Tuesday, September 18, 2012

First Subway, Now Starbucks

I'm sure some of you have come across this little gem about the women who lost 85 pounds by eating at Starbucks.  Of course most of us remember Jared Fogle who lost weight by eating "healthier" Subway sandwiches as well.   Was there anything magic about Subway or Starbucks or any other restaurant that starts with the letter S that caused people to lose wt?  Of course not!  People lost weight because they dramatically reduced their calorie intake and got some exercise in too, but they also had "help" by sticking with foods that were already portioned and not diverting from it.  This reminds me of the many questions that I have received over the years about pre-packaged food programs like Nutri-system and Medifast, etc.  Let's take a look at the pro's and con's of these shall we?

The advantages:
1) They are useful for people who need to lose weight but have limited cooking skills.   My dad is one of those people;  he can fry eggs and that is pretty much the extent of his cooking skills.  His significant other has much better cooking skills, but because of some health complications that she has she can't stand long enough to cook; as a result they both ate out for most of their meals and were significantly overweight.  My dad knew he needed to lose weight because he was diagnosed with Type 2 diabetes, and he wanted to try Medifast because he knew someone else that had lost weight on it.  By using the food items in that plan and by eating lean protein and vegetables in the evening (at a restaurant) he was able to lose quite a bit of weight, not have to struggle with learning to cook, and actually have food he enjoyed. 
2) These programs can be useful for people with limited cognitive ability.  As I mentioned before I do work with people who might have impaired judgement related to a stroke or another type of medical condition.  Using the pre-packaged foods takes a lot of the guesswork out of the meal planning and they have less to remember.  Also, heating up a pre-packaged dinner might be safer for someone who might forget that they left the stove on.
3) They can be useful as a training tool for eating smaller portions.  Some people eat large portions or take seconds out of habit, and said habits can be hard to break.  You might start out by cooking a meal, putting a certain amount on your plate, enjoying what you eat...and then the remainder on the stove smells so good that you just want to have a little bit more....and soon you are way over the limit.  If all you have a packaged dinners or shakes, you don't have any leftovers to temp you, and you learn you can actually be quite content with less food.  You might only use the packaged food for a short time period until you are used to eating smaller portions.
4) Some people really, really, for whatever reason, do not want to think about what they are eating and want something easy and requiring of little preparation.  A pre-packaged plan that includes whole meals might actually help this individual eat more healthy than he/she would otherwise, especially if he/she normally does a lot of eating on the run.  For example, many people just eat a bowl of cereal for breakfast if they are in a hurry; if they ate the oatmeal supplied by medifast they would actually get more protein than than if they just ate regular cereal/oatmeal.
5) Sometimes a person might need to lose weight quickly for a surgical procedure.  Where I work, if people elect to have weight loss surgery they must lose a certain amount of weight beforehand to hopefully decrease fatty deposits in the liver so the surgeon can have an easier time during the surgery and they recovery will hopefully be smoother and free of complications.

The disadvantages:
1) If you are using pre-packaged foods that come straight out of the fast food restaurant or straight out of the freezer case; you might wind up deficient in protein or other nutrients that you need.  For example, at the age of 66 a person really should be eating protein at every meal so that your body can absorb it better.  Eating Starbucks oatmeal probably isn't going to help with that.  Once again on average an adult is going to need 20-30 grams of protein per meal, and a lot of the frozen dinners maybe only provide about 14 grams.
2) Some of the programs out there, including Nutri-System, might have a higher sodium content than some people can handle.  I work with a lot of people that have congestive heart failure or chronic kidney disease and they have to watch their sodium intake or else they will retain fluid. (And not just in a "I hate my puffy ankles" way, but in a "I can't even breathe because of the extra fluid" way).  I have had a few people who decided to try programs like Nutri-System and had to quit because of the fluid retention they were experiencing.
3) These type of programs often don't teach people to think critically about what you're eating.  My patients with cognitive impairment are probably not going to be able to develop critical thinking skills about their food intake, but what about the rest of us?   If you stop the program (likely because of one of the other disadvantages I'm going to cover), chances are you are going to resume your former poor eating habits and gain the weight right back.  And if you a person who eats when you are experiencing stress, or eats a lot on the run, this type of program didn't help you deal with any of the "non-hunger" reasons that people eat or overeat.  And that weight cycling can be pretty discouraging when it comes to future attempts to lose weight.
4) On a related note, these type of programs don't encourage cooking skills.  What if you want to go off the program some day?  Once again, you may find yourself back with your former bad eating habits or relying on the old high calorie favorites because you are not sure what to do.
5)These type of programs can be expensive.  Some people don't mind paying for the extra labor involved for the sake of convenience, and of course everyone can decide how to spend their own money.  I personally, however, would rather cook healthy meals at home as much as possible and put the money I save towards one of my interests.  I remember when I first looked at some of the Nutri-System meals and looked at the prices; I knew I could easily make some of those same entrees in bulk and portion out and freeze those meals for later.  In other words, I could make multiple entrees for the price of that one Nutri-System meal.
6) Some people just need more variety than what these programs have to offer.  Once again, some people (like my dad) are content to just eat the same type of food over and over again and it doesn't bother them.  That would drive me crazy, but then I love to experiment with different seasonings and different ways of preparing food.  I find that people tend to stick to a plan better if they are not bored and have some flexibility too.
7) Some people just don't like the food.  If you are on a plan where all you can dream about is eating "real" food again than you are probably not on the right plan for you.  A good plan is something that you can live with and hopefully enjoy most of the time.

Take home message--some pre-packaged plans can be advantageous for people to use in the short term or if the ability to make good choices or cook is impaired for some reason.  Overall, however, you will save money, improve your knowledge of nutrition and how your body works, and improve your cooking skills by learning to make healthy food at home.

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