reduce the likelihood of heart attack.
The report is one of a series updating the dietary guidelines issued by the Institute in 1989. It is based on a review of thousands of studies of the effects of consumption of fats, protein and carbohydrates and the potential relationship with various diseases.
Despite all of the weight-loss products and diets that are currently on the market, Hartley recommends that his patients eat a low-fat diet and count their calories if they want to lose weight and keep it off.
“It’s pretty much trying to balance the number of calories you consume with the number of calories that you burn,” Hartley said. “It’s very similar to when someone joins Weight Watchers, and they follow the point system for food. It doesn’t really matter what you eat, but it’s a certain number of calories. If you consume more calories than you burn, you’re going to gain weight. But if you consume less calories than you burn, you’re going to lose weight.”
The Atkin’s diet, a popular weight-loss program that restricts carbohydrates and requires people to eat more protein and vegetables, seems to work for some people, but Hartley said it probably isn’t the best way to lose weight.
“The Atkin’s diet does seem to work for some people. But if you have gallstones, it can trigger the formation of more gallstones,” he said. “It’s hard to stay on a restrictive diet like that forever. When you shift back to a regular diet, you gain the weight back. The Atkin’s diet is a relatively new thing. There aren’t any long-term results available. But my suspicions would be that it would be hard to stick with a diet like that for an extended period of time.”
Hartley said he usually recommends that obese patients try to lose about 10 percent of their total body weight as they begin a weight-loss program. That would mean about 20 pounds for someone, whose weight is about 200 pounds.
“I will tell a woman to try to lose one-half pound a week,” he said. “Then I keep bringing them back into my office for follow-up appointments. I weigh them to see how they are progressing.”
If a patient wants to lose weight, Hartley said he advises them to begin eating the same foods for each meal every day.
“The best thing to do is to eat the same thing every day so you become so bored that you don’t want anything to eat that much,” he said. “I tell my patients to eat oatmeal for breakfast, a veggie burger for lunch and a small piece of meat, rice and broccoli for dinner. And then eat grapes or pretzels for a snack in the evenings.”
Hartley said most people do not realize that one slice of pizza has 300 calories, and some hamburgers sold at fast food restaurants can contain more than 30 grams of fat.
“There is one pizza place in town that advertises a 21-cut pizza, which is more than 6,000 calories if you eat the whole pizza,” he said. “Fast food is also really bad for your diet.”
Fayette, Greene and Washington counties have the highest percentage of overweight and obese adults in the state, with a whopping 62 percent of the population tipping the scale too high, according to a recent press release issued by the American Heart Association.
Obesity triggers a variety of chronic health problems, including diabetes, hypertension, stroke and overall decreased life expectancy.
“Obesity is a real epidemic,” said Hartley, responding to those statistics. “We’re seeing diabetes and sleep apnea (diseases associated with obesity) in teen-agers. The weight of people in the United States has increased steadily since the Civil War. I think it’s because food is available, and it’s inexpensive. People don’t exercise as much as they used to because of automobiles. A lot of people don’t have to do manual labor in their jobs today so they aren’t getting any exercise at work.”
Hartley said he suspects that obesity is a big problem in Fayette County because of the high poverty level and the lack of education.
“Studies have shown that women tend to be heavier in lower social-economic groups,” he said. “Some of the food that is better for you is more expensive, and it requires more preparation time and more knowledge to prepare. It’s a lot cheaper and easier for someone to go to the grocery store and grab a bag of chips than it is for them to shop wisely and plan healthy meals for their families.”
In addition to recommending an hour of exercise daily for adults, the Institute of Medicine suggested the same amount of exercise for children. This comes at a time when concern is increasing about the large number of obese children.
Because of the concern about obese children, Hartley recommended that parents make sure that their children have regular check-ups with pediatricians, who will weigh them and offer suggestions.
“If parents notice that their children are beginning to develop a weight problem, they should try to limit the amount of pop, pizza and other high-fat snacks that their children may be eating,” he said. “Doctors should also tell parents to shop wisely. It’s tough because it seems like everyone is eating the wrong things right now. When I was a kid, pop was a treat. Now, it seems like people are drinking pop for breakfast.”
Hartley said pediatricians usually advise parents, whose children have a weight problem, to make sure that their children are getting enough exercise.
“Doctors will tell the parents to get their kids off the Internet and video games and into organized sports programs,” he said. “Kids don’t play outside in their neighborhoods like they did years ago. Kids spend more time inside their homes watching TV and playing video games. A lot of kids aren’t getting enough exercise, and that’s leading to an obesity problem.”